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IBD
High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India
Ashish Agarwal, Saurabh Kedia, Saransh Jain, Vipin Gupta, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Venigalla Pratap Mouli, Rajan Dhingra, Govind Makharia, Vineet Ahuja
Intest Res 2018;16(4):588-598.   Published online October 10, 2018
DOI: https://doi.org/10.5217/ir.2018.00023
AbstractAbstract 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.

Citations

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    Future Pharmacology.2024; 4(1): 279.     CrossRef
  • RATE OF INFECTION (TUBERCULOSIS) IN BRAZILIANS IBD PRIVATE PATIENTS: FOLLOW-UP 15 YEARS
    Didia B CURY, Liana C B CURY, Ana C MICHELETTI, Rogério A OLIVEIRA, José J S GONÇALVES
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    Thomas Theo Brehm, Maja Reimann, Niklas Köhler, Christoph Lange
    Clinical Microbiology and Infection.2024; 30(8): 989.     CrossRef
  • “Mitigating tuberculosis reactivation risk in IBD patients on anti-TNF therapy”
    Peeyush Kumar, Saurabh Kedia, Vineet Ahuja
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  • Association of Tumor Necrosis Factor α Inhibitor Use with Diagnostic Features and Mortality of Tuberculosis in the United States, 2010–2017
    Shereen S Katrak, Rongxia Li, Sue Reynolds, Suzanne M Marks, Jessica R Probst, Terence Chorba, Kevin Winthrop, Kenneth G Castro, Neela D Goswami
    Open Forum Infectious Diseases.2022;[Epub]     CrossRef
  • Stringent screening strategy significantly reduces reactivation rates of tuberculosis in patients with inflammatory bowel disease on anti‐TNF therapy in tuberculosis endemic region
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    Peeyush Kumar, Sudheer Kumar Vuyyuru, Saurabh Kedia, Vineet Ahuja
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    Expert Review of Gastroenterology & Hepatology.2021; 15(3): 275.     CrossRef
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    Adam Krusiński, Anna Grzywa-Celińska, Katarzyna Szewczyk, Luiza Grzycka-Kowalczyk, Justyna Emeryk-Maksymiuk, Janusz Milanowski, Andrew S. Day
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  • Long-term outcomes in perianal fistulizing Crohn’s disease in a resource-limited setting: A cohort analysis
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  • Higher risk of tuberculosis in combination therapy for inflammatory bowel disease
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  • Multidrug-resistant Disseminated Tuberculosis Related to Infliximab in a Patient with Ulcerative Colitis and Negative Evaluation for Latent Tuberculosis
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IBD
Are Truelove and Witts criteria for diagnosing acute severe colitis relevant for the Indian population? A prospective study
Saransh Jain, Saurabh Kedia, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Peush Sahni, Sujoy Pal, Nihar Ranjan Dash, Govind Makharia, Simon P. L. Travis, Vineet Ahuja
Intest Res 2018;16(1):69-74.   Published online January 18, 2018
DOI: https://doi.org/10.5217/ir.2018.16.1.69
AbstractAbstract PDFPubReaderePub
<b>Background/Aims</b><br/>

Truelove and Witts criteria have been used to define acute severe colitis since the 1950s. However, hemoglobin (an additional criterion of the definition) levels in the general population in developing countries are lower than in the population of developed countries. We aimed to determine the relevance of Truelove and Witts criteria in the Indian population.

Methods

Consecutive patients with acute severe colitis satisfying the Truelove and Witts criteria, hospitalized at a single center between April 2015 and December 2016 were included. All patients received intravenous corticosteroids and 16 required colectomy. The hemoglobin levels at admission were subsequently excluded from the classification criteria, and the effect this had on the criteria for diagnosis was determined.

Results

Out of 61 patients of acute severe colitis diagnosed according to the original Truelove and Witts criteria, 12 patients (20%) had 1 additional criterion, 33 (54%) had 2 additional criteria and 16 (26%) had 3 or more additional criteria in addition to 6 or more blood stained stools on admission. On excluding hemoglobin as an additional criterion from the Truelove and Witts definition, all patients still met the criteria for acute severe colitis.

Conclusions

Truelove and Witts criteria can be used to define acute severe colitis in India, despite lower mean hemoglobin in the native population.

