Endoscopic stricturotomy in the treatment of anastomotic strictures in inflammatory bowel disease (IBD) and non-IBD patients

Abstract Backgrounds Endoscopic stricturotomy (ESt) has been shown to be effective in treating inflammatory bowel disease (IBD)-associated anastomotic strictures. However, the outcome of ESt in benign, non-IBD conditions has not been described. The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures. Methods Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted. The primary outcomes were surgery-free survival and procedure-related complications. Results A total of 49 IBD and 15 non-IBD patients were included in this study. The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches. Underlying diseases in the non-IBD group included colorectal cancer (n = 7), diverticulitis (n = 5), large bowel prolapse (n = 2), and constipation (n = 1). Immediate technical success was achieved in all patients in both groups. Bleeding complications occurred on five occasions (4.7% per procedure) in the IBD group, while no complication occurred in the non-IBD group (P = 0.20). Stricture improvement on follow-up endoscopy was found in 10 (20.4%) and 5 (33.3%) patients in the IBD and non-IBD groups, respectively (P = 0.32). Six (12.2%) patients in the IBD group and four (26.7%) patients in the non-IBD group eventually required stricture-related surgery (P = 0.23). IBD patients appeared to have a higher tendency for maintaining surgery-free after the procedure than non-IBD patients (P = 0.08). Conclusions Endoscopic stricturotomy was shown to have comparable outcomes, though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.

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Pre-Pouch Ileitis is Associated with Development of Crohn’s Disease-Like Complications and Pouch Failure

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa251 ◽

2020 ◽

Author(s):

Gaurav Syal ◽

Ron Shemtov ◽

Nirupama Bonthala ◽

Eric A Vasiliauskas ◽

Edward J Feldman ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Immunosuppressive Therapy ◽

Bowel Disease ◽

Free Survival ◽

Pouch Failure ◽

Anastomotic Strictures ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background and Aims It is unclear whether pre-pouch ileitis heralds an aggressive inflammatory pouch disease in patients with ileal-pouch anal anastomosis (IPAA). We compared outcomes of patients with pouchitis and concomitant pre-pouch ileitis to those with pouchitis alone. Methods Patients undergoing IPAA surgery for inflammatory bowel disease who subsequently developed pouchitis with concomitant pre-pouch ileitis (pre-pouch ileitis group) were matched by year of IPAA surgery and pre-operative diagnosis (ulcerative colitis or inflammatory bowel disease-unclassified) with patients who developed pouchitis alone (pouchitis group). Primary outcomes were development of Crohn’s disease (CD)-like complications (non-anastomotic strictures or perianal disease >6 months after ileostomy closure) and pouch failure. Secondary outcomes were need for surgical/endoscopic interventions and immunosuppressive therapy. Log-rank test was used to compare outcome-free survival and Cox regression was performed to identify predictors of outcomes. Results There were 66 patients in each group. CD-like complications and pouch failure developed in 36.4% and 7.6% patients in pre-pouch ileitis group and 10.6% and 1.5% in pouchitis group, respectively. CD-like complications-free survival (log-rank p=0.0002) and pouch failure-free survival (log-rank p=0.046) were significantly lower in the pre-pouch ileitis group. Pre-pouch ileitis group had a higher risk of requiring surgical/endoscopic interventions (log-rank p=0.0005) and immunosuppressive therapy (log-rank p<0.0001). Pre-pouch ileitis was independently associated with an increased risk of CD-like complications (HR 3.8; p=0.0007), need for surgical/endoscopic interventions (HR 4.1; p=0.002) and immunosuppressive therapy (HR 5.0; p=0.0002). Conclusions Pre-pouch ileitis is associated with a higher risk of complicated disease and pouch failure than pouchitis. It should be considered a feature of CD.

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Faculty Opinions recommendation of Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti-TNF alpha: 5-year follow-up study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725693263.793539599 ◽

2017 ◽

Author(s):

Bruce Smoller ◽

Nooshin Bagherani

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Large Cohort ◽

Tnf Alpha ◽

Follow Up Study ◽

Inflammatory Bowel

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P56 Two year follow up of children with inflammatory bowel disease (IBD) treated with Vedolizumab and Ustekinumab

10.1136/flgastro-2021-bspghan.65 ◽

2021 ◽

Author(s):

Roxana Mardare ◽

Natasha Burgess ◽

Dominic Studart ◽

Protima Deb ◽

Marco Gasparetto ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Inflammatory Bowel

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Utility of routinely collected electronic health records data to support effectiveness evaluations in inflammatory bowel disease: a pilot study of tofacitinib

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2021-100337 ◽

2021 ◽

Vol 28 (1) ◽

pp. e100337

Author(s):

Vivek Ashok Rudrapatna ◽

Benjamin Scott Glicksberg ◽

Atul Janardhan Butte

Keyword(s):

