- Inflammatory Bowel Diseases
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High mucosal cytomegalovirus DNA helps predict adverse short-term outcome in acute severe ulcerative colitis
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Saransh Jain, Divya Namdeo, Pabitra Sahu, Saurabh Kedia, Peush Sahni, Prasenjit Das, Raju Sharma, Vipin Gupta, Govind Makharia, Lalit Dar, Simon PL Travis, Vineet Ahuja
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Intest Res 2021;19(4):438-447. Published online November 6, 2020
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DOI: https://doi.org/10.5217/ir.2020.00055
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 Abstract
 PDF Supplementary Material PubReader ePub
- Background/Aims
Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC.
Methods
Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ index (ulcerative colitis index of severity > 6 at day 1+fecal calprotectin > 1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome.
Results
Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0–2,700,000] vs. 116 copies/mg [0–27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load > 2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6–39.7; P< 0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4–364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC.
Conclusions
High mucosal CMV DNA ( > 2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC.
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Citations
Citations to this article as recorded by  - Systematic Review: Outcome Prediction in Acute Severe Ulcerative Colitis
Julia Angkeow, Alissa Rothman, Lara Chaaban, Nicole Paul, Joanna Melia
Gastro Hep Advances.2024; 3(2): 260. CrossRef - Predictors of adverse outcomes of steroids in patients with severe ulcerative colitis (systematic review and meta-analyses)
A. F. Mingazov, O. I. Sushkov, B. R. Kalanov, T. A. Baranova, S. I. Achkasov
Koloproktologia.2024; 23(1): 172. CrossRef - Predicting Outcome after Acute Severe Ulcerative Colitis: A Contemporary Review and Areas for Future Research
Sudheer Kumar Vuyyuru, Olga Maria Nardone, Vipul Jairath
Journal of Clinical Medicine.2024; 13(15): 4509. CrossRef - Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India
Sandeep Mundhra, David Thomas, Saransh Jain, Pabitra Sahu, Sudheer Vuyyuru, Peeyush Kumar, Bhaskar Kante, Rajesh Panwar, Peush Sahni, Rama Chaudhry, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
Indian Journal of Gastroenterology.2023; 42(3): 411. CrossRef - The role of cytomegalovirus colitis on short- and long-term outcomes for patients with ulcerative colitis
Mengmeng Zhang, Xiaoyin Bai, Huimin Zhang, Yan You, Hong Lv, Yue Li, Bei Tan, Ji Li, Hui Xu, Weiyang Zheng, Hong Yang, Jiaming Qian
Scandinavian Journal of Gastroenterology.2022; 57(3): 282. CrossRef - Cytomegalovirus in ulcerative colitis: an evidence-based approach to diagnosis and treatment
Anuraag Jena, Shubhra Mishra, Anupam Kumar Singh, Aravind Sekar, Vishal Sharma
Expert Review of Gastroenterology & Hepatology.2022; 16(2): 109. CrossRef - Prospective validation of AIIMS index as a predictor of steroid failure in patients with acute severe ulcerative colitis
Pabitra Sahu, Saransh Jain, Saurabh Kedia, Sudheer K. Vuyyuru, Peush Sahni, Raju Sharma, Rajesh Panwar, Prasenjit Das, Vipin Gupta, Govind Makharia, Simon Travis, Vineet Ahuja
Indian Journal of Gastroenterology.2022; 41(3): 273. CrossRef - Cytomegalovirus Infection in Patients with Inflammatory Bowel Disease
Jun Lee
The Korean Journal of Gastroenterology.2022; 80(2): 60. CrossRef - The Impact of Human Herpesviruses in Clinical Practice of Inflammatory Bowel Disease in the Era of COVID-19
Shuhei Hosomi, Yu Nishida, Yasuhiro Fujiwara
Microorganisms.2021; 9(9): 1870. CrossRef - Does cytomegalovirus load predict the outcome of acute severe ulcerative colitis?
You Sun Kim
Intestinal Research.2021; 19(4): 357. CrossRef
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- Inflammatory Bowel Diseases
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Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
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Sanchit Sharma, Arti Gupta, Saurabh Kedia, Samagra Agarwal, Namrata Singh, Sandeep Goyal, Saransh Jain, Vipin Gupta, Pabitra Sahu, Sudheer Kumar Vuyyuru, Bhaskar Kante, Raju Sharma, Rajesh Panwar, Peush Sahni, Govind Makharia, Vineet Ahuja
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Intest Res 2021;19(3):291-300. Published online May 26, 2020
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DOI: https://doi.org/10.5217/ir.2019.09172
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Abstract
PDFSupplementary MaterialPubReaderePub
- Background/Aims
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.
