Intestinal Research

Original Articles

IBD

Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring: Peeyush Kumar, Sudheer K. Vuyyuru, Prasenjit Das, Bhaskar Kante, Mukesh Kumar Ranjan, David Mathew Thomas, Sandeep Mundhra, Pabitra Sahu, Pratap Mouli Venigalla, Saransh Jain, Sandeep Goyal, Rithvik Golla, Shubi Virmani, Mukesh K. Singh, Karan Sachdeva, Raju Sharma, Nihar Ranjan Dash, Govind Makharia, Saurabh Kedia, Vineet Ahuja; Intest Res 2023;21(4):460-470. Published online March 17, 2023; DOI: https://doi.org/10.5217/ir.2022.00128

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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.

Citations

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Population Pharmacokinetic Model for the Use of Intravenous or Subcutaneous Infliximab in Patients with Inflammatory Bowel Disease: Real-World Data from a Prospective Cohort Study
Joo Hye Song, Sung Noh Hong, Myeong Gyu Kim, Minjung Kim, Seong Kyung Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim
Gut and Liver.2025; 19(3): 376. CrossRef
Effectiveness of Switching to Subcutaneous Infliximab in Ulcerative Colitis Patients Experiencing Intravenous Infliximab Failure
June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sung Wook Hwang
Gut and Liver.2024; 18(4): 667. CrossRef
Tofacitinib in Steroid-Refractory Acute Severe Ulcerative Colitis: A Retrospective Analysis
Sayan Malakar, Srikanth Kothalkar, Umair Shamsul Hoda, Uday C Ghoshal
Cureus.2023;[Epub] CrossRef

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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

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Background/Aims

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
Inflammatory bowel disease
Mayank Jain, Jayanthi Venkataraman
Indian Journal of Medical Research.2021; 153(4): 421. CrossRef
High Serum Osmolality May Predict the Disease Severity in Patients with Acute Ulcerative Colitis
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
International Journal of Surgery Case Reports.2019; 61: 234. CrossRef

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Predictive factors for malignancy in undiagnosed isolated small bowel strictures: Ujjwal Sonika, Sujeet Saha, Saurabh Kedia, Nihar Ranjan Dash, Sujoy Pal, Prasenjit Das, Vineet Ahuja, Peush Sahni; Intest Res 2017;15(4):518-523. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.518

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Background/Aims

Patients with small bowel strictures have varied etiologies, including malignancy. Little data are available on the demographic profiles and etiologies of small bowel strictures in patients who undergo surgery because of intestinal obstruction but do not have a definitive pre-operative diagnosis.

Methods

Retrospective data were analyzed for all patients operated between January 2000 and October 2014 for small bowel strictures without mass lesions and a definite diagnosis after imaging and endoscopic examinations. Demographic parameters, imaging, endoscopic, and histological data were extracted from the medical records. Univariate and multivariate analyses were conducted to identify factors that could differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) and between malignant and benign strictures.

Results

Of the 7,425 reviewed medical records, 89 met the inclusion criteria. The most common site of strictures was the proximal small intestine (41.5%). The most common histological diagnoses in patients with small bowel strictures were ITB (26.9%), CD (23.5%), non-specific strictures (20.2%), malignancy (15.5%), ischemia (10.1%), and other complications (3.4%). Patients with malignant strictures were older than patients with benign etiologies (47.6±15.9 years vs. 37.4±16.4 years, P=0.03) and age >50 years had a specificity for malignant etiology of 80%. Only 7.1% of the patients with malignant strictures had more than 1 stricture and 64% had proximally located strictures. Diarrhea was the only factor that predicted the diagnosis of CD 6.5 (95% confidence interval, 1.10–38.25; P=0.038) compared with the diagnosis of ITB.

Conclusions

Malignancy was the cause of small bowel strictures in approximately 16% patients, especially among older patients with a single stricture in the proximal location. Empirical therapy should be avoided and the threshold for surgical resection is low in these patients.

Citations

Citations to this article as recorded by

Cryptogenic multifocal ulcerous stenosing enteritis: A ray of light on the umbra of the dark continent
Mithu Bhowmick, Vishal Sharma
Indian Journal of Gastroenterology.2024; 43(6): 1082. CrossRef
Ileal endometriosis: a rare cause of multifocal small bowel strictures
Timothy Peacock, William Harrison, Alexandra Limmer, Suzanne Di Sano, King‐Sang Wong
ANZ Journal of Surgery.2022; 92(7-8): 1914. CrossRef
Infectious diseases affecting the small bowel – what not to miss
Martin Keuchel, Marc Bota, Peter Baltes
Current Opinion in Gastroenterology.2021; 37(3): 255. CrossRef
Small bowel ulcers
Martin Keuchel, Niehls Kurniawan, Peter Baltes
Current Opinion in Gastroenterology.2019; 35(3): 213. CrossRef
Rebleeding rate and risk factors in nonsteroidal anti‐inflammatory drug‐induced enteropathy
Junseok Park, Seong Ran Jeon, Jin‐Oh Kim, Hyun Gun Kim, Tae Hee Lee, Jun‐Hyung Cho, Bong Min Ko, Joon Seong Lee, Moon Sung Lee
Journal of Digestive Diseases.2018; 19(5): 279. CrossRef

5,735 View
59 Download
5 Web of Science
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