Inflammatory Bowel Disease ◽

Pilot Study ◽

Disease Activity ◽

Real World ◽

Bowel Disease ◽

P Value ◽

Health Records ◽

Real World Evidence ◽

Inflammatory Bowel

ObjectivesElectronic health records (EHR) are receiving growing attention from regulators, biopharmaceuticals and payors as a potential source of real-world evidence. However, their suitability for the study of diseases with complex activity measures is unclear. We sought to evaluate the use of EHR data for estimating treatment effectiveness in inflammatory bowel disease (IBD), using tofacitinib as a use case.MethodsRecords from the University of California, San Francisco (6/2012 to 4/2019) were queried to identify tofacitinib-treated IBD patients. Disease activity variables at baseline and follow-up were manually abstracted according to a preregistered protocol. The proportion of patients meeting the endpoints of recent randomised trials in ulcerative colitis (UC) and Crohn’s disease (CD) was assessed.Results86 patients initiated tofacitinib. Baseline characteristics of the real-world and trial cohorts were similar, except for universal failure of tumour necrosis factor inhibitors in the former. 54% (UC) and 62% (CD) of patients had complete capture of disease activity at baseline (month −6 to 0), while only 32% (UC) and 69% (CD) of patients had complete follow-up data (month 2 to 8). Using data imputation, we estimated the proportion achieving the trial primary endpoints as being similar to the published estimates for both UC (16%, p value=0.5) and CD (38%, p-value=0.8).Discussion/ConclusionThis pilot study reproduced trial-based estimates of tofacitinib efficacy despite its use in a different cohort but revealed substantial missingness in routinely collected data. Future work is needed to strengthen EHR data and enable real-world evidence in complex diseases like IBD.

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A186 OLDER AGE IS ASSOCIATED WITH INCREASED EXTRAINTESTINAL MANIFESTATIONS IN INFLAMMATORY BOWEL DISEASE

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.184 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 201-202

Author(s):

Z Chattha ◽

R Chattha ◽

S Reza ◽

M Moradshahi ◽

M Fadida ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Regression Analysis ◽

Bowel Disease ◽

Multivariate Regression Analysis ◽

Older Age ◽

Extraintestinal Manifestations ◽

Forward Selection ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background The relationship between older age and extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) remains unknown. Aims This study aims to determine whether older age is associated with increased risk of EIMs in IBD patients. Methods This was a retrospective study of IBD patients seen at the McMaster University Medical Centre, in Hamilton, ON, Canada from 2012–2020. Patients were identified to have the primary outcome of interest if their gastroenterologist documented the presence of any EIM either during the baseline assessment or during the period of follow up. The independent variable, age at start of follow-up, was dichotomized into two categories age >=40 vs. <40.Prior knowledge in combination with forward selection was used to develop a logistic regression model. The variables utilized for the forward selection model included gender, disease duration, and current biologic use. Results A total of 995 IBD patients (625 with CD) were considered for the regression analysis, all for whom the EIM status was recorded. Out of the 995 patients, 270 patients reported at least one EIM – 99 with arthritis/arthralgia, 79 with dermatologic manifestations, 16 with ophthalmic manifestations, 30 with liver manifestations, and 116 with other EIMs. A univariate regression analysis foundincreased odds of EIMs in older patientsas compared to younger patients (odds ratio (OR) 1.41 (95% CI, 1.05 – 1.89)). In the multivariate regression analysis, current biologic use was found to have a significant relationship with odds of having EIMs (OR 1.49; 95% CI, 1.06 – 2.09). After adjustment for biologic use, patients aged 40 or over had 1.46 times higher odds of having EIMs (95% CI 1.03 – 2.05). A sub-analysis of individual EIM categoriesdid not show a significant association with older age. Conclusions Older age is associated with increased risk of EIMs in IBD patients. Patients with EIMs were also more likely to be treated with biological therapies. Clinicians should inquire about the presence of EIMs in older IBD patients. Funding Agencies None

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Open access follow-up for inflammatory bowel disease: A pragmatic randomised trial and costeffectiveness study

Gastroenterology ◽

10.1016/s0016-5085(00)85019-2 ◽

2000 ◽

Vol 118 (4) ◽

pp. A722

Author(s):

Krishnaraj Ragunath ◽

John G. Williams ◽

Wai-Yee Cheung ◽

Mesbahur M. Rahman ◽

Ian T. Russell ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Open Access ◽

Bowel Disease ◽

Randomised Trial ◽

Inflammatory Bowel

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P088 Mucosal CD103+ CD4+ and CD103+CD8+ T-cell subsets in the gut of inflammatory bowel disease patients at diagnosis and during follow-up

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx180.215 ◽

2018 ◽

Vol 12 (supplement_1) ◽

pp. S137-S138

Author(s):

