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Shenoy S, Jena A, Levinson C, Sharma V, Deepak P, Aswani-Omprakash T, Sebastian S, Colombel JF, Agrawal M. Inflammatory bowel disease in south Asia: a scoping review. Lancet Gastroenterol Hepatol 2025; 10:259-274. [PMID: 39954693 DOI: 10.1016/s2468-1253(24)00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 09/27/2024] [Accepted: 10/02/2024] [Indexed: 02/17/2025]
Abstract
Inflammatory bowel disease (IBD) is rising at an alarming rate in south Asia and there is a paucity of data on IBD in this region. For this scoping review, we conducted a systematic search to identify all observational and interventional studies on IBD in south Asia. Of 14 924 potentially eligible studies, 524 were included in this scoping review and summarised under the domains of epidemiology, natural history, phenotype and comorbid conditions, therapeutics, and psychosocial health. According to the literature, IBD incidence and prevalence are rising in south Asia and among south Asian immigrants, and the diagnostic rate is higher in men than in women. Genetic predisposition is an important risk factor in south Asia, whereas environmental risk factors are less clear. Delay in diagnosis, although possibly decreasing over time, is common in south Asia and is associated with worse outcomes. There are no clear differences in IBD phenotype and severity in south Asia relative to Europe and North America. Corticosteroids and immunomodulators are the mainstay of treatment in south Asia whereas the use of biologics is less common. Mental health disorders, malnutrition, and reduced quality of life are prevalent in patients with IBD in south Asia, and the use of complementary and alternative medicines among patients is an important consideration. Key knowledge gaps include the paucity of data from countries other than India, prospective, long-term, follow-up studies, and clinical drug trials in south Asia. IBD is a growing challenge in this region and warrants urgent clinical interventions, research, resource allocation, and health policy implementation.
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Affiliation(s)
- Shabari Shenoy
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; South Asian IBD Alliance, New York, NY, USA
| | - Anuraag Jena
- Department of Gastroenterology, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, India; South Asian IBD Alliance, New York, NY, USA
| | - Carrie Levinson
- Gustave L and Janet W Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St Louis, St Louis, MO, USA; South Asian IBD Alliance, New York, NY, USA
| | | | - Shaji Sebastian
- South Asian IBD Alliance, New York, NY, USA; IBD Unit, Hull University Teaching Hospitals, Hull, UK
| | - Jean-Frederic Colombel
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manasi Agrawal
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Health and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; South Asian IBD Alliance, New York, NY, USA; Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
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Huang CW, Wei SC, Shieh MJ, Chou JW, Chuang CH, Wang HY, Chang CW, Wu DC, Huang TY, Liu YH, Tsai TJ, Tai WC, Tai CM, Chung CS, Tsai WS, Chang CH, Lin CP, Lee HC, Chang CC, Feng IC, Lin CC, Cheng ML, Yen HH. Epidemiology and temporal trends of adult inflammatory bowel disease in Taiwan: Multicenter study from the TSIBD registration. J Formos Med Assoc 2025:S0929-6646(25)00034-8. [PMID: 39893095 DOI: 10.1016/j.jfma.2025.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/29/2024] [Accepted: 01/21/2025] [Indexed: 02/04/2025] Open
Abstract
BACKGROUND Despite industrialization and advances in healthcare, the prevalence of inflammatory bowel disease (IBD), which encompasses Crohn's disease (CD) and ulcerative colitis (UC), is increasing in Taiwan. Population-based studies can estimate the incidence or prevalence of IBD; however, there is a lack of information regarding the disease phenotype. Therefore, this study was designed to investigate the epidemiologic trends of IBD in Taiwan to gain a more comprehensive understanding. METHODS Patient data were reviewed from a prospectively registered study by the Taiwan Society of IBD (TSIBD). RESULTS We collected data from 2752 patients with IBD, of whom 881 had CD and 1871 had UC. Their average age was 41.99 ± 15.19 years. The CD group had more male patients than the UC group (67.88% vs. 60.72%; p < .001). The rates of appendectomy, bowel resection, and surgery for perianal disease before IBD diagnosis, along with the increased use of steroids, immunomodulators, and biologics, were higher in the CD group. From 2005 to 2023, the ratio of UC to CD cases in Taiwan decreased, the proportions of patients with colonic and penetrating CD also declined, and the proportion of patients with UC exhibiting ulcerative proctitis increased. CONCLUSION In Taiwan, similar to high-income countries, the ratio of UC to CD cases has declined. The reduced of colonic and penetrating CD indicates that diagnostic awareness has improved and colonoscopic examination has become more comprehensive in Taiwan.
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Affiliation(s)
- Chih-Wen Huang
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan
| | - Shu-Chen Wei
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jium Shieh
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Wei Chou
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chiao-Hsiung Chuang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Horng-Yuan Wang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chen-Wang Chang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Deng-Chyang Wu
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tien-Yu Huang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Hwa Liu
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Tzung-Jiun Tsai
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chen Tai
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi-Ming Tai
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chen-Shuan Chung
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, New Taipei, Taiwan; Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Sy Tsai
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Colon and Rectal Surgery, Colorectal Section, Department of Surgery Chang, Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsin Chang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Pin Lin
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsi-Chang Lee
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Chao Chang
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, 110301, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - I-Che Feng
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Gastroenterology and Hepatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Chi Lin
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Division of Colon & Rectal Surgery, Department of Surgery Taipei Veterans General Hospital Taipei Taiwan, Taiwan; Department of Surgery, Faculty of Medicine, School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan, Taiwan
| | - Mu-Liang Cheng
- Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Department of Gastroenterology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan; Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Balarajah S, Martinez-Gili L, Alexander JL, Mullish BH, Perry RW, Li JV, Marchesi JR, Parkes M, Orchard TR, Hicks LC, Williams HRT. Diverse Phenotypes, Consistent Treatment: A Study of 30 997 South Asian and White Inflammatory Bowel Disease Patients Using the UK Inflammatory Bowel Disease BioResource. J Crohns Colitis 2025; 19:jjae186. [PMID: 39657589 PMCID: PMC11737890 DOI: 10.1093/ecco-jcc/jjae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/24/2024] [Accepted: 12/05/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Studies in the UK and North America have suggested a distinct disease profile in South Asians compared to that of White populations. Disparities in the medical and surgical management of IBD in minority ethnic groups (including Black Americans and Asians) in the US have been shown, while data from Europe, including the UK, have been lacking. This study sought to evaluate South Asian (SA) and White (WH) inflammatory bowel disease (IBD) phenotypes, and to explore treatment approach variations between these cohorts in the UK using the IBD BioResource database. DESIGN Differences between WH and SA IBD patients were analysed using demographic, phenotypic and outcome data. Drug utilisation patterns and surgical outcomes were assessed in propensity score-matched (PSM) cohorts with multivariable logistic regression, Cox regression and Kaplan-Meier analysis. RESULTS 30,997 eligible patients were included. UC was the predominant disease subtype in SA (p<0.001). SA were younger at diagnosis (p<0.001), had a male preponderance (p<0.001), and were less likely to have a smoking history at diagnosis. The SA CD phenotype differed from WH, with less ileal (SA 30.3%, WH 38.4%, p=0.008) and stricturing (SA 16.9%, WH 25.6%, p<0.001) disease, but more perianal disease (SA 38.5%, WH 32.2%, p=0.009). More SA UC patients had extensive disease (SA 41.7%, WH 34.1%, p<0.001). In PSM cohorts, comparing treatments, there were no differences in 5-aminosalicylate, corticosteroid, thiopurine, anti-TNF or vedolizumab use. Survival analysis in matched cohorts showed no difference in time to surgery (CD) or colectomy (UC), and SA ethnicity was not associated with a difference in risk of surgery/colectomy. CONCLUSION Demographic and phenotypic differences exist between UK SA and WH IBD patients, highlighting distinct ethnicity-related variance, and the need for a research focus on under-represented populations. In comparing matched SA and WH patients, no disparity in medical and surgical IBD therapy in UK healthcare has been demonstrated: treatment is consistent regardless of ethnicity.
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Affiliation(s)
- Sharmili Balarajah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Martinez-Gili
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James Leslie Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
- Department of Gastroenterology, London North West University Healthcare Trust, London, UK
| | - Benjamin Harvey Mullish
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Robert William Perry
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Jia V Li
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | - Miles Parkes
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Timothy Robin Orchard
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Lucy Charlotte Hicks
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Horace Richard Timothy Williams
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK
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Taft TH, Aswani-Omprakash T. Caregiver burden of IBD patients in Asian Emerging Nations is significant and necessitates attention and resource allocation. Indian J Gastroenterol 2024; 43:1086-1089. [PMID: 39088167 DOI: 10.1007/s12664-024-01653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Tiffany H Taft
- The Rome Foundation Research Institute, Chapel Hill, NC, USA.
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Sarangi Y, Kumar A, Malage S, Ghosh N, Rahul R, Singh A, Sharma S, Singh RK, Behari A, Kumar A. Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: Predictors of Early and Late Complications. Cureus 2024; 16:e75086. [PMID: 39759750 PMCID: PMC11697769 DOI: 10.7759/cureus.75086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2024] [Indexed: 01/07/2025] Open
Abstract
Background Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is often considered the preferred surgical treatment for ulcerative colitis. This study was conducted to investigate the early and late complications of ileal pouch-anal anastomosis in patients with ulcerative colitis, as well as the factors associated with these complications. Methodology All relevant clinical and operative data of patients (n = 101) who underwent IPAA for ulcerative colitis between January 1995 and December 2018 were retrieved from a prospectively maintained database. Early complications, various late complications, and their predictive factors were studied. Results A total of 101 patients underwent IPAA. Early complications (≤30 days) occurred in 72 (71.3%) patients, mostly Clavien-Dindo grades 1 and 2. No significant risk factors were associated with early complications. Among the late complications, pouchitis was the most common complication (n = 37, 36.6%), followed by anastomotic stricture (n = 27, 26.7%). Pouch failure was seen in 11 (10.9%) patients. No significant factors were found to be associated with the development of pouchitis. Pelvic sepsis (odds ratio (OR) = 2.704, 95% confidence interval (CI) = 1.041-7.022, p = 0.041) and handsewn anastomosis (OR = 3.943, 95% CI = 1.093-14.229, p = 0.036) were significantly related to the development of anastomotic stricture and pouch-vaginal fistulae, respectively. Conclusions The most common early and late complications following IPAA were pelvic sepsis and pouchitis, respectively. These complications were managed successfully with an acceptable pouch failure rate. No predictive factor was found to be significant with early complications. However, pelvic sepsis and hand-sewn anastomosis were associated with stricture formation and pouch vaginal fistulae, respectively.
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Affiliation(s)
- Yajnadatta Sarangi
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Somanath Malage
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Nalinikanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Rahul Rahul
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Ashish Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Supriya Sharma
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Rajneesh K Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
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Shankar S, Majumder S, Mukherjee S, Bhaduri A, Kasturi R, Ghosh S, Iacucci M, Shivaji UN. Inflammatory bowel disease: a narrative review of disease evolution in South Asia and India over the last decade. Therap Adv Gastroenterol 2024; 17:17562848241258360. [PMID: 39575157 PMCID: PMC11580062 DOI: 10.1177/17562848241258360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 11/24/2024] Open
Abstract
The rapid emergence of inflammatory bowel disease (IBD) in Asia in the last two decades is anticipated to pose significant challenges to the healthcare systems of developing countries including India. Several epidemiological factors in the Asia Pacific region have been explored as risk factors for the development of IBD. In this narrative review, we discuss the evolution of adult-onset and paediatric IBD in South Asia and India, in relation to the current global epidemiology, over the last decade. The focus lies on the changing epidemiological landscape of IBD in Asia which signals a paradigm shift in the disease trajectory of a chronic, relapsing, complex disease. We enumerate the disease burden of IBD in India and Asia, analyse the risk factors for its recent rise in incidence and briefly discuss the unique entity of very early-onset IBD. We also list the locoregional challenges in diagnosis and management along with suggestions to overcome them. We highlight the lacunae in data which warrants further research. The anticipated infrastructural challenges and disease evolution are likely to be similar in most newly industrialized countries across South Asia. A combined effort led by IBD experts in the region to understand the true disease burden is important. A strong collaborative network on research and formulation of preventive strategies relevant to the region will help reduce the burden in the future.
