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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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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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

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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

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

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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

Citations to this article as recorded by

Risk of tuberculosis with anti-TNF therapy in Indian patients with inflammatory bowel disease despite negative screening
Suprabhat Giri, Sukanya Bhrugumalla, Akash Shukla, Sagar Gangadhar, Srujan Reddy, Sumaswi Angadi, Leela Shinde, Aditya Kale
Arab Journal of Gastroenterology.2025; 26(1): 33. CrossRef
Assessment and management for latent tuberculosis before advanced therapies for immune-mediated inflammatory diseases: A comprehensive review
Daya Krishna Jha, Rinkalben Kakadiya, Ananya Sharma, Shankar Naidu, Dipankar De, Vishal Sharma
Autoimmunity Reviews.2025; 24(3): 103758. CrossRef
Biologics, Small Molecules and More in Inflammatory Bowel Disease: The Present and the Future
Manish Manrai, Atul Abhishek Jha, Saurabh Dawra, Aditya Vikram Pachisia
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
Arquivos de Gastroenterologia.2024;[Epub] CrossRef
(Re-)introduction of TNF antagonists and JAK inhibitors in patients with previous tuberculosis: a systematic review
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
Arab Journal of Gastroenterology.2024; 25(4): 455. CrossRef
Regional risk of tuberculosis and viral hepatitis with tumor necrosis factor-alpha inhibitor treatment: A systematic review
Nina Jahnich, Peter D. Arkwright
Frontiers in Pharmacology.2023;[Epub] CrossRef
Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy
Kyunghwan Oh, Kee Don Choi, Hyeong Ryul Kim, Tae Sun Shim, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park
Clinical Endoscopy.2023; 56(2): 239. CrossRef
CT in the detection of latent tuberculosis: a systematic review
N. Moore, M. Maher, G. Murphy, M. O'Callaghan Maher, O.J. O'Connor, M.F. McEntee
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Shruti Verma, Arshdeep Singh, Chandan Kakkar, Ashish Tripathi, Vandana Midha, Ajit Sood
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Maede Ghanaeipour, Nima Behnaminia, Erfan Khadem, Amirhossein Nafari
The International Journal of Gastroenterology and Hepatology Diseases.2022;[Epub] CrossRef
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
Peeyush Kumar, Sudheer K. Vuyyuru, Bhaskar Kante, Pabitra Sahu, Sandeep Goyal, Deepak Madhu, Saransh Jain, Mukesh Kumar Ranjan, Sandeep Mundhra, Rithvik Golla, Mukesh Singh, Shubi Virmani, Anvita Gupta, Nidhi Yadav, Mani Kalaivani, Raju Sharma, Prasenjit
Alimentary Pharmacology & Therapeutics.2022; 55(11): 1431. CrossRef
Increased Risk of Infection With High Infliximab Trough Level
Suprabhat Giri, Harish Darak
Journal of Clinical Gastroenterology.2022; 56(4): 374. CrossRef
Editorial: choosing the optimal screening method for latent TB in patients with IBD commencing anti‐TNF‐therapy—authors' reply
Peeyush Kumar, Sudheer Kumar Vuyyuru, Saurabh Kedia, Vineet Ahuja
Alimentary Pharmacology & Therapeutics.2022; 55(10): 1348. CrossRef
Positioning of tofacitinib in treatment of ulcerative colitis: a global perspective
Shubhra Mishra, Anuraag Jena, Rinkalben Kakadiya, Vishal Sharma, Vineet Ahuja
Expert Review of Gastroenterology & Hepatology.2022; 16(8): 737. CrossRef
Tumor necrosis factor-alpha antibody labeled-polyethylene glycol-coated nanoparticles: A mesenchymal stem cells-based drug delivery system in the rat model of cisplatin-induced nephrotoxicity
Faten A. M. Abo-Aziza, Saleh M. Albarrak, Abdel-Kader A. Zaki, Shaymaa E. El-Shafey
Veterinary World.2022; : 2475. CrossRef
Efficacy and safety of biosimilar versus originator infliximab in patients with inflammatory bowel disease: A real-world cohort analysis
Peeyush Kumar, Sudheer K. Vuyyuru, Bhaskar Kante, Saurabh Kedia, Pabitra Sahu, Mukesh Kumar Ranjan, Sandeep Mundhra, Rithvik Golla, Mukesh Kumar, Shubi Virmani, Anvita Gupta, Nidhi Yadav, Govind Makharia, Vineet Ahuja
Indian Journal of Gastroenterology.2022; 41(5): 446. CrossRef
Epidemiology, burden of disease, and unmet needs in the treatment of ulcerative colitis in Asia
Shu-Chen Wei, Jose Sollano, Yee Tak Hui, Wei Yu, Paul V. Santos Estrella, Lyndon John Q. Llamado, Nana Koram
Expert Review of Gastroenterology & Hepatology.2021; 15(3): 275. CrossRef
Various Forms of Tuberculosis in Patients with Inflammatory Bowel Diseases Treated with Biological Agents
Adam Krusiński, Anna Grzywa-Celińska, Katarzyna Szewczyk, Luiza Grzycka-Kowalczyk, Justyna Emeryk-Maksymiuk, Janusz Milanowski, Andrew