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Citations
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Duo Xu, Ziheng Peng, Yong Li, Qian Hou, Yu Peng, Xiaowei Liu
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Andreas Sturm, Raja Atreya, Dominik Bettenworth, Bernd Bokemeyer, Axel Dignass, Robert Ehehalt, Christoph-Thomas Germer, P. C. Grunert, Ulf Helwig, Karoline Horisberger, Klaus Herrlinger, Peter Kienle, Torsten Kucharzik, Jost Langhorst, Christian Maaser,
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Liz Purcell, Rumbidzai Mutsekwa, Rebecca Angus, Dheeraj Shukla, Michelle Palmer
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Andreas Sturm, Raja Atreya, Dominik Bettenworth, Bernd Bokemeyer, Axel Dignaß, Robert Ehehalt, Christoph Germer, Philip C. Grunert, Ulf Helwig, Klaus Herrlinger, Peter Kienle, Martin E. Kreis, Torsten Kucharzik, Jost Langhorst, Christian Maaser, Johann Oc
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Pabitra Sahu, Saurabh Kedia, Vineet Ahuja, Rakesh K. Tandon
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Nikola Mitrev, Hin Huang, Barbara Hannah, Viraj Chandana Kariyawasam
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- Miscellaneous
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Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver
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Ashish Agarwal, Alka Singh, Wajiha Mehtab, Vipin Gupta, Ashish Chauhan, Mahendra Singh Rajput, Namrata Singh, Vineet Ahuja, Govind K. Makharia
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Intest Res 2021;19(1):106-114. Published online April 22, 2020
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DOI: https://doi.org/10.5217/ir.2019.00136
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Abstract
PDFPubReaderePub
- Background/Aims
Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease.
Methods
Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan.
Results
In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively.
Conclusions
Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.
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- IBD
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High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India
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Ashish Agarwal, Saurabh Kedia, Saransh Jain, Vipin Gupta, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Venigalla Pratap Mouli, Rajan Dhingra, Govind Makharia, Vineet Ahuja
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Intest Res 2018;16(4):588-598. Published online October 10, 2018
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DOI: https://doi.org/10.5217/ir.2018.00023
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Abstract
PDFPubReaderePub
- Background/Aims
The data on the risk of tuberculosis (TB) reactivation with infliximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on IFX and its predictors in patients with IBD was assessed.
Methods
This retrospective review included consecutive patients with IBD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated).
Results
Of 69 patients (22 ulcerative colitis/47 Crohn’s disease; mean age, 35.6±14.5 years; 50.7% males; median follow-up duration after IFX, 19 months [interquartile range, 5.5–48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LTB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PTB, 12.5%) after a median of 19 weeks (interquartile range, 14.0–84.5 weeks) of IFX. Of these 8 patients’ none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn’s disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation.
Conclusions
There is an extremely high rate of TB with IFX in Indian patients with IBD. Current screening techniques are ineffective and it is difficult to predict TB after IFX.
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Prevalence of hepatitis B, hepatitis C and human immunodeficiency viral infections in patients with inflammatory bowel disease in north India
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Parnita Harsh, Vipin Gupta, Saurabh Kedia, Sawan Bopanna, Sucharita Pilli, Surendernath, Govind Kumar Makharia, Vineet Ahuja
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Intest Res 2017;15(1):97-102. Published online January 31, 2017
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DOI: https://doi.org/10.5217/ir.2017.15.1.97
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Abstract
PDFPubReaderePub
- <b>Background/Aims</b><br/>
Patients with inflammatory bowel disease (IBD) often require immunosuppressive therapy and blood transfusions and therefore are at a high risk of contracting infections due to hepatitis B (HBV) and hepatitis C (HCV) and human immunodeficiency virus (HIV). In the present study, we assessed the prevalence of these infections in patients with IBD. MethodsThis retrospective study included 908 consecutive patients with IBD (ulcerative colitis [UC], n=581; Crohn's disease [CD], n=327) who were receiving care at a tertiary care center. Ninety-five patients with intestinal tuberculosis (ITB) were recruited as disease controls. Prospectively maintained patient databases were reviewed for the prevalence of HBV surface antigen, anti-HCV antibodies, and HIV (enzyme-linked immunosorbent assay method). HCV RNA was examined in patients who tested positive for anti-HCV antibodies. Prevalence data of the study were compared with that of the general Indian population (HBV, 3.7%; HCV, 1%; HIV, 0.3%). ResultsThe prevalence of HBV, HCV, and HIV was 2.4%, 1.4%, and 0.1%, respectively, in the 908 patients with IBD. Among the 581 patients with UC, 2.2% (12/541) had HBV, 1.7% (9/517) had HCV, and 0.2% (1/499) had HIV. Among the 327 patients with CD, 2.8% (8/288) had HBV, 0.7% (2/273) had HCV, and 0% (0/277) had HIV. One patient with CD had HBV and HCV coinfection. The prevalence of HBV, HCV, and HIV in patients with ITB was 5.9% (4/67), 1.8% (1/57), and 1.2% (1/84), respectively. ConclusionsThe prevalence of HBV, HCV, and HIV in north Indian patients with IBD is similar to the prevalence of these viruses in the general community. Nonetheless, the high risk of flare after immunosuppressive therapy mandates routine screening of patients with IBD for viral markers.
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