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Affiliation(s)
- Sahana Shankar
- Division of Paediatric Gastroenterology, Department of Paediatrics, Mazumdar Shaw Medical Center, NH Health City, Bangalore, India
| | - Snehali Majumder
- Department of Clinical Research, Narayana Hrudayalaya, NH Health City, Bangalore, India APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Suparna Mukherjee
- Department of Clinical Nutrition and Dietetics, Narayana Hrudayalaya, NH Health City, Bangalore, India
| | | | - Rangarajan Kasturi
- Department of Gastroenterology, Mazumdar Shaw Medical Center, a Unit of Narayana Health, Bangalore, India
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Marietta Iacucci
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Uday N. Shivaji
- Institute of Immunology and Immunotherapy, University of Birmingham, 2nd Floor, Institute of Translational Medicine, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK Department of Gastroenterology, Mazumdar Shaw Medical Center, a Unit of Narayana Health, Bangalore, India
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Guo A, Östensson M, Størdal K, Ludvigsson J, Mårild K. Early-Life Hygiene-Related Factors and Risk of Inflammatory Bowel Disease: A Scandinavian Birth Cohort Study. Inflamm Bowel Dis 2024; 30:1820-1830. [PMID: 37921331 PMCID: PMC11447116 DOI: 10.1093/ibd/izad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND We aimed to investigate whether early-life hygiene-related factors influenced the risk of inflammatory bowel disease (IBD) in a Scandinavian population and test the association's consistency across cohorts. METHODS This study followed 117 493 participants in the All Babies in Southeast Sweden study and the Norwegian Mother, Father, and Child Cohort Study. IBD diagnoses were defined by national registers. Comprehensive data on hygiene-related exposures, such as having pets, rural living, daycare attendance, and siblings, were retrieved from questionnaires administered from pregnancy until child's age of 36 months. A multivariable Cox regression model yielded adjusted hazard ratios (aHRs) for IBD accounting for socioeconomic status and perinatal factors. Cohort-specific estimates were pooled using a random-effects model. RESULTS In over 2 024 299 person-years of follow-up 451 participants developed IBD. In pooled estimates children attending daycare up to 36 months of life vs not attending daycare were less likely to develop Crohn's disease (aHR, 0.60; 95% confidence interval [CI], 0.37- 0.98). Children having 1 or more siblings had a modestly increased risk of IBD (aHR, 1.17; 95% CI, 0.96-1.42; aHR for each sibling, 1.12; 95% CI, 1.01-1.24). The other hygiene factors were not significantly linked to later IBD. In the Norwegian Mother, Father, and Child Cohort Study cohort, bed sharing was associated with an increased risk of IBD, most notably for ulcerative colitis (aHR, 1.67; 95% CI, 1.01-2.78). CONCLUSIONS In this birth cohort study from 2 high-income Scandinavian countries, some early-life hygiene-related exposures were associated with IBD risk. The generalizability of these results to countries of other socioeconomic level is unknown.
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Affiliation(s)
- Annie Guo
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Östensson
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ketil Størdal
- Department of Pediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Children’s Center, Oslo University Hospital, Oslo, Norway
| | - Johnny Ludvigsson
- Crown Princess Victoria Children’s Hospital and Div of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karl Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden
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Liu X, Dong Y, Wang C, Guo Z. Application of chitosan as nano carrier in the treatment of inflammatory bowel disease. Int J Biol Macromol 2024; 278:134899. [PMID: 39187100 DOI: 10.1016/j.ijbiomac.2024.134899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), is characterized by persistent and recurrent gastrointestinal inflammation. Conventional IBD therapies often involve the use of antibiotics, NSAIDs, biological agents, and immunomodulators. While these medications can mitigate acute inflammatory symptoms, their long-term efficacy is frequently compromised due to cumulative toxic effects. In recent years, significant attention has shifted toward nanoparticle (NP)-based therapies as potential alternatives for IBD management. Various drug delivery strategies, including those targeting microbiota interactions, ligand-receptor binding, pH sensitivity, biodegradability, pressure response, and specific charge and size parameters, have been explored and optimized in animal studies. This review provides a comprehensive overview of the current landscape of chitosan NP-mediated drug delivery systems for IBD treatment. Additionally, it will discuss the prevailing challenges and propose future research directions to advance chitosan NP-based therapeutic strategies for IBD.
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Affiliation(s)
- Xiaoming Liu
- Department of Gastroenterology, Huaihe Hospital of Henan University, 115 Ximen Street, Kaifeng 475000, Henan, China
| | - Yunrui Dong
- Hubei University of Science and Technology, 88 Xianning Road, Xianning 437100, Hubei, China
| | - Chenyu Wang
- Department of General Surgery, Huaihe Hospital of Henan University, 115 Ximen Street, Kaifeng 475000, Henan, China
| | - Zhiguo Guo
- Department of Gastroenterology, Suzhou Hospital of Anhui Medical University (Suzhou Municipal Hospital of Anhui Province), No.616 Bianyangsan Road, Suzhou 234000, Anhui, China.
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Bhowmik S, Mehra L, Ghosh T, Akhtar S, Tiwari A, Dutta R, Kedia S, Yadav R, Makharia GK, Ahuja V, Das P. A Systematic Review and Metaanalysis to Examine the Utility of Histological Parameters Such as Mucosal Basal Plasmacytosis and Eosinophilia for Distinguishing Inflammatory Bowel Disease and Non-IBD-Type Colitis. Int J Surg Pathol 2024:10668969241271352. [PMID: 39300818 DOI: 10.1177/10668969241271352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background and aim: Basic differentiation between an inflammatory bowel disease (IBD)-type colitis and a non-IBD type of colitis is the essential histological pre-requisite before further subclassifications are made. The combination of mucosal prominent eosinophilic cell infiltrate along with basal plasmacytosis is supposed to be a useful histological feature that can differentiate between IBD-type and non-IBD-type colitis. Hence, this systematic review and metaanalysis aimed to assess the reliability of mucosal basal plasmacytosis and eosinophilia for histological differentiation of IBD-type versus non-IBD-type colitis. Methods: We searched the PROSPERO, PubMed, Embase, and Scopus from January 1, 2000 to July 30, 2022 for all types of studies (prospective, cross-sectional, or retrospective studies) having histological features (including mucosal basal plasmacytosis, eosinophilia, and neutrophilic infiltration) in IBD and/or non-IBD colitis cases. Two reviewers extracted data, which were aggregated using random-effects models. Results: The 59 selected articles were evaluated for the predecided parameters. Both basal plasmacytosis and lamina propria plasmacytosis did not show any significant correlation between IBD-type and non-IBD-type colitis. The proportions for basal plasmacytosis with 95% CI were 0.50 (0.19-0.82) in IBD-type colitis and 0.46 (0.40-0.52) in non-IBD-type colitis, with a P value of .79. The proportion of lamina propria plasmacytosis with 95% CI was 0.67 (0.42-0.92) in IBD and 0.60 (0.35-0.85) in non-IBD-type colitis, with a P value being .7. Conclusions: This systematic review documented the dearth of published data on key histological features such as basal plasmacytosis and mucosal eosinophilia which are believed to differentiate between IBD-type and non-IBD-type colitis.
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Affiliation(s)
- Shubham Bhowmik
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Lalita Mehra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Tamoghna Ghosh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Sagir Akhtar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Ashok Tiwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Rimlee Dutta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Saurav Kedia
- Department of Gastroenterology All India Institute of Medical Sciences, New Delhi, DL, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
| | - Govind K Makharia
- Department of Gastroenterology All India Institute of Medical Sciences, New Delhi, DL, India
| | - Vineet Ahuja
- Department of Gastroenterology All India Institute of Medical Sciences, New Delhi, DL, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, DL, India
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10
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Alqudah A, Qnais E, Abu-Safieh K, Gammoh O, Bseiso Y, Wedyan M, Alqudah M, Alemleh M, Alotaibi BS. Therapeutic potential of a novel pyrazolyl-pyridine derivative in the treatment of experimental colitis. Future Med Chem 2024; 16:1971-1982. [PMID: 39157857 PMCID: PMC11485772 DOI: 10.1080/17568919.2024.2385298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Aim: Investigating a novel compound, DMPNP, for treating colitis in mice, a key issue in inflammatory bowel diseases (IBD).Methods: Mice with induced colitis received DMPNP (50, 100, 150 mg/kg) or sulfasalazine (SUL), evaluated via tissue assessment, Disease Activity Index (DAI), myeloperoxidase (MPO), nitric oxide (NO) levels and cytokine analysis.Results: DMPNP significantly reduced colitis symptoms, inflammation and oxidative stress at higher doses, with marked improvements in DAI, MPO, NO and cytokines, comparable to SUL results.Conclusion: DMPNP shows potent anti-inflammatory and immunomodulatory properties, indicating potential as an IBD therapeutic. Further clinical trials are suggested to validate these outcomes.
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Affiliation(s)
- Abdelrahim Alqudah
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Esam Qnais
- Department of Biology & Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Kayed Abu-Safieh
- Department of Chemistry, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Omar Gammoh
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Yousra Bseiso
- Department of Biology & Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Mohammed Wedyan
- Department of Biology & Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Mohammed Alqudah
- Physiology Department, School of Medicine & Biomedical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohammad Alemleh
- Department of Chemistry, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Badriyah S Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
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11
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Shah B, Solanki N. Aegeline attenuates TNBS-induced colitis by suppressing the NFƙB-mediated NLRP3 inflammasome pathway in mice. Inflammopharmacology 2024; 32:2589-2599. [PMID: 38767762 DOI: 10.1007/s10787-024-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
A chronic inflammatory condition of the intestine, ulcerative colitis (UC), is challenging to successfully manage once diagnosed. Currently, available medical therapies for UC exhibit minimal efficacy with unacceptable side effects, while inventive biological agents are expensive and yet not well accepted by patients. Discovering more effective and safer treatments to treat UC is therefore essential. One of the primary alkaloids found in Aegle marmelos, aegeline, has anti-inflammatory and antioxidant properties as well as being able to suppress several pro-inflammatory cytokines responsible for inflammation. The study aimed to investigate the effectiveness of aegeline in alleviating 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis through the NFƙB-mediated NLRP3 inflammasome pathway. Mice were randomly allocated into six groups, Normal control (NC), Model control (MC-TNBS, 2,4,6-trinitrobenzene sulfonic acid), STD (TNBS + sulfasalazine 100 mg/kg), AG1, AG2, and AG3 (TNBS + aegeline 5, 10, 20 mg/kg) respectively. Physical parameters such as a change in body weight, stool consistency, rectal bleeding, colon length, myeloperoxidase (MPO) levels and nitric oxide (NO) levels, and disease activity index (DAI) were assessed and supporting gene expression studies of various pro-inflammatory cytokines and enzymes were evaluated and histopathological changes observed. Administration of aegeline (10, 20 mg/kg) was found to be effective in colon protection by lowering the disease activity score and myeloperoxidase level and improving other physical parameters. Aegeline in high dose significantly downregulated the gene expression of NFƙB, iNOS, COX-2, NLRP3, IL-1β, and IL-18, conferring great anti-inflammatory potential. Suggestive of the findings, aegeline reduced the damage to the colon by downregulating transcriptional genes and enzymes leading to inflammation and mitigated TNBS-induced colitis probably through the NFƙB-mediated NLRP3 inflammasome pathway.
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Affiliation(s)
- Bhagyabhumi Shah
- Department of Pharmacology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology (CHARUSAT), CHARUSAT Campus, Changa, 388421, Gujarat, India.
| | - Nilay Solanki
- Department of Pharmacology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology (CHARUSAT), CHARUSAT Campus, Changa, 388421, Gujarat, India.
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12
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Sharma P, Putambekar V, Kumar P, Thomas DM, Vuyyuru SK, Kante B, Mundhra SK, Sharma R, Dash NR, Makharia G, Kedia S, Ahuja V. Incidence of intestinal & extra-intestinal cancers among individuals with Crohn's disease in northern India. Indian J Med Res 2024; 160:61-69. [PMID: 39382506 PMCID: PMC11463866 DOI: 10.25259/ijmr_1722_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 10/10/2024] Open
Abstract
Background & objectives Crohn's disease (CD) is associated with a higher risk of malignancy, which is attributed to disease behaviour and the usage of immunosuppressants. The burden of malignancy in CD is scarcely reported from Asia. We report real-world data on CD-related malignancy from a northern Indian cohort. Methods This retrospective analysis included individuals with CD who were followed up at the All India Institute of Medical Sciences, New Delhi, from 2005 to 2021. The standardized incidence ratio (SIR) was used to calculate the relative risk of malignancy in CD affected individuals compared to the general population. Results In this study, 952 study participants were included, with a mean age at diagnosis of 36.9±15.11 yr; 61.1 per cent were male. The median follow-up duration was 34 months [IQR (interquartile range): 19-73]. Most study participants received steroids (76.7%), immunomodulators (68.7%), or anti-TNF therapy (10.8%). The overall incidence of malignancy was 1.05 per cent, indicating a 10.45 times higher risk in CD [SIR: 10.45; 95% Confidence interval (CI):4.98-17.96]. Eight out of 826, 1 of 106 and 1 of 25 study participants developed malignancy in the first, second and third decades, respectively. The cumulative risk of malignancy was 2.7, 5.5, and 13.4 per cent in the first, second, and third decades, respectively. Regarding bowel malignancies, one study participant each developed ileocaecal adenocarcinoma, anorectal adenocarcinoma, malignant rectal fibrous histiocytoma, and gastric adenocarcinoma. Extraintestinal malignancies included single cases each of follicular neoplasia of the thyroid, neuroendocrine tumour of the pancreatic tail, breast cancer, hepatocellular cancer, oral cancer, and prostate cancer. No cases of lymphoma or skin malignancy were reported. Interpretation & conclusions At 30 yr, the cumulative risk of malignancy among Indian CD-affected individuals was 13.4 per cent, with a SIR of 10.45 (95% CI: 4.98- 17.96). The risk increased with increasing age at disease onset and duration.