Citations

Citations to this article as recorded by  
  • Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response
    Alex Adams, Vipin Gupta, Waled Mohsen, Thomas P Chapman, Deloshaan Subhaharan, Pradeep Kakkadasam Ramaswamy, Sudheer Kumar, Saurabh Kedia, Colleen GC McGregor, Tim Ambrose, Bruce D George, Rebecca Palmer, Oliver Brain, Alissa Walsh, Vineet Ahuja, Simon P
    Gut.2023; 72(3): 433.     CrossRef
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    Mayank Jain, Jayanthi Venkataraman
    Indian Journal of Medical Research.2021; 153(4): 421.     CrossRef
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    Abdussamed VURAL, Aslı VURAL, Selahattin VURAL, Selim TURFAN, Ahmet Cumhur DÜLGER
    Online Türk Sağlık Bilimleri Dergisi.2020; 5(2): 324.     CrossRef
  • Relationship Between Vitamin D Deficiency and Disease Activity in Patients with Inflammatory Bowel Disease in Ahvaz, Iran


    Esmat Rasouli, Narges Sadeghi, Abazar Parsi, Seyed Jalal Hashemi, Morteza Nayebi, Aliakbar Shayesteh
    Clinical and Experimental Gastroenterology.2020; Volume 13: 419.     CrossRef
  • A current overview of corticosteroid use in active ulcerative colitis
    Marco Salice, Fernando Rizzello, Carlo Calabrese, Lucia Calandrini, Paolo Gionchetti
    Expert Review of Gastroenterology & Hepatology.2019; 13(6): 557.     CrossRef
  • Optimal management of acute severe ulcerative colitis
    Saransh Jain, Vineet Ahuja, Jimmy K Limdi
    Postgraduate Medical Journal.2019; 95(1119): 32.     CrossRef
  • A challenge in diagnosis and management of ulcerative colitis in elderly patient with atypical presentation: A reported case
    Panutchaya Kongon, Vorapatu Tangsirapat, Vittawat Ohmpornuwat, Kannakrit Sumtong, Vichack Chakrapan Na Ayudhya, Kobkool Chakrapan Na Ayudhya, Paiboon Sookpotarom, Paisarn Vejchapipat
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  • 84 Download
  • 6 Web of Science
  • 7 Crossref
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Role of random biopsies in surveillance of dysplasia in ulcerative colitis patients with high risk of colorectal cancer
Sawan Bopanna, Maitreyee Roy, Prasenjit Das, S Dattagupta, V Sreenivas, V Pratap Mouli, Saurabh Kedia, Rajan Dhingra, Rajesh Pradhan, N Suraj Kumar, Dawesh P Yadav, Govind Makharia, Vineet Ahuja
Intest Res 2016;14(3):264-269.   Published online June 27, 2016
DOI: https://doi.org/10.5217/ir.2016.14.3.264
AbstractAbstract PDFPubReaderePub
<b>Background/Aims</b><br/>

Recent data suggest that the incidence of ulcerative colitis (UC) related colorectal cancer (CRC) in India is similar to that of West. The optimum method for surveillance is still a debate. Surveillance with random biopsies has been the standard of care, but is a tedious process. We therefore undertook this study to assess the yield of random biopsy in dysplasia surveillance.

Methods

Between March 2014 and July 2015, patients of UC attending the Inflammatory Bowel Disease clinic at the All India Institute of Medical Sciences with high risk factors for CRC like duration of disease >15 years and pancolitis, family history of CRC, primary sclerosing cholangitis underwent surveillance colonoscopy for dysplasia. Four quadrant random biopsies at 10 cm intervals were taken (33 biopsies). Two pathologists examined specimens for dysplasia, and the yield of dysplasia was calculated.

Results

Twenty-eight patients were included. Twenty-six of these had pancolitis with a duration of disease greater than 15 years, and two patients had associated primary sclerosing cholangis. No patient had a family history of CRC. The mean age at onset of disease was 28.89±8.73 years and the duration of disease was 19.00±8.78 years. Eighteen patients (64.28%) were males. A total of 924 biopsies were taken. None of the biopsies revealed any evidence of dysplasia, and 7/924 (0.7%) were indefinite for dysplasia.

Conclusions

Random biopsy for surveillance in longstanding extensive colitis has a low yield for dysplasia and does not suffice for screening. Newer techniques such as chromoendoscopy-guided biopsies need greater adoption.

Citations

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