B Roosenboom ◽

C Smids ◽

P Wahab ◽

M Groenen ◽

E Van Koolwijk ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

T Cell ◽

Bowel Disease ◽

Cd8 T Cell ◽

T Cell Subsets ◽

Inflammatory Bowel

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Anti-Tumor Necrosis Factor-Alpha Withdrawal in Children With Inflammatory Bowel Disease in Endoscopic and Histologic Remission

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab046 ◽

2021 ◽

Author(s):

Luca Scarallo ◽

Giulia Bolasco ◽

Jacopo Barp ◽

Martina Bianconi ◽

Monica di Paola ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Treatment Withdrawal ◽

Clinical Relapse ◽

Necrosis Factor Alpha ◽

Mayo Score ◽

Endoscopic Score ◽

Inflammatory Bowel ◽

Factor Alpha

Abstract Background The aim of the present study was to investigate outcomes of anti-TNF-alpha (ATA) withdrawal in selected pediatric patients with inflammatory bowel disease who achieved clinical remission and mucosal and histological healing (MH and HH). Methods A retrospective analysis was performed on children and adolescents affected by Crohn disease (CD) and ulcerative colitis (UC) who were followed up at 2 tertiary referral centers from 2008 through 2018. The main outcome measure was clinical relapse rates after ATA withdrawal. Results One hundred seventy patients received scheduled ATA treatment; 78 patients with CD and 56 patients with UC underwent endoscopic reassessment. We found that MH was achieved by 32 patients with CD (41%) and 30 patients with UC (53.6%); 26 patients with CD (33.3%) and 22 patients with UC (39.3%) achieved HH. The ATA treatment was suspended in 45 patients, 24 affected by CD and 21 by UC, who all achieved concurrently complete MH (Simplified Endoscopic Score for CD, 0; Mayo score, 0, respectively) and HH. All the patients who suspended ATA shifted to an immunomodulatory agent or mesalazine. In contrast, 17 patients, 8 with CD and 9 with UC, continued ATA because of growth needs, the persistence of slight endoscopic lesions, and/or microscopic inflammation. Thirteen out of 24 patients with CD who suspended ATA experienced disease relapse after a median follow-up time of 29 months, whereas no recurrence was observed among the 9 patients with CD who continued treatment (P = 0.05). Among the patients with UC, there were no significant differences in relapse-free survival among those who discontinued ATA and those who did not suspend treatment (P = 0.718). Conclusions Despite the application of rigid selection criteria, ATA cessation remains inadvisable in CD. In contrast, in UC, the concurrent achievement of MH and HH may represent promising selection criteria to identify patients in whom treatment withdrawal is feasible.

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The SPOSIB SB2 Sicilian Cohort: Safety and Effectiveness of Infliximab Biosimilar SB2 in Inflammatory Bowel Diseases, Including Multiple Switches

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa036 ◽

2020 ◽

Cited By ~ 5

Author(s):

Fabio Salvatore Macaluso ◽

Walter Fries ◽

Anna Viola ◽

Andrea Centritto ◽

Maria Cappello ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Tumor Necrosis ◽

Prospective Observational Study ◽

Cumulative Number ◽

Serious Adverse Events ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Necrosis Factor

Abstract Background No data on the recently introduced infliximab (IFX) biosimilar SB2 in inflammatory bowel disease (IBD) are available. Methods The Sicilian Prospective Observational Study of Patients With IBD Treated With Infliximab Biosimilar SB2 is a multicenter, observational, prospective study performed among the cohort of the Sicilian Network for Inflammatory Bowel Disease. All consecutive IBD patients starting the IFX biosimilar SB2 from its introduction in Sicily (March 2018) to September 2019 (18 months) were enrolled. Results Two hundred seventy-six patients (Crohn disease: 49.3%, ulcerative colitis: 50.7%) were included: 127 (46.0%) were naïve to IFX and naïve to anti-tumor necrosis factor medications (anti-TNFs), 65 (23.5%) were naïve to IFX and previously exposed to anti-TNFs, 17 (6.2%) were switched from an IFX originator to SB2, 43 (15.6%) were switched from the biosimilar CT-P13 to SB2, and 24 (8.7%) were multiply switched (from IFX originator to CT-P13 to SB2). The cumulative number of infusions of SB2 was 1798, and the total follow-up time was 182.7 patient-years. Sixty-seven serious adverse events occurred in 57 patients (20.7%; incidence rate: 36.7 per 100 patient-year), and 31 of these events caused the withdrawal of the drug. The effectiveness after 8 weeks of treatment was evaluated in patients naïve to IFX (n = 192): 110 patients (57.3%) had steroid-free remission, while 56 patients had no response (29.2%). At the end of follow-up, 72 patients (26.1%) interrupted the treatment, without significant differences in treatment persistency estimations between the five groups (log-rank P = 0.15). Conclusions The safety and effectiveness of SB2 seem to be overall similar to those reported for the IFX originator and CT-P13.

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