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Affiliation(s)
- Parth Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Peeyush Kumar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - David Mathew Thomas
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer K. Vuyyuru
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Kumar Mundhra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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13
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Alqudah A, Qnais E, Gammoh O, Bseiso Y, Wedyan M, Alqudah M, Hatahet T. Cirsimaritin Alleviates Dextran Sodium Sulfate-Induced Acute Colitis in Experimental Animals: A Therapeutic Approach for Inflammatory Bowel Disease. Prev Nutr Food Sci 2024; 29:31-39. [PMID: 38576881 PMCID: PMC10987388 DOI: 10.3746/pnf.2024.29.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease that affects the entire digestive tract. IBD can be classified as ulcerative colitis or Crohn's disease. The key symptoms of IBD include the emergence of abscesses or pustules, pronounced abdominal discomfort, diarrhea, fistulas, and intestinal narrowing, all of which can greatly affect a patient's daily well-being. Several factors, including bacterial infections, immune response irregularities, and changes in the intestinal milieu, can contribute to the onset of IBD. The aim of this study was investigating the role of cirsimaritin in reducing the severity of colitis in animal model. To induce colitis in laboratory Swiss albino mice, a 4% dextran sulfate sodium (DSS) concoction was provided in their hydration source for a duration of six days. Before the onset of colitis, mice were treated with cirsimaritin (10 mg/kg) once daily to evaluate its potential treatment effects against DSS-induced inflammation. The results showed that 10 mg/kg of cirsimaritin decreased colitis severity (P<0.05). Moreover, cirsimaritin successfully reversed the detrimental effects induced by DSS, including weight reduction, colon truncation, tissue-related damage, increased levels of inflammatory cells in the affected region, and secretion of proinflammatory cytokines. Our findings suggest that cirsimaritin can effectively alleviate acute colitis triggered by DSS.
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Affiliation(s)
- Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Esam Qnais
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa 13133, Jordan
| | - Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan
| | - Yousra Bseiso
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa 13133, Jordan
| | - Mohammed Wedyan
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa 13133, Jordan
| | - Mohammad Alqudah
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
- Physiology Department, School of Medicine and Biomedical Sciences, Arabian Gulf University, Manama 26671, Bahrain
| | - Taher Hatahet
- School of Pharmacy, Queen’s University Belfast, Belfast BT7 1NN, UK
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14
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Dutta AK. Indian Journal of Gastroenterology-January-February 2024 issue highlights. Indian J Gastroenterol 2024; 43:1-6. [PMID: 38372945 DOI: 10.1007/s12664-024-01547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, A Block, 7Th Floor, Kilminnal, Ranipet, Vellore, 632 517, India.
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15
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Devi J, Ballard DH, Aswani-Omprakash T, Parian AM, Deepak P. Perianal fistulizing Crohn's disease: Current perspectives on diagnosis, monitoring and management with a focus on emerging therapies. Indian J Gastroenterol 2024; 43:48-63. [PMID: 38308773 DOI: 10.1007/s12664-024-01524-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024]
Abstract
Crohn's disease (CD), a chronic inflammatory bowel disorder, manifests in various phenotypes, with fistulizing perianal CD (CD-PAF) being one of its most severe phenotypes. Characterized by fistula formation and abscesses, CD-PAF impacts 17% to 34% of all CD cases and with a significantly deleterious impact on patient's quality of life, while increasing the risk for anorectal cancers. The pathogenesis involves a complex interplay of genetic, immunological and environmental factors, with cytokines such as tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) playing pivotal roles. Diagnostic protocols require a multi-disciplinary approach including colonoscopy, examination under anesthesia and magnetic resonance imaging. In terms of treatment, biologics alone often prove inadequate, making surgical interventions such as setons and fistula surgeries essential. Emerging therapies such as mesenchymal stem cells are under study. The South Asian context adds layers of complexity, including diagnostic ambiguities related to high tuberculosis prevalence, healthcare access limitations and cultural stigma toward perianal Crohn's disease and ostomy surgery. Effective management necessitates an integrated, multi-disciplinary approach, especially in resource-constrained settings. Despite advances, there remain significant gaps in understanding the disease's pathophysiology and a dearth of standardized outcome measures, underscoring the urgent need for comprehensive research.
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Affiliation(s)
- Jalpa Devi
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in Saint Louis, 660 S. Euclid Avenue, Campus Box 8124, Saint Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - Alyssa M Parian
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in Saint Louis, 660 S. Euclid Avenue, Campus Box 8124, Saint Louis, MO, 63110, USA.
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16
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Desai D, Dhoble P. Rapidly changing epidemiology of inflammatory bowel disease: Time to gear up for the challenge before it is too late. Indian J Gastroenterol 2024; 43:15-17. [PMID: 37773577 DOI: 10.1007/s12664-023-01453-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
| | - Pavan Dhoble
- Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India
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17
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Aswani-Omprakash T, Balasubramaniam M, McGarva J, Pandit A, Mutlu EA, Hanauer SB, Taft TH. Post-traumatic stress disorder symptoms are frequent among inflammatory bowel disease patients of South Asian descent-A case-control study. Indian J Gastroenterol 2024; 43:244-253. [PMID: 37823984 DOI: 10.1007/s12664-023-01424-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/27/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Post-traumatic stress (PTS) is the psycho-physiological response to a traumatic or life-threatening event and is implicated in inflammatory bowel disease (IBD). IBD-PTS is present in up to 30% of white, non-Hispanic patients. The rates of IBD in Asian populations are expanding, making the exploration of IBD-PTS in this population imperative. METHODS Adult patients of South/Southeast (S/SE) Asian decent with IBD for more than 6 months were recruited online via social media and patient-support groups. Participants completed the post-traumatic stress disorder (PTSD) Checklist-5 (PCL-5), the United States National Institutes of Health's Patient-Reported Outcomes Measurement Information System (NIH-PROMIS) -43 profile and demographics. S/SE Asian participants were age and sex matched (1:2) with randomly selected white, non-Hispanic controls. Statistical analyses evaluated differences in IBD-PTS symptoms between groups, the relationship between disease severity and health-related quality of life (HRQoL) and predictors of IBD-PTS severity. RESULTS Forty-seven per cent of the 51 S/SE Asian participants met the diagnostic cut-off for PTSD on the PCL-5 compared to 13.6% of 110 IBD controls. The mean global score on the PCL-5 was three times higher in S/SE Asians. Patients of S/SE Asian decent were over five times more likely to have PTSD due to their IBD experiences than controls, nearly doubling when controlling for disease activity. More severe IBD-PTS was present in S/SE Asian patients with active disease and those with extraintestinal manifestations. Higher global levels of IBD-PTS were associated with poorer HRQoL in S/SE Asians where increased hyperarousal from IBD-PTS predicted more sleep disturbance. CONCLUSIONS S/SE Asian patients are five times more likely to experience IBD-PTS than their white, non-Hispanic counterparts. Several cultural factors lead to IBD-PTS in S/SE Asian patients that must be considered by IBD providers. Preventing, screening for and treating IBD-PTS in this population appears warranted.
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Affiliation(s)
- Tina Aswani-Omprakash
- Mount Sinai Icahn School of Medicine, School of Public Health, New York, NY, USA
- South Asian IBD Alliance, New York, NY, USA
| | - Madhura Balasubramaniam
- South Asian IBD Alliance, New York, NY, USA
- Department of Humanities and Social Sciences, Indian Institute of Technology, Madras, Chennai, 600 036, India
| | - Josie McGarva
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Anjali Pandit
- South Asian IBD Alliance, New York, NY, USA
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Ece A Mutlu
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois College of Medicine, Chicago, IL, USA
- Rush University, The Graduate College, Chicago, IL, USA
| | - Stephen B Hanauer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Tiffany H Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA.
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18
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Mishra Y, Mishra V, Aljabali AAA, El-Tanani M, Naikoo GA, Charbe N, Chava SR, Tambuwala MM. 3D Printed Personalized Colon-targeted Tablets: A Novel Approach in Ulcerative Colitis Management. Curr Drug Deliv 2024; 21:1211-1225. [PMID: 37718525 DOI: 10.2174/1567201821666230915150544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/19/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023]
Abstract
Ulcerative colitis (UC) and Crohn's disease (CD) are two types of idiopathic inflammatory bowel disease (IBD) that are increasing in frequency and incidence worldwide, particularly in highly industrialized countries. Conventional tablets struggle to effectively deliver anti-inflammatory drugs since the inflammation is localized in different areas of the colon in each patient. The goal of 3D printing technology in pharmaceutics is to create personalized drug delivery systems (DDS) that are tailored to each individual's specific needs. This review provides an overview of existing 3D printing processes, with a focus on extrusion-based technologies, which have received the most attention. Personalized pharmaceutical products offer numerous benefits to patients worldwide, and 3D printing technology is becoming more affordable every day. Custom manufacturing of 3D printed tablets provides innovative ideas for developing a tailored colon DDS. In the future, 3D printing could be used to manufacture personalized tablets for UC patients based on the location of inflammation in the colon, resulting in improved therapeutic outcomes and a better quality of life.
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Affiliation(s)
- Yachana Mishra
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara (Punjab)-144411, India
| | - Vijay Mishra
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara (Punjab)-144411, India
| | - Alaa A A Aljabali
- Faculty of Pharmacy, Department of Pharmaceutics & Pharmaceutical Technology, Yarmouk University, Irbid 21163, Jordan
| | - Mohamed El-Tanani
- Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Gowhar A Naikoo
- Department of Mathematics and Sciences, College of Arts and Applied Sciences, Dhofar University, Salalah PC 211, Oman
| | - Nitin Charbe
- Center for Pharmacometrics & Systems Pharmacology, Department of Pharmaceutics (Lake Nona), University of Florida, Orlando, FL, USA
| | | | - Murtaza M Tambuwala
- Lincoln Medical School, University of Lincoln, Brayford Pool Campus, Lincoln LN6 7TS. United Kingdom
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Li CJ, Wang YK, Zhang SM, Ren MD, He SX. Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast. World J Gastroenterol 2023; 29:5751-5767. [PMID: 38075848 PMCID: PMC10701338 DOI: 10.3748/wjg.v29.i42.5751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039. AIM To comprehensively investigate IBD data, providing further insights into the management of this chronic disease. METHODS We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1). RESULTS North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases. CONCLUSION As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.
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Affiliation(s)
- Cheng-Jun Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi-Kai Wang
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Shun-Ming Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, Shaanxi Province, China
| | - Mu-Dan Ren
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shui-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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20
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Li CJ, Wang YK, Zhang SM, Ren MD, He SX. Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast. World J Gastroenterol 2023; 29:5764-5780. [DOI: 10.3748/wjg.v29.i42.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039.
AIM To comprehensively investigate IBD data, providing further insights into the management of this chronic disease.
METHODS We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1).
RESULTS North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases.
CONCLUSION As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.
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Affiliation(s)
- Cheng-Jun Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi-Kai Wang
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Shun-Ming Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, Shaanxi Province, China
| | - Mu-Dan Ren
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shui-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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21
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Kumar P, Vuyyuru SK, Das P, Kante B, Ranjan MK, Thomas DM, Mundhra S, Sahu P, Venigalla PM, Jain S, Goyal S, Golla R, Virmani S, Singh MK, Sachdeva K, Sharma R, Dash NR, Makharia G, Kedia S, Ahuja V. Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring. Intest Res 2023; 21:460-470. [PMID: 36926698 PMCID: PMC10626021 DOI: 10.5217/ir.2022.00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND/AIMS Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn's disease (CD). METHODS Inflammatory bowel disease patients treated with anti-TNF agents (January 2005-October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies. RESULTS One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28-100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (P<0.001), postoperative recurrence (P=0.001) and high IL-7R expression (P<0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03-0.28; P<0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15-0.62; P=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (P<0.001), and high C-reactive protein (P<0.001), OSM (P<0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03-0.39; P=0.001) on multivariate analysis respectively. CONCLUSIONS Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.
