Intestinal Research

Original Articles

Inflammatory Bowel Diseases

High mucosal cytomegalovirus DNA helps predict adverse short-term outcome in acute severe ulcerative colitis: 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; Intest Res 2021;19(4):438-447. Published online November 6, 2020; DOI: https://doi.org/10.5217/ir.2020.00055

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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.

Citations

Citations to this article as recorded by

Epstein-Barr virus infection is an independent risk factor for surgery in patients with moderate-to-severe ulcerative colitis
Hui Zhang, Xi Gu, Wei He, Shu-Liang Zhao, Zhi-Jun Cao
World Journal of Gastroenterology.2025;[Epub] CrossRef
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

Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease: 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; Intest Res 2021;19(3):291-300. Published online May 26, 2020; DOI: https://doi.org/10.5217/ir.2019.09172

Abstract PDF Supplementary Material PubReader ePub

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.

Citations

Citations to this article as recorded by

Adjunct polymeric exclusive enteral nutrition helps achieve biochemical remission in active Crohn’s disease in adults irrespective of disease location and concomitant corticosteroid use
Hellen Kuo, Katrina Tognolini, Rumbidzai Mutsekwa, Dheeraj Shukla, Laura Willmann, Hadi Moattar, Alexander Dorrington, Naveed Ishaq, Maneesha Bhullar, John Edwards, Waled Mohsen, Pradeep Kakkadasam Ramaswamy
Frontline Gastroenterology.2025; 16(1): 3. CrossRef
Inflammatory bowel disease in south Asia: a scoping review
Shabari Shenoy, Anuraag Jena, Carrie Levinson, Vishal Sharma, Parakkal Deepak, Tina Aswani-Omprakash, Shaji Sebastian, Jean-Frederic Colombel, Manasi Agrawal
The Lancet Gastroenterology & Hepatology.2025; 10(3): 259. CrossRef
Enteral Nutrition in Crohn’s Disease: A Comprehensive Review of Its Role in Induction and Maintenance of Remission and Perioperative Management in Adult Patients
André Bargas, Carolina Palmela, Luisa Glória
Nutrients.2025; 17(9): 1481. CrossRef
Pancreatic Enzyme Replacement Therapy Improves Exclusive Enteral Nutrition Related Diarrhea in Crohn's Disease: A Prospective Randomized Trial
Jian Kang, Jing Wang, Juan Su, Wei Wang, Yueyue Lu, Zhishun Tang, Liping Zou, Anning Yin, Jiao Li, Haixia Ren, Qian Zhou, Huipeng Wan, Ping An
United European Gastroenterology Journal.2025;[Epub] CrossRef
Progress and Clinical Applications of Crohn’s Disease Exclusion Diet in Crohn’s Disease
Duo Xu, Ziheng Peng, Yong Li, Qian Hou, Yu Peng, Xiaowei Liu
Gut and Liver.2024; 18(3): 404. CrossRef
Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (Version 4.1) – living guideline
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,
Zeitschrift für Gastroenterologie.2024; 62(08): 1229. CrossRef
Refractory Crohn’s Disease: Perspectives, Unmet Needs and Innovations
Luisa Bertin, Martina Crepaldi, Miriana Zanconato, Greta Lorenzon, Daria Maniero, Caterina De Barba, Erica Bonazzi, Sonia Facchin, Marco Scarpa, Cesare Ruffolo, Imerio Angriman, Andrea Buda, Fabiana Zingone, Edoardo Vincenzo Savarino, Brigida Barberio
Clinical and Experimental Gastroenterology.2024; Volume 17: 261. CrossRef
Use of oral diet and nutrition support in management of stricturing and fistulizing Crohn's disease
Kush Fansiwala, Neha D. Shah, Kelly A. McNulty, Mary R. Kwaan, Berkeley N. Limketkai
Nutrition in Clinical Practice.2023; 38(6): 1282. CrossRef
Exclusive Enteral Nutrition Orchestrates Immunological Balances as Early as Week 4 in Adult Patients of Crohn’s Disease: A Pilot, Open-Lable Study
Na Diao, Xinyu Liu, Minzhi Lin, Qingfan Yang, Bingyang Li, Jian Tang, Ni Ding, Xiang Gao, Kang Chao
Nutrients.2023; 15(24): 5091. CrossRef
Exclusive enteral nutrition with oral polymeric diet helps in inducing clinical and biochemical remission in adults with active Crohn's disease
Pradeep Kakkadasam Ramaswamy
Journal of Parenteral and Enteral Nutrition.2022; 46(2): 423. CrossRef
Is the frequency of dietitian support associated with greater clinical improvements in adults with Crohn's disease undertaking exclusive enteral nutrition?
Liz Purcell, Rumbidzai Mutsekwa, Rebecca Angus, Dheeraj Shukla, Michelle Palmer
Journal of Human Nutrition and Dietetics.2022; 35(3): 435. CrossRef
Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004
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
Zeitschrift für Gastroenterologie.2022; 60(03): 332. CrossRef
Diet and nutrition in the management of inflammatory bowel disease
Pabitra Sahu, Saurabh Kedia, Vineet Ahuja, Rakesh K. Tandon
Indian Journal of Gastroenterology.2021; 40(3): 253. CrossRef
Review of exclusive enteral therapy in adult Crohn’s disease
Nikola Mitrev, Hin Huang, Barbara Hannah, Viraj Chandana Kariyawasam
BMJ Open Gastroenterology.2021; 8(1): e000745. CrossRef
Current Use of EEN in Pre-Operative Optimisation in Crohn’s Disease
Sharafaath Shariff, Gordon Moran, Caris Grimes, Rachel Margaret Cooney
Nutrients.2021; 13(12): 4389. CrossRef
Exclusive Enteral Nutrition in Adult Crohn’s Disease: an Overview of Clinical Practice and Perceived Barriers
Roberto de Sire, Olga Maria Nardone, Anna Testa, Giulio Calabrese, Anna Caiazzo, Fabiana Castiglione
Clinical and Experimental Gastroenterology.2021; Volume 14: 493. CrossRef
Making Decisions about Dietary Therapy in Inflammatory Bowel Disease
Sydney Solomon, Eunie Park, Joseph A. Picoraro
Gastrointestinal Disorders.2020; 2(4): 353. CrossRef
EEN Yesterday and Today … CDED Today and Tomorrow
Marta Herrador-López, Rafael Martín-Masot, Víctor Manuel Navas-López
Nutrients.2020; 12(12): 3793. 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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

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