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Affiliation(s)
- Peeyush Kumar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer K. Vuyyuru
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Kumar Ranjan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - David Mathew Thomas
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mundhra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Pabitra Sahu
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Pratap Mouli Venigalla
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saransh Jain
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Goyal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Rithvik Golla
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shubi Virmani
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh K. Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Sachdeva
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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22
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Park J, Jeong GH, Song M, Yon DK, Lee SW, Koyanagi A, Jacob L, Kostev K, Dragioti E, Radua J, Cheon JH, Shin JI, Smith L. The global, regional, and national burden of inflammatory bowel diseases, 1990-2019: A systematic analysis for the global burden of disease study 2019. Dig Liver Dis 2023; 55:1352-1359. [PMID: 37137806 DOI: 10.1016/j.dld.2023.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND In recent years, the global epidemiology of inflammatory bowel disease (IBD) has changed rapidly. AIMS We described the updated global IBD epidemiology results based on the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). METHODS We estimated the prevalence rate, death rate, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) from GBD 2019 in 195 countries and territories between 1990 and 2019. RESULTS The crude prevalence of IBD increased by 47% in 2019 globally. Accordingly, the age-standardized prevalence rate showed 19% decrease. The age-standardized death rates, YLDs, YLLs, and DALYs of IBD in 2019 decreased compared to those in 1990. The annual percentage change in age-standardized prevalence rate decreased most in United States and increased in East Asia and high-income Asia Pacific from 1990 to 2019. Continents with high socioeconomic index (SDI) had higher age-standardized prevalence rates compared to continents with low SDI. The 2019 age-standardized prevalence rate of high latitudes was higher than that of low latitudes in Asia, Europe, and North America. CONCLUSION The observed trends and geographic variations in IBD documented in the 2019 GBD study will aid policymakers in policy, research, and investment development.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gwang Hun Jeong
- College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Minjin Song
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of medicine, Suwon, Republic of Korea
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Karel Kostev
- University Hospital of Marburg, Marburg, Germany
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linkoping University, SE-581 85 Linkoping, Sweden
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, King's College London, London, UK; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, CB1 1PT Cambridge, UK
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23
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Palandurkar GS, Kumar S. Biofilm's Impact on Inflammatory Bowel Diseases. Cureus 2023; 15:e45510. [PMID: 37868553 PMCID: PMC10585119 DOI: 10.7759/cureus.45510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
The colon has a large surface area covered with a thick mucus coating. Colon's biomass consists of about 1,012 colony-forming units per gram of feces and 500-1,000 distinct bacterial species. The term inflammatory bowel disease (IBD) indicates the collection of intestinal illnesses in which the digestive system (esophagus, large intestine, mouth, stomach, and small intestine) experiences persistent inflammation. IBD development is influenced by environmental (infections, stress, and nutrition) and genetic factors. The microbes present in gut microbiota help maintain intestinal homeostasis and support immune and epithelial cell growth, differentiation, as well as proliferation. It has been discovered that a variety of variables and microorganisms are crucial for the development of biofilms and mucosal colonization during IBD. An extracellular matrix formed by bacteria supports biofilm production in our digestive system and harms the host's immunological response. Irritable bowel syndrome (IBS) and IBD considerably affect human socioeconomic well-being and the standard of living. IBD is a serious public health issue, affecting millions of people across the globe. The gut microbiome may significantly influence IBS pathogenesis, even though few diagnostic and treatment options are available. As a result, current research focuses more on disrupting biofilm in IBD patients and stresses primarily on drugs that help improve the quality of life for human well-being. We evaluate studies on IBD and bacterial biofilm to add fresh insights into the existing state of knowledge of biofilm formation in IBD, incidence of IBD patients, molecular level of investigations, bacteria that are involved in the formation of biofilm, and present and down the line regimens and probiotics. Planning advanced ways to control and eradicate bacteria in biofilms should be the primary goal to add fresh insights into generating innovative diagnostic and alternative therapy options for IBD.
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Affiliation(s)
- Gopal S Palandurkar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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24
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Kumar A, Kanika, Kumar V, Ahmad A, Mishra RK, Nadeem A, Siddiqui N, Ansari MM, Raza SS, Kondepudi KK, Khan R. Colon-Adhering Delivery System with Inflammation Responsiveness for Localized Therapy of Experimental Colitis. ACS Biomater Sci Eng 2023; 9:4781-4793. [PMID: 37497615 DOI: 10.1021/acsbiomaterials.3c00480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Ulcerative colitis (UC) is a chronic inflammation-related disease that severely affects the colon and rectum regions. A variety of therapy regimens are used for the treatment of UC. Clinically, therapeutic enema is the choice of therapy for UC patients. Irrespective of on-site administration, the major limitation of therapeutic enemas is the dispossession of the medicine followed by low drug availability for the therapeutic action. In our present work, we have developed an enzyme-responsive injectable hydrogel (ER-hydrogel) to overcome the limitations of therapeutic enema. The hydrogels possess two major advantages, which are being exploited for therapeutic drug delivery in UC: prolonged retention and enzyme responsiveness. The former is one of the prominent advantages of hydrogel compared to free drug enema and the latter controls the release of the drug or provides drug release on-demand. The ER-hydrogel was formulated by the heat-cool method and for therapeutic purposes, a corticosteroid drug, budesonide (Bud), was encapsulated into the ER-hydrogel and evaluated for its various physicochemical and therapeutic potentials in dextran sodium sulfate (DSS)-induced UC. In vitro and ex vivo adhesion studies confirm the retention or mucoadhesive nature of the ER-hydrogel, and the upsurge in Bud release from the Bud-loaded ER-hydrogel upon the addition of esterase enzyme confirms the enzyme-mediated drug release from the ER-hydrogel. Moreover, Bud-loaded ER-hydrogel exhibited promising results in alleviating the disease activity index of UC, and restored the length of the colon, which is the main hallmark of UC. In terms of the health of the colon tissue, the Bud-loaded ER-hydrogel restored the colonic tissue damage, as seen in the H&E-stained, AB-NR-stained, and HID-AB-stained colon sections. Finally, the Bud-loaded ER-hydrogel also markedly subsided the IL-1β, TNF-α, MPO, and nitrite levels in serum and colon tissues. Thus, the fabricated Bud-loaded ER-hydrogel possesses appreciable translational potential due to its ability to significantly ameliorate inflammatory changes compared to naive or water-based therapeutic enema in acute experimental colitis in mice.
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Affiliation(s)
- Ajay Kumar
- Chemical Biology Unit, Institute of Nano Science and Technology, Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Mohali, Punjab 140306, India
| | - Kanika
- Chemical Biology Unit, Institute of Nano Science and Technology, Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Mohali, Punjab 140306, India
| | - Vibhu Kumar
- National Agri-Food Biotechnology Institute, Mohali, Punjab 140306, India
| | - Anas Ahmad
- Julia McFarlane Diabetes Research Centre (JMDRC) and Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Rakesh Kumar Mishra
- Chemical Biology Unit, Institute of Nano Science and Technology, Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Mohali, Punjab 140306, India
| | - Ahmed Nadeem
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Nahid Siddiqui
- Amity Institute of Biotechnology, Amity University, Noida 201303, India
| | - Md Meraj Ansari
- Centre for Pharmaceutical Nanotechnology, Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, Sector 67, Mohali, Punjab 160062, India
| | - Syed Shadab Raza
- Department of Stem Cell Biology and Regenerative Medicine, Era University, Sarfarazganj, Lucknow 226003, India
| | | | - Rehan Khan
- Chemical Biology Unit, Institute of Nano Science and Technology, Sector-81, Knowledge City, Sahibzada Ajit Singh Nagar, Mohali, Punjab 140306, India
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25
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Swastha D, Varsha N, Aravind S, Samyuktha KB, Yokesh MM, Balde A, Ayilya BL, Benjakul S, Kim SK, Nazeer RA. Alginate-based drug carrier systems to target inflammatory bowel disease: A review. Int J Biol Macromol 2023:125472. [PMID: 37336375 DOI: 10.1016/j.ijbiomac.2023.125472] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
Inflammatory bowel disease (IBD) is an inflammatory disorder that affects the gastrointestinal tract. IBD has become an increasingly common condition in both developed and developing nations over the last few decades, owing to a variety of factors like a rising population and diets packed with processed and junk foods. While the root pathophysiology of IBD is unknown, treatments are focused on medications aimed to mitigate symptoms. Alginate (AG), a marine-derived polysaccharide, is extensively studied for its biocompatibility, pH sensitivity, and crosslinking nature. This polymer is thoroughly researched in drug delivery systems for IBD treatment, as it is naturally available, non-toxic, cost effective, and can be easily and safely cross-linked with other polymers to form an interconnected network, which helps in controlling the release of drugs over an extended period. There are various types of drug delivery systems developed from AG to deliver therapeutic agents; among them, nanotechnology-based systems and hydrogels are popular due to their ability to facilitate targeted drug delivery, reduce dosage, and increase the therapeutic efficiency. AG-based carrier systems are not only used for the sustained release of drug, but also used in the delivery of siRNA, interleukins, and stem cells for site directed drug delivery and tissue regenerating ability respectively. This review is focussed on pathogenesis and currently studied medications for IBD, AG-based drug delivery systems and their properties for the alleviation of IBD. Moreover, future challenges are also be discoursed to improve the research of AG in the field of biopharmaceuticals and drug delivery.
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Affiliation(s)
- Dinakar Swastha
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Nambolan Varsha
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Suresh Aravind
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Kavassery Balasubramanian Samyuktha
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Muruganandam Mohaneswari Yokesh
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Akshad Balde
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Bakthavatchalam Loganathan Ayilya
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Soottawat Benjakul
- Department of Food Technology, Faculty of Agro-Industry, Prince of Songkhla University, 90112 Hat Yai, Songkhla, Thailand
| | - Se-Kwon Kim
- Department of Marine Science and Convergence Engineering, Hanyang University, Ansan, 11558, Gyeonggi-do, South Korea
| | - Rasool Abdul Nazeer
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India.
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Gopalan S, Nagarajan S, Somasundaram A, Thiyagarajan MK. Inflammatory bowel disease associated knowledge in South Indian populations: rational Study. Afr Health Sci 2023; 23:442-450. [PMID: 38223636 PMCID: PMC10782346 DOI: 10.4314/ahs.v23i2.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Objectives The pivotal of the study was to compare the effectiveness of education in disease-associated knowledge of Inflammatory Bowel Disease (IBD) patients between pre-test and post-test using the IBD-KNOW questionnaire and patient educational resources. Methods This study used a patient proforma and IBD- KNOW questionnaire to perform the study prospectively by interviewing method. The patient selection was based on inclusion and exclusion criteria by convenient sampling technique from November 2018 to July 2019 at a multispecialty hospital. Knowledge scores and inter-item correlation were calculated between the pre-test and post-test by R Programming software with p<0.05. Results Among 40 patients with IBD diagnosis, the baseline sociodemographic characteristics were recorded. The response rate of IBD knowledge between the pre-test and post-test resulted in significant differences with varying scales but the response rate was lesser in the domains of management and pregnancy-based questions in the pre-test and post-test. Conclusions Recently there was a swift in IBD incidence, this may be improved by affording suitable patient education and counseling for further knowledge level in managing the disease by coping strategy. On comparison between the pre-test and post-test, this study recommends innovative educational methods to enable continuing education for chronic disease which can be easily accessible and reliable for IBD patients.
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Affiliation(s)
- Sathyaprabha Gopalan
- Department of Pharmacy, Annamalai University, Chidambaram, (Tamil Nadu) India
- Department of Pharmacy Practice, KMCH College of Pharmacy (Affiliated to TN. Dr.M. G. R. Medical University), Coimbatore, (Tamil Nadu) India
| | | | - Aravindh Somasundaram
- Department of Gastroenterology, Kovai Medical Center and Hospital, Coimbatore, (Tamil Nadu) India
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Rajbhandari R, Blakemore S, Gupta N, Mannan S, Nikolli K, Yih A, Drown L, Bukhman G. Crohn's Disease Among the Poorest Billion: Burden of Crohn's Disease in Low- and Lower-Middle-Income Countries. Dig Dis Sci 2023; 68:1226-1236. [PMID: 36044105 PMCID: PMC10102033 DOI: 10.1007/s10620-022-07675-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/16/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND To establish the epidemiology and patterns of care of Crohn's Disease in low- and lower-middle-income countries. METHODS A cross-sectional survey of gastroenterology providers in countries where the world's poorest billion live was conducted to learn more about the state of diagnostic and treatment capacity for Crohn's. Quantitative data were analyzed in R and Excel. RESULTS A total of 46 survey responses from 15 countries were received, giving a response rate of 54.8%. All responses collected were from providers practicing in Africa and South Asia. The mean number of patients with Crohn's cared for in the last year was 89.5 overall but ranged from 0 reported at one facility in Rwanda to 1000 reported at two different facilities in India. Overall, Crohn's disease made up 20.6% of the inflammatory bowel disease diagnoses reported by survey respondents, with Africa exhibiting a larger proportion of Crohn's compared to ulcerative colitis than Asia. Most providers reported that patients with Crohn's have symptoms for 6-24 months prior to diagnosis and that 26-50% of their patients live in rural areas. The most reported diagnostic challenges are differentiating between Crohn's and intestinal tuberculosis, poor disease awareness, and lack of trained pathologists. The most widely reported challenge in managing Crohn's disease is patients' inability to afford biologics, reported by 65% of providers. CONCLUSION Our study suggests there may be a greater burden of Crohn's disease in low- and lower-middle-income countries than is indicated in prior literature. Respondents reported many challenges in diagnosing and treating Crohn's disease.
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Affiliation(s)
- Ruma Rajbhandari
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02199, USA.
| | - Samantha Blakemore
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02199, USA
- Partners in Health, NCD Synergies, Boston, MA, 02199, USA
| | - Sara Mannan
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Klejda Nikolli
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Alison Yih
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Laura Drown
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02199, USA
- Partners in Health, NCD Synergies, Boston, MA, 02199, USA
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Sharma S, Bhatia R, Devi K, Rawat A, Singh S, Bhadada SK, Bishnoi M, Sharma SS, Kondepudi KK. A synbiotic combination of Bifidobacterium longum Bif10 and Bifidobacterium breve Bif11, isomaltooligosaccharides and finger millet arabinoxylan prevents dextran sodium sulphate induced ulcerative colitis in mice. Int J Biol Macromol 2023; 231:123326. [PMID: 36681226 DOI: 10.1016/j.ijbiomac.2023.123326] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/23/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
Decreased bifidobacterial abundance, disrupted gut barrier function, dysregulated immune response and ulceration have been reported in the gut microbiota of IBD patients. Non-digestible carbohydrates with bifidogenic effect enrich the gut microbiota with Bifidobacterium spp. and could help in overcoming inflammatory gut conditions. In this study, the protective effect of Bifidobacterium longum Bif10 and Bifidobacterium breve Bif11; isomaltooligosaccharides (IMOS); Finger millet arabinoxylan (FM-AX) and their Synbiotic mix were evaluated against dextran sodium sulphate (DSS) induced UC in male Balb/c mice for 25 days. All the interventions ameliorated symptoms of colitis such as disease activity index (DAI), histological damage to the colon, gut-bacterial dysbiosis and inflammation. However, the synbiotic mix was more potent in amelioration of some of the parameters such as decreased TNF-α and lipocalin levels; increased anti-inflammatory markers (IL-10 and IL-22), and improved short chain fatty acids (SCFAs) levels in the cecum content. Furthermore, mouse colitis histological scoring (MCHI) also suggested the preventive role of synbiotic mix. All the dietary interventions aid in improving the DAI and immune parameters; restoration or regeneration of the altered selected gut bacteria, enhances the SCFA production, strengthens gut barrier, prevents gut inflammation and decreases the colonic MCHI score in DSS fed mice.
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Affiliation(s)
- Shikha Sharma
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India; Department of Biotechnology, Panjab University, Chandigarh 160014, India
| | - Ruchika Bhatia
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India; Department of Biotechnology, Panjab University, Chandigarh 160014, India
| | - Kirti Devi
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India; Department of Biotechnology, Panjab University, Chandigarh 160014, India
| | - Anita Rawat
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India; Regional Center for Biotechnology, Faridabad, Haryana 121001, India
| | - Shashank Singh
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Mahendra Bishnoi
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India; Department of Biotechnology, Panjab University, Chandigarh 160014, India; Regional Center for Biotechnology, Faridabad, Haryana 121001, India
| | - Shyam Sunder Sharma
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
| | - Kanthi Kiran Kondepudi
- Healthy Gut Research Group, Centre for Excellence in Functional Foods, Division of Food & Nutritional Biotechnology, National Agri-Food Biotechnology Institute (NABI), S.A.S. Nagar 140306, Punjab, India; Department of Biotechnology, Panjab University, Chandigarh 160014, India; Regional Center for Biotechnology, Faridabad, Haryana 121001, India.
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29
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Adams A, Gupta V, Mohsen W, Chapman TP, Subhaharan D, Kakkadasam Ramaswamy P, Kumar S, Kedia S, McGregor CG, Ambrose T, George BD, Palmer R, Brain O, Walsh A, Ahuja V, Travis SPL, Satsangi J. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023; 72:433-442. [PMID: 36171080 DOI: 10.1136/gutjnl-2022-327533] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/27/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVES We aimed to determine whether changes in acute severe colitis (ASC) management have translated to improved outcomes and to develop a simple model predicting steroid non-response on admission. DESIGN Outcomes of 131 adult ASC admissions (117 patients) in Oxford, UK between 2015 and 2019 were compared with data from 1992 to 1993. All patients received standard treatment with intravenous corticosteroids and endoscopic disease activity scoring (Ulcerative Colitis Endoscopic Index of Severity (UCEIS)). Steroid non-response was defined as receiving medical rescue therapy or surgery. A predictive model developed in the Oxford cohort was validated in Australia and India (Gold Coast University Hospital 2015-2020, n=110; All India Institute of Medical Sciences, New Delhi 2018-2020, n=62). RESULTS In the 2015-2019 Oxford cohort, 15% required colectomy during admission vs 29% in 1992-1993 (p=0.033), while 71 (54%) patients received medical rescue therapy (27% ciclosporin, 27% anti-tumour necrosis factor, compared with 27% ciclosporin in 1992-1993 (p=0.0015). Admission C reactive protein (CRP) (false discovery rate, p=0.00066), albumin (0.0066) and UCEIS scores (0.015) predicted steroid non-response. A four-point model was developed involving CRP of ≥100 mg/L (one point), albumin of ≤25 g/L (one point), and UCEIS score of ≥4 (1 point) or ≥7 (2 points). Patients scoring 0, 1, 2, 3 and 4 in the validation cohorts had steroid response rates of 100, 75.0%, 54.9%, 18.2% and 0%, respectively. Scoring of ≥3 was 84% (95% CI 0.70 to 0.98) predictive of steroid failure (OR 11.9, 95% CI 10.8 to 13.0). Colectomy rates in the validation cohorts were were 8%-11%. CONCLUSIONS Emergency colectomy rates for ASC have halved in 25 years to 8%-15% worldwide. Patients who will not respond to corticosteroids are readily identified on admission and may be prioritised for early intensification of therapy.
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Affiliation(s)
- Alex Adams
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Vipin Gupta
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK.,Department of Gastroenterology, North Bristol NHS Trust, Bristol, UK
| | - Waled Mohsen
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK.,Digestive Diseases Unit, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Thomas P Chapman
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK.,Department of Gastroenterology, St Richard's and Worthing Hospitals, University Hospitals Sussex NHS Foundation Trust, West Sussex, UK
| | - Deloshaan Subhaharan
- Digestive Diseases Unit, Gold Coast University Hospital, Southport, Queensland, Australia
| | | | - Sudheer Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tim Ambrose
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Bruce D George
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Rebecca Palmer
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Alissa Walsh
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Simon P L Travis
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Jack Satsangi
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
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30
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Elemental content in under-utilized green leafy vegetables of urban waterbodies in Kolkata, India and their associated health risk. J Food Compost Anal 2023. [DOI: 10.1016/j.jfca.2023.105212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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31
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Kante B, Vuyyuru SK, Gupta R, Dwivedi T, Kumar P, Mundhra S, Golla R, Virmani S, Verma M, Makharia G, Ahuja V, Kedia S. High seroprevalence against SARS-CoV-2 in non-vaccinated patients with inflammatory bowel disease from Northern India. Indian J Gastroenterol 2023; 42:70-78. [PMID: 36738383 PMCID: PMC9898695 DOI: 10.1007/s12664-022-01310-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The information on seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in patients with IBD and healthy controls (HCs). METHODS Patients with IBD and HCs (contact of patients) underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Siemens kit IgG against antigen-S1RBD) between July 2020 and April 2021. Information on demography, disease characteristics, drug history and past history of SARS-CoV-2 infection were noted. Patients on 5-aminosalicylic acid or no treatment were considered not on immunosuppressants and those who had received steroids, thiopurines or methotrexate within six months of inclusion were considered being on immunosuppressants. RESULTS A total of 235 patients (51.9%, males; mean age, 38.7 ± 12.4 years; median disease duration, 60 months [interquartile range, IQR: 36-120]) (ulcerative colitis [UC]: 69.4%, Crohn's disease [CD]: 28.9%, IBD unclassified [IBDU]: 1.7%) and 73 HCs (mean age, 39.6 ± 10.9 years, 80% males) were enrolled. Of the 235 patients, 128 (54.5%) patients were on immunosuppressants and 107 (45.5%) were not on immunosuppressants. Seventy-four (31.5%) patients were seropositive, of which two (0.9%) had previous history of SARS-CoV-2 infection and none received coronavirus disease-19 (COVID-19) vaccine. Seroprevalence between IBD patients and HCs (32% vs. 27%, p > 0.05) and between patients with and without immunosuppressants (28.1% vs. 36%, p > 0.05) was similar. Age, gender, disease type, duration and activity in the last six months; and medication use were similar between patients with positive and negative serology. There was a progressive increase in seroprevalence from July 2020 to April 2021. CONCLUSION Up to 1/3rd of patients with IBD were seropositive for immunoglobulin G (IgG) SARS-Cov-2 antibody indicating high seroprevalence in patients with IBD from Northern India.
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Affiliation(s)
- Bhaskar Kante
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Sudheer Kumar Vuyyuru
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Peeyush Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Sandeep Mundhra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rithvik Golla
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Shubi Virmani
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Mahak Verma
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India.
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32
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Barnaba Durairaj MV, Jaleel R, Pulimood AB. Granulomatous inflammation is less common in delayed-onset Crohn's disease. Trop Doct 2023; 53:113-116. [PMID: 35903927 DOI: 10.1177/00494755221104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crohn's disease (CD) usually affects younger individuals but delayed-onset disease is not uncommon. We studied the epidemiology, demographic profile, and clinical characteristics of patients with delayed-onset CD (disease onset >50 years) and compared them with CD in younger individuals (disease onset 20-40 years) in a tertiary care center in India. The presenting symptoms, site of involvement, and treatment profile were similar, except for weight loss, which was more often noted in young-onset CD. However, granulomatous inflammation on mucosal biopsy was twice as common in young-onset compared to delayed-onset CD. As it is thus seen less often in delayed-onset CD, this may lead to a potential delay in diagnosis and treatment.
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Affiliation(s)
| | - Rajeeb Jaleel
- Department of Gastroenterology, 30025Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Anna B Pulimood
- Department of Pathology, 30025Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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33
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Pal P, Ramchandani M, Banerjee R, Inavolu P, Nabi Z, Rughwani H, Singh APH, Patel R, Vijayalaxmi P, Singh JR, Rebala P, Rao GV, Reddy DN, Tandan M. Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1757470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background/Aims With the growing multidisciplinary model of practice in the management of complex inflammatory bowel disease (IBD) and rising incidence of IBD, interventional IBD (IIBD) promises to play a key role. We aimed to evaluate current the role of IIBD in India and its short-term outcomes.
Methods IBD patients undergoing IIBD procedures for stricture, bleeding, colitis-associated neoplasia, therapeutic small bowel endoscopy including retained capsule retrieval and postsurgical complications were enrolled prospectively between September 2021 and May 2022. Demographic and disease details, indications, initial and redo procedure details, technical/clinical success, and complications were recorded.
Results IIBD procedures were performed in total 54 patients (61% males, median age: 37.5 years, range: 21–74 years, Crohn's disease [CD]: 42, ulcerative colitis [UC]: 12 between September 2021 and April 2022). Endoscopic balloon dilation (EBD) was performed in 44 patients (56 strictures, 9% anastomotic, 9% pouch) who underwent total 83 EBD procedures in 63 sessions. Short-term clinical efficacy after maximal dilation, technical success (i.e., scope passage after EBD), and complications (all mild) were noted in 95.4, 81.8, and 9.1%, respectively. Recurrent symptoms were seen in 27.3% on short-term follow-up (1–8 months, median: 5 months) for which redilation, surgery, and endoscopic stricturotomy were done in 22.7, 2.3, and 2.3% respectively. During small bowel EBD, motorized spiral enteroscopy-guided retained capsule endoscope retrieval was done in four patients. Ulcerative colitis-associated neoplasia (UCAN) was resected endoscopically in six patients (endoscopic submucosal dissection (ESD)—1, endoscopic mucosal resection (EMR)—5). High-grade dysplasia was resected in two patients (1 ESD for recurrent UCAN, 1 EMR had residual neoplasia on follow-up treated with underwater EMR). R0 resection was achieved in 83.3%. Endoscopic hemostasis was done with hemoclipping and sclerotherapy for UC-related bleeding in two, whereas a case of CD with proximal ileal bleeding was controlled with antegrade single-balloon enteroscopy-assisted hemoclipping.
Conclusions IIBD is a promising modality in resource-limited settings like India acting as a bridge between medical therapy and surgery. Surgery can be avoided in a significant proportion with good short-term outcomes. Long-term outcomes need to be evaluated.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Pradev Inavolu
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Hardik Rughwani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | | | - Rajendra Patel
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Polina Vijayalaxmi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Jagdeesh Rampal Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Pradeep Rebala
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Guduru Venkat Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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34
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D'Aloisio LD, Shetty V, Ballal M, Gibson DL. Following the Indian Immigrant: adoption of westernization results in a western gut microbiome and an increased risk of inflammatory bowel diseases. FEMS Microbiol Ecol 2022; 98:6825449. [PMID: 36370451 DOI: 10.1093/femsec/fiac133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
Indians who migrate to westernized countries such as Canada, the USA, and the UK are at an increased risk of developing inflammatory bowel disease (IBD). While the underlying aetiology of IBD remains unclear, a gut microbiome, i.e. no longer symbiotic with its host, is a major player. Increasing IBD incidence in Indian immigrants may be due to the adoption of western practices that result in loss of tolerance of a symbiotic community in the gut and its underlying immune responses. However, little is known about the microbial changes in the Indian gut, including shifts in the microbiome when they migrate to westernized countries. In this Current Opinion, we discuss what is known about the Indian gut microbiome and how living in a westernized environment may be impeding what was once a symbiotic relationship with their gut microbiome and intestinal mucosae, which may be the driving factor in their increased risk of IBD.
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Affiliation(s)
- Leah D D'Aloisio
- Department of Biology, University of British Columbia- Okanagan Campus, V1V 1V7 Kelowna, Canada
| | - Vignesh Shetty
- Enteric Disease Division, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, 576104 Manipal, India.,Department of Medicine, University of Cambridge, CB2 2QQ Cambridge, United Kingdom
| | - Mamatha Ballal
- Enteric Disease Division, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, 576104 Manipal, India
| | - Deanna L Gibson
- Department of Biology, University of British Columbia- Okanagan Campus, V1V 1V7 Kelowna, Canada.,Department of Medicine, University of British Columbia- Okanagan Campus, V1V 1V7 Kelowna, Canada
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35
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Goren I, Sharar Fischler T, Yanai H, Pal P, Adigopula B, Pendyala S, Ganesh G, Vishnubhotla R, Rabinowitz KM, Shaham Barda E, Yadamreddy D, Godny L, Peleg N, Banerjee R, Dotan I. Newly Diagnosed Crohn's Disease Patients in India and Israel Display Distinct Presentations and Serological Markers: Insights from Prospective Cohorts. J Clin Med 2022; 11:jcm11236899. [PMID: 36498474 PMCID: PMC9737641 DOI: 10.3390/jcm11236899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Crohn’s disease (CD) incidence is rising in India. However, features of newly diagnosed patients with CD in this population are largely unknown. The Indo-Israeli IBD GastroEnterology paRtnership (TiiiGER) aimed to investigate differences in presentation among patients with newly diagnosed CD in India and Israel, and to explore phenotype−serotype correlations. Methods: A prospective observational cohort study of consecutive adults (>18 years) conducted in two large referral centers in India and Israel (2014−2018). Clinical data, an antiglycan serological panel, and 20 CD-associated genetic variants were analyzed. Outcomes: complicated phenotype at diagnosis and early complicated course (hospitalizations/surgeries) within 2 years of diagnosis. Results: We included 260 patients (104, Indian (65.4%, male; age, 37.8); 156 Israeli (49.4%, male; 31.8, age)). Median lag time from symptoms onset to diagnosis was 10.5 (IQR 3−38) vs. 3 (IQR 1−8) months in Indian vs. Israeli patients (p < 0.001). Complicated phenotype at diagnosis was observed in 48% of Indian and 30% of Israeli patients (p = 0.003). Complicated phenotype was associated with higher anti-Saccharomyces cerevisiae antibody (ASCA) seropositivity rate among Israeli patients (p < 0.001), but not among Indian patients. Antiglycan serology did not correlate with the tested genetic variants. Early complicated course occurred in 28 (18%) Israeli and 13 (12.5%) Indian patients. The time from diagnosis to complication was comparable (log rank p = 0.152). Antiglycan serology did not correlate with a complicated early course in either cohort. Conclusions: There are significant differences in patients presenting with newly diagnosed CD in India and Israel, including phenotype and distinct biomarkers at diagnosis. These differences suggest different genetic and environmental disease modifiers.
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Affiliation(s)
- Idan Goren
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Correspondence:
| | - Tali Sharar Fischler
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Henit Yanai
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Partha Pal
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Bhargavi Adigopula
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Sushmitha Pendyala
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Girish Ganesh
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Ravikanth Vishnubhotla
- Department of Genomics and Molecular Biology, Institute of Translational Research, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad 500032, India
| | - Keren Masha Rabinowitz
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49414, Israel
| | - Efrat Shaham Barda
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49414, Israel
| | - Durga Yadamreddy
- Department of Genomics and Molecular Biology, Institute of Translational Research, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad 500032, India
| | - Lihi Godny
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Noam Peleg
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Rupa Banerjee
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Iris Dotan
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
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36
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Gupta A, Singh N, Madan D, Farooqui M, Singh N, Thomas DM, Kante B, Singh M, Virmani S, Verma M, Bajaj A, Markandey M, Kumar P, Vuyyuru SK, Sahu P, Monga N, Makharia G, Kedia S, Ahuja V. Development and Validation of a Smartphone Application for Telenutrition in Patients with Inflammatory Bowel Disease. Diagnostics (Basel) 2022; 12:2482. [PMID: 36292172 PMCID: PMC9600056 DOI: 10.3390/diagnostics12102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
The use of smartphone-based applications as a telenutrition tool could redefine the nutritional management of IBD. We developed and validated a digital health platform in the form of a smartphone application for the nutritional assessment of IBD patients. Our team of gastroenterologists and dieticians at the All-India Institute of Medical Sciences, New Delhi developed a smartphone application titled IBD NutriCare, which was made available in both Android and iOS interfaces in English and seven other Indian languages. The application includes >650 Indian recipes and provides subjective global assessment and IBD clinical activity scores in a patient-friendly manner. The utility of the smartphone app was validated in comparison with the traditional 24-h dietary recall method. A total of 49 IBD patients were enrolled in the study. The mean difference in energy intake between the two dietary assessment methods was −4.776 kJ (95% LOA, range −417.916−408.365 kJ). A total of 94% of patients found the smartphone application convenient and acceptable in comparison to the recall method for dietary assessment. Bland−Altman plots showed a good level of agreement for nutrients and food groups between the two methods. Telenutrition in the form of a smartphone application helps in real-time tracking of dietary details of IBD patients, thus making appropriate interventions and large-scale data acquisition feasible.
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Affiliation(s)
- Arti Gupta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Divya Madan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mariyam Farooqui
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - David Mathew Thomas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mukesh Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shubi Virmani
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mehak Verma
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Aditya Bajaj
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manasvini Markandey
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Peeyush Kumar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sudheer Kumar Vuyyuru
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pabitra Sahu
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nitika Monga
- Indian Council of Medical Research, New Delhi 110029, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
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Bamola VD, Dubey D, Samanta P, Kedia S, Ahuja V, Madempudi RS, Neelamraju J, Chaudhry R. Role of a probiotic strain in the modulation of gut microbiota and cytokines in inflammatory bowel disease. Anaerobe 2022; 78:102652. [PMID: 36198385 DOI: 10.1016/j.anaerobe.2022.102652] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effect of a probiotic strain Bacillus clausii UBBC-07 on gut microbiota and cytokines in IBD patients. METHOD Patients were randomly allocated to either placebo or probiotic Bacillus clausii UBBC-07 for four weeks along with the standard medical treatment (SMT). Enrolled patients were evaluated before and after intervention for presence of the given probiotic, change in gut microbiota, change in serum cytokines, serotonin and dopamine, symptoms of disease, physical, behavioral and psychological parameters. RESULTS Probiotic strain Bacillus clausii UBBC-07 showed good survival in IBD patients in the treatment group (p < 0.01) without any reported adverse event. Metagenomic analysis showed that the given probiotic strain was able to modulate the gut microbiota in treated group. Phylum Firmicutes was increased and phylum Bacteroidetes was decreased in the probiotic treated group. A significant increase was observed in the abundance of anaerobic bacterial genera Lactobacillus, Bifidobacterium and Faecalibacterium in the probiotic treated group (p < 0.01) as compared to placebo group. Significant increase was observed in IL-10 (p < 0.05) and variable decrease in the secretion of IL-1β, TNF- α, IL-6, IL -17 and IL -23 in probiotic treated group. In the treatment group a significant decrease in the symptoms of IBD and improvement in the psychological parameter to various degrees was noted. CONCLUSION These results indicated that probiotic strain B clausii UBBC-07 affected the gut microbiota and cytokine secretion and shown efficacy in IBD patients.
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Affiliation(s)
- V Deepak Bamola
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Divya Dubey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Projoyita Samanta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ratna Sudha Madempudi
- Centre for Research & Development, Unique Biotech Ltd., Plot No. 2, Phase-II, Alexandria Knowledge Park, Hyderabad, Telangana, 500078, India
| | - Jayanthi Neelamraju
- Centre for Research & Development, Unique Biotech Ltd., Plot No. 2, Phase-II, Alexandria Knowledge Park, Hyderabad, Telangana, 500078, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Impact of sociodemographic factors and screening, diagnosis, and treatment strategies on colorectal cancer mortality in Brazil: A 20-year ecological study. PLoS One 2022; 17:e0274572. [PMID: 36107976 PMCID: PMC9477339 DOI: 10.1371/journal.pone.0274572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic factors predicting higher mortality caused by CRC and survival rates. Moreover, we aimed to verify whether the performance of screening, diagnostic and treatment procedures had an impact on mortality. Ecological observational study of mortality due to CRC was conducted in Brazil from 2000–2019. The adjustment variable was age, which was used to calculate the age-standardized mortality rate (ASMR). The exposure variables were number of deaths and ASMR. Outcome variables were age-period-cohort, race classification, marital status, geographic region, and screening, diagnostic, and treatment procedures. Age-period-cohort analysis was performed. ANOVA and Kruskal-Wallis test with post hoc tests were used to assess differences in race classification, marital status, and geographic region. Multinomial logistic regression was used to test for interaction among sociodemographic factors. Survival analysis included Kaplan-Meier plot and Cox regression analysis were performed. Multivariate linear regression was used to test prediction using screening, diagnosis, and treatment procedures. In Brazil, mortality from CRC increased after age 45 years. The highest adjusted mortality rates were found among white individuals and in the South of the country (p < 0.05). Single, married, and widowed northern and northeastern persons had a higher risk of death than legally separated southern persons (p < 0.05). Lower survival rates were observed in brown and legally separated individuals and residents from the North (p < 0.05). An increase in first-line chemotherapy and a decrease in second-line chemotherapy were associated with high mortality in the north (p<0.05). In the south, second-line chemotherapy and abdominoperineal rectal resection were associated with high mortality (p < 0.05). Regional differences in sociodemographic factors and clinical procedures can serve as guidelines for adjusting public health policies.
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Cota D, Patil D. Antibacterial potential of ellagic acid and gallic acid against IBD bacterial isolates and cytotoxicity against colorectal cancer. Nat Prod Res 2022; 37:1998-2002. [PMID: 35968644 DOI: 10.1080/14786419.2022.2111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Ellagic acid and Gallic acid are polyphenols which have shown beneficial effects in animal models of colitis. In the present study Ellagic acid and Gallic acid were evaluated for antibacterial potential against clinical IBD isolates. (HM95, HM233, HM251, HM615). Cytotoxicity was determined against human colorectal adenocarcinoma cells (Caco2, COLO.205, HT.29), whereas, cytocompatibility against normal rat intestinal epithelial (IEC-6) using MTT assay. Ellagic acid showed the lowest MIC and MBC value of 2.5 and 5 mg/mL respectively against HM251 and HM233. Gallic acid exhibited the lowest MIC and MBC value of 1.25 and 2.5 mg/mL respectively against HM251 and HM615. Cytotoxicity assay resulted in reduction of percent cell viability when tested at concentrations ranging from 400-12.5 µg/mL. The polyphenols presented a concentration-dependent deduction in percent cell viability after 48 h exposure It is likely that these polyphenols are good anti-colitic agents. However, further investigations are required.
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Affiliation(s)
- Damita Cota
- Rani Chennamma College of Pharmacy, Belagavi, Karnataka, India
| | - Dhanashree Patil
- Dr. Prabhakar Kore Basic Science Research Center, KLE Academy of Higher Education and Research (KLE University), Belagavi, Karnataka, India
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Relapse rates after withdrawal of thiopurines in patients with inflammatory bowel disease. Int J Colorectal Dis 2022; 37:1817-1826. [PMID: 35835862 DOI: 10.1007/s00384-022-04216-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Withdrawal of thiopurines after remission is associated with an increased risk of relapse in patients with inflammatory bowel disease (IBD). However, long-term data on thiopurine withdrawal is limited, especially from developing countries where the cost of long-term therapy poses a significant burden on patients. METHODS Patients with IBD on thiopurine monotherapy for ≥ 4 months, who stopped thiopurines while in clinical remission and were not on any other immunomodulator or biologics at the time of withdrawal, were included in this retrospective analysis. RESULTS Among 1093 patients with IBD on thiopurine monotherapy, 461 patients stopped thiopurine due to various reasons. Among these, 218 (ulcerative colitis (UC) = 179; Crohn's disease (CD) = 39) patients were in clinical remission and were continued on mesalamine. Overall, 36.7% (n = 80) relapsed after a median duration of 20 months (IQR: 9-49). Relapse rate was higher in UC than CD (39.7% vs 23%, p = 0.055). Cumulative probabilities of relapse were 17%, 34%, and 44% at the end of 1, 3, and 5 years, respectively. The relapse rate at 5 years was significantly lower in patients who had stopped azathioprine after 4 years of therapy (31% vs 54%, p = 0.007). On multi-variate cox regression analysis, male sex [HR: 1.6(1.0-2.6), p = 0.02] and short duration of therapy with thiopurines [HR: 1.02 (1.01-1.02), p = 0.004] before withdrawal were associated with increased risk of relapse. CONCLUSION Approximately 50% patients with IBD in remission would relapse after 5 years of thiopurine withdrawal. Male sex and shorter treatment duration predict relapse. Treatment should be continued in patients who tolerate and maintain remission on long-term thiopurine.
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Park SH, Park SH. Personalized medicine in inflammatory bowel disease: Perspectives on Asia. J Gastroenterol Hepatol 2022; 37:1434-1445. [PMID: 35726657 DOI: 10.1111/jgh.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 12/09/2022]
Abstract
Inflammatory bowel diseases are chronic, relapsing inflammatory disorders of the gastrointestinal tract with variable disease courses and complications, which in some cases can result in significant morbidities and disabilities. Etiologies remain unclear due to complex interactions between genetic and environmental factors. Considering the heterogeneity of inflammatory bowel diseases, personalized approaches in diagnosing and managing affected patients would be beneficial in maximizing treatment efficacies and minimizing adverse events. Personalized medicine may also help to stratify patients with a high risk of progression and inflammatory bowel disease-related complications and identify sub-phenotypic mechanisms to facilitate drug discovery and the development of new treatments. In Asia, with a rapidly increasing incidence and prevalence of inflammatory bowel diseases, studies have shown that patients of Asian ethnicity differ from their Western counterparts in terms of genetic and clinical aspects of inflammatory bowel diseases. Therefore, personalized medicine may differ for patients of Asian ethnicity with inflammatory bowel diseases. We reviewed and summarized current evidence concerning personalized medicine for the diagnosis and management of patients with inflammatory bowel diseases and its possible role from an Asian perspective.
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Affiliation(s)
- Su Hyun Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Chatterjee K, Dutta AK, Goel A, Aaron R, Balakrishnan V, Thomas A, John A, Jaleel R, David D, Kurien RT, Chowdhury SD, Simon EG, Joseph AJ, Premkumar P, Pulimood AB. Common polymorphisms of protein tyrosine phosphate non-receptor type 2 gene are not associated with risk of Crohn’s disease in Indian. World J Gastrointest Pathophysiol 2022; 13:114-123. [PMID: 36161231 PMCID: PMC9350595 DOI: 10.4291/wjgp.v13.i4.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple genetic risk factors for Crohn’s disease (CD) have been identified. However, these observations are not consistent across different populations. The protein tyrosine phosphate non-receptor type 2 (PTPN2) gene plays a role in various aspects of host defense including epithelial barrier function, autophagy, and innate and adaptive immune response. Two common polymorphisms in the PTPN2 gene (rs2542151 and rs7234029) have been associated with risk of CD in Western countries.
AIM To evaluate the association of PTPN2 gene polymorphisms with risk of CD in Indian population.
METHODS We conducted a prospective case-control study. Patients with CD were recruited, and their clinical and investigation details were noted. Controls were patients without organic gastrointestinal disease or other comorbid illnesses. Two common polymorphisms in the PTPN2 gene (rs2542151 and rs7234029) were assessed. DNA was extracted from peripheral blood samples of cases and controls and target DNA was amplified using specific sets of primers. The amplified fragments were digested with restriction enzymes and the presence of polymorphism was detected by restriction fragment length polymorphism. The frequency of alleles was determined. The frequencies of genotypes and alleles were compared between cases and controls to look for significant differences.
RESULTS A total of 108 patients with CD (mean age 37.5 ± 12.7 years, females 42.6%) and 100 controls (mean age 39.9 ± 13.5 years, females 37%) were recruited. For the single nucleotide polymorphism (SNP) rs7234029, the overall frequency of G variant genotype (AG or GG) was noted to be significantly lower in the cases compared to controls (35.2% vs 50%, P = 0.05). For the SNP rs2542151, the overall frequency of G variant genotype (GT or GG) was noted to be similar in cases compared to controls (43.6% vs 47%, P = 0.73). There were no significant differences in minor allele (G) frequency for both polymorphisms between the cases and controls. Both the SNPs had no significant association with age of onset of illness, gender, disease location, disease behaviour, perianal disease, or extraintestinal manifestations of CD.
CONCLUSION Unlike observation form the West, polymorphisms in the PTPN2 gene (rs7234029 and rs2542151) are not associated with an increased risk of developing CD in Indian patients.
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Affiliation(s)
- Kaushik Chatterjee
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Amit Kumar Dutta
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Ashish Goel
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Rekha Aaron
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Vijayalekshmi Balakrishnan
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Ajith Thomas
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Anoop John
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Rajeeb Jaleel
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Deepu David
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - SD Chowdhury
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - AJ Joseph
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Prasanna Premkumar
- Departments of Biostatistics, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Anna B Pulimood
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
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Oli AK, Maidur RN, Hurkadli PS, Javalgi AP, Javaregowda PK, Goni M. INCIDENCE OF INFLAMMATORY BOWEL DISEASE: A SINGLE CENTRE RETROSPECTIVE STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:345-351. [PMID: 36102430 DOI: 10.1590/s0004-2803.202203000-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract. The etiology of this alarming condition is multifactorial. A Recently increasing trend in IBD is noted in our country. OBJECTIVE The present study was designed with the main objective to assess the incidence and to identify the associated risk factors including demographic, geographical areas, and dietary patterns of IBD population of Northern of Karnataka viz. Hubli-Dharwad city. METHODS A retrospective investigation was conducted on a cohort of 226 patients with a working diagnosis of IBD and those who were admitted between 2015 to 2019 the department of gastroenterology, SDMCMS&H. The diagnosis of IBD was made based on clinical, radiological, endoscopic, and histopathologic findings. The patients were categorized into IBD and those who have symptoms suggestive of IBD but did not fit into the diagnostic criteria into, non-IBD groups. The data about of on demography, diet patterns, and laboratory parameters were recorded. RESULTS Among 226 patients enrolled in this study 2015-2019, IBD was confirmed in 54 Ulcerative colitis - 44 (19.46%), Crohn's disease - 10 (4.42%) patients with varying distribution of disease among different age groups and both genders, Ulcerative colitis (UC) [M: F: 28 (63.6%): 16 (36.4%)] and Crohn's disease (CD) [M: F: 07 (70.0%):03 (30.0%)]. Dietary pattern and other habitats had no significant contribution to illness and its symptoms. Urban (U) and Rural (R) divide was UC [U: R: 32 (72.7%): 12 (27.3%)], CD [U:R:07(70.0%):03(30.0%)] maintained. CONCLUSION Incidence of IBD was high with UC as compared to CD. The incidence of IBD among patients presenting with symptoms suggestive of IBD is 19.46% with UC being major as compared to CD (4.42%). Male predominant patterns of IBD incidences were noted. Year by year increasing trend in disease burden was observed. The Dietary pattern has no direct correlation with IBD disease prevalence and incidences.
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Affiliation(s)
- Ajay Kumar Oli
- Shri Dharmasthala Manjunatheshwara University, SDM Research Institute for Biomedical Sciences, Department of Biomedical science, Karnataka, India
| | - Rohit N Maidur
- Shri Dharmasthala Manjunatheshwara University, SDM College of Medical Sciences and Hospital, Department of Gastroenterology and Heptaology, Dharwad, India
| | - Preetham S Hurkadli
- Shri Dharmasthala Manjunatheshwara University, SDM College of Medical Sciences and Hospital, Department of Gastroenterology and Heptaology, Dharwad, India
| | - Anita P Javalgi
- Shri Dharmasthala Manjunatheshwara University, SDM College of Medical Sciences and Hospital, Department of Pathology, Dharwad, India
| | - Palaksha Kanive Javaregowda
- Shri Dharmasthala Manjunatheshwara University, SDM Research Institute for Biomedical Sciences, Department of Biomedical science, Karnataka, India
| | - Mallikarjun Goni
- Shri Dharmasthala Manjunatheshwara University, SDM Research Institute for Biomedical Sciences, Department of Biomedical science, Karnataka, India
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Phenotyping of Fecal Microbiota of Winnie, a Rodent Model of Spontaneous Chronic Colitis, Reveals Specific Metabolic, Genotoxic, and Pro-inflammatory Properties. Inflammation 2022; 45:2477-2497. [PMID: 35732858 DOI: 10.1007/s10753-022-01706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
Winnie, a mouse carrying a missense mutation in the MUC2 mucin gene, is a valuable model for inflammatory bowel disease (IBD) with signs and symptoms that have multiple similarities with those observed in patients with ulcerative colitis. MUC2 mucin is present in Winnie, but is not firmly compacted in a tight inner layer. Indeed, these mice develop chronic intestinal inflammation due to the primary epithelial defect with signs of mucosal damage, including thickening of muscle and mucosal layers, goblet cell loss, increased intestinal permeability, enhanced susceptibility to luminal inflammation-inducing toxins, and alteration of innervation in the distal colon. In this study, we show that the intestinal environment of the Winnie mouse, genetically determined by MUC2 mutation, selects an intestinal microbial community characterized by specific pro-inflammatory, genotoxic, and metabolic features that could imply a direct involvement in the pathogenesis of chronic intestinal inflammation. We report results obtained by using a variety of in vitro approaches for fecal microbiota functional characterization. These approaches include Caco-2 cell cultures and Caco-2/THP-1 cell co-culture models for evaluation of geno-cytotoxic and pro-inflammatory properties using a panel of 43 marker RNAs assayed by RT-qPCR, and cell-based phenotypic testing for metabolic profiling of the intestinal microbial communities by Biolog EcoPlates. While adding a further step towards understanding the etiopathogenetic mechanisms underlying IBD, the results of this study provide a reliable method for phenotyping gut microbial communities, which can complement their structural characterization by providing novel functional information.
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Banerjee R, Pal P, Hilmi I, Ghoshal UC, Desai DC, Rahman MM, Dutta U, Mohiuddin SA, Al Mohannadi M, Philip M, Ramesh GN, Niriella MA, De Silva AP, de Silva HJ, Pisespongsa P, Limsrivilai J, Aniwan S, Nawarathne M, Fernandopulle N, Aye TT, Ni N, Al Awadhi S, Joshi N, Ngoc PTV, Kieu TV, Nguyen AD, Abdullah M, Ali E, Zeid A, Sollano JD, Saberi B, Omar M, Mohsin MN, Aftab H, Wai TM, Shastri YM, Chaudhuri S, Ahmed F, Bhatia SJ, Travis SPL. Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South-East Asia, and Middle East: Preliminary findings from the Inflammatory Bowel Disease-Emerging Nations' Consortium. J Gastroenterol Hepatol 2022; 37:1004-1015. [PMID: 35178742 DOI: 10.1111/jgh.15801] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South-East Asia, and the Middle East, yet epidemiological data are scarce. METHODS We performed a cross-sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South-East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita. RESULTS Among 10 400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly-onset IBD (5% age > 60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; interquartile range 5-30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year. CONCLUSIONS The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI.
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Affiliation(s)
- Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ida Hilmi
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Devendra C Desai
- Department of Gastroenterology, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Syed A Mohiuddin
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Munnera Al Mohannadi
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mathew Philip
- Lisie Institute of Gastroenterology, Lisie Hospital, Kochi, India
| | | | - Madunil A Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Arjuna P De Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | | | | | - Julajak Limsrivilai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Than Than Aye
- Department of Gastroenterology, Thingangyun General Hospital, University of Medicine 2, Yangon, Myanmar
| | - Nwe Ni
- Department of Gastroenterology, Mandalay General Hospital and University of Medicine, Mandalay, Myanmar
| | - Sameer Al Awadhi
- Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
| | | | | | | | | | - Murdani Abdullah
- Department of Internal Medicine, Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Ezzat Ali
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Ahmed Zeid
- Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | | | | | - Mostafa Noor Mohsin
- Department of Gastroenterology, Chittagong Medical College, Chittagong, Bangladesh
| | - Hafeza Aftab
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Tin Moe Wai
- Department of Gastroenterology, Yangon General Hospital, University of Medicine (1), Yangon, Myanmar
| | - Yogesh M Shastri
- Department of Gastroenterology, NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
| | | | - Faruque Ahmed
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | | | - Simon P L Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
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Kedia S, Ahuja V. Does the road to primary prevention of inflammatory bowel disease start from childhood? JGH Open 2022; 6:365-368. [PMID: 35774343 PMCID: PMC9218530 DOI: 10.1002/jgh3.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Saurabh Kedia
- Department of GastroenterologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Vineet Ahuja
- Department of GastroenterologyAll India Institute of Medical SciencesNew DelhiIndia
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Guo Y, He X, Zhao RM, Yang HZ, Huang Z, Zhang J, Yu XQ. Zn-dipicolylamine-based reactive oxygen species-responsive lipids for siRNA delivery and in vivo colitis treatment. Acta Biomater 2022; 147:287-298. [PMID: 35489607 DOI: 10.1016/j.actbio.2022.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 12/22/2022]
Abstract
The reduction of ROS and inflammatory factor levels plays important role in the treatment of colitis. A series of ROS-responsive lipids (ZnDPA-R) based on the thioketal structure were designed and synthesized. It was hoped that the lipidic materials could combine ROS consumption and siRNA delivery capacity to achieve synergistic treatment of colitis. The target liposomes could combine with the phosphate backbone of siRNA to form lipoplexes with the size of ∼100 nm, and could deliver siRNA cargo into the cell. The results of in vitro anti-inflammatory experiments showed that the lipids may effectively consume ROS in cells. Meanwhile, the lipoplexes significantly reduced the expression levels of TNF-α mRNA and related inflammatory factors in macrophages. After PEGylation, the lipoplex was used for the treatment of mouse colitis, and biodistribution results proved that the lipoplexes effectively aggregated in the intestine. The delivery system could not only response to the high ROS level at colitis via thioketal breaking, but also could assist in the treatment of inflammation by ROS consumption. The treatment results revealed that the levels of TNF-α mRNA and related inflammatory factors at the colon lesion were largely reduced, and the inflammatory symptoms were significantly relieved. Hematology test results indicated that the treatment was safe and induced no obvious side effects on mice. This study may shed light on the synergistic treatment for colitis via anti-inflammatory siRNA delivery and ROS depletion strategies. STATEMENT OF SIGNIFICANCE: Downregulation of inflammatory factors and reactive oxygen species (ROS) levels is critical in treating colitis. In the present study, a series of ROS-responsive lipid molecules based on the Zn-DPA headgroup and thioketal linkage were synthesized for delivering TNF-α siRNA and for treating colitis. In addition to silencing the expression of TNF-α mRNA and the related inflammatory factors, the material also achieved synergistic treatment by simultaneous consumption of ROS in the colon lesion. In vitro cell experiments and in vivo colitis treatment in mice showed that the lipoplex exerted a satisfactory therapeutic effect on colitis, and the symptoms of colitis in mice were significantly alleviated. The present study may shed light on the synergistic treatment for colitis through anti-inflammatory siRNA delivery and ROS depletion strategies.
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Advances in the colon-targeted chitosan based drug delivery systems for the treatment of inflammatory bowel disease. Carbohydr Polym 2022; 288:119351. [DOI: 10.1016/j.carbpol.2022.119351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
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A decade of inflammatory bowel disease: a single center experience in Egypt. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract and includes ulcerative colitis and Crohn’s disease. Inflammatory bowel disease has always seemed to be rare in the Middle East and Northern Africa. In this study, we explored the clinical characteristics of inflammatory bowel disease patients in our center.
Methods
This retrospective study was conducted on patients with an established diagnosis of inflammatory bowel disease over 10 years from September 2009 to September 2019 who were referred to our inflammatory bowel disease center. Clinical information was obtained from medical records and patient interviews. We included all patients in whom the diagnosis of ulcerative colitis or Crohn’s disease was confirmed by clinical, laboratory, endoscopic, and histological examination over a 10-year period from 2009 to 2019.
Results
Our study had one hundred and sixty-nine inflammatory bowel disease patients; one hundred and thirty-six ulcerative colitis patients and the remaining thirty-three patients had Crohn’s disease. The main presenting symptom was bloody diarrhea (78 patients) representing 46.2% of the patients in our study. The majority of ulcerative colitis patients (55.9%) had moderate disease (Truelove & Witts score), while the majority of Crohn’s disease patients (66.7%) had moderate to severe disease (Crohn’s Disease Activity Index).
Conclusions
The prevalence of inflammatory bowel disease is still low in Egypt despite the rising curve of newly diagnosed cases.
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50
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Gutiérrez A, Zapater P, Ricart E, González-Vivó M, Gordillo J, Olivares D, Vera I, Mañosa M, Gisbert JP, Aguas M, Sánchez-Rodríguez E, Bosca-Watts M, Laredo V, Camps B, Marín-Jiménez I, Zabana Y, Martín-Arranz MD, Muñoz R, Navarro M, Sierra E, Madero L, Vela M, Pérez-Calle JL, Sainz E, Calvet X, Arias L, Morales V, Bermejo F, Fernández-Salazar L, Van Domselaar M, De Castro L, Rodríguez C, Muñoz-Villafranca C, Lorente R, Rivero M, Iglesias E, Herreros B, Busquets D, Riera J, Martínez-Montiel MP, Roldón M, Roncero O, Hinojosa E, Sierra M, Barrio J, De Francisco R, Huguet J, Merino O, Carpio D, Ginard D, Muñoz F, Piqueras M, Almela P, Argüelles-Arias F, Alcaín G, Bujanda L, Manceñido N, Lucendo AJ, Varela P, Rodríguez-Lago I, Ramos L, Sempere L, Sesé E, Barreiro-de Acosta M, Domènech E, Francés R. Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients. Front Med (Lausanne) 2022; 9:823900. [PMID: 35178413 PMCID: PMC8844561 DOI: 10.3389/fmed.2022.823900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Previous studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. Methods Prospective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. Results We included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 ± 12 vs. 54 ± 16 years, p < 0.001), had been diagnosed younger (31 ± 12 vs. 36 ± 15 years, p < 0.001), and had a shorter disease duration (14 ± 7 vs. 18 ± 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92–2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0–1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. Conclusions Compared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe.
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Affiliation(s)
- Ana Gutiérrez
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain.,IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Zapater
- IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Farmacología Clínica, Hospital General Universitario Alicante, Alicante, Spain.,Instituto IDIBE, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Medicina Digestiva Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María González-Vivó
- Servicio Medicina Digestiva, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Gordillo
- Servicio Patología Digestiva, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - David Olivares
- Servicio Medicina Digestiva, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Isabel Vera
- Servicio Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Aparato Digestivo, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Mariam Aguas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitario La Fé, Valencia, Spain
| | | | - Maia Bosca-Watts
- Servicio Medicina Digestiva, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Viviana Laredo
- Servicio Medicina Digestiva, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Blau Camps
- Servicio Medicina Digestiva, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Ignacio Marín-Jiménez
- Servicio Medicina Digestiva, Hospital Gregorio Marañón, Madrid, Spain.,Gastroenterology Department, Instituto de Investigación Biomédica Gregorio Marañón IiSGM, Madrid, Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Roser Muñoz
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain
| | - Mercè Navarro
- Servicio Medicina Digestiva, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Eva Sierra
- Servicio Medicina Digestiva, Hospital Universitario Miguel Servert, Zaragoza, Spain
| | - Lucía Madero
- Servicio Medicina Digestiva, Hospital General Universitario de Elche, Elche, Spain
| | - Milagros Vela
- Servicio Medicina Digestiva, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Empar Sainz
- Servicio Medicina Digestiva, Hospital Sant Joan de Déu - Althaia, Manresa, Spain
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Unitat Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Tauli, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Lara Arias
- Servicio Medicina Digestiva, Hospital Universitario de Burgos, Burgos, Spain
| | - Victor Morales
- Servicio Medicina Digestiva, Hospital General de Granollers, Barcelona, Spain
| | - Fernando Bermejo
- Servicio Medicina Digestiva, Hospital de Fuenlabrada, Fuenlabrada, Spain.,IIS Hospital La Paz IdiPaz-Madrid, Madrid, Spain
| | | | | | - Luisa De Castro
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo- SERGAS. IIS Galicia Sur. SERGAS-UVIG, Vigo, Spain
| | - Cristina Rodríguez
- Servicio Medicina Digestiva, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Rufo Lorente
- Servicio Medicina Digestiva, Hospital General Ciudad Real, Ciudad Real, Spain
| | - Montserrat Rivero
- Servicio Medicina Digestiva, Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Eva Iglesias
- Servicio Medicina Digestiva, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Belén Herreros
- Servicio Medicina Digestiva, Hospital Marina Baixa, Villajoyosa, Spain
| | - David Busquets
- Servicio Medicina Digestiva, Hospital de Girona Dr. Trueta/ICO, Girona, Spain
| | - Joan Riera
- Servicio Medicina Digestiva, Hospital Universitario Son LLàtzer, Palma de Mallorca, Spain
| | | | - Marta Roldón
- Servicio Cirugía General y del Aparato Digestivo, Hospital San Jorge, Huesca, Spain
| | - Oscar Roncero
- Servicio Medicina Digestiva, Hospital General La Mancha Centro, Ciudad Real, Spain
| | - Esther Hinojosa
- Servicio Medicina Digestiva, Hospital de Manises, Valencia, Spain
| | - Mónica Sierra
- Servicio Medicina Digestiva, Complejo Asistencial Universitario de León, León, Spain
| | - Jesús Barrio
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - José Huguet
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Olga Merino
- Servicio Medicina Digestiva, Hospital de Cruces, Bilbao, Spain
| | - Daniel Carpio
- Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Daniel Ginard
- Servicio Medicina Digestiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Fernando Muñoz
- Servicio Medicina Digestiva, Hospital Clínico Universitario Salamanca, Salamanca, Spain
| | - Marta Piqueras
- Servicio Medicina Digestiva, Consorci Sanitari Terrasa, Barcelona, Spain
| | - Pedro Almela
- Servicio Medicina Digestiva, Hospital General Universitario Castellón, Castellón de la Plana, Spain
| | | | - Guillermo Alcaín
- Servicio Medicina Digestiva, Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitario Donostia, San Sebastián, Spain.,Instituto Biodonostia, Universidad Pais Vasco, San Sebastián, Spain
| | - Noemí Manceñido
- Servicio Medicina Digestiva, Hospital Infanta Sofía, Madrid, Spain
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital General Tomelloso, Ciudad Real, Spain
| | - Pilar Varela
- Servicio Medicina Digestiva, Hospital Cabueñes, Gijón, Spain
| | - Iago Rodríguez-Lago
- Servicio de Aparato Digestivo, Hospital Universitario de Galdakao, IIS Biocruces, Galdakao, Spain.,Facultad de Medicina, University of Deusto, Bilbao, Spain
| | - Laura Ramos
- Servicio Medicina Digestiva, Hospital Universitario La Laguna, Santa Cruz Tenerife, Spain
| | - Laura Sempere
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain.,IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain
| | - Eva Sesé
- Servicio Medicina Digestiva, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Aparato Digestivo, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Rubén Francés
- IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Hepatic and Intestinal Immunobiology Group, Dpto. Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Spain.,Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universidad Miguel Hernández, Elche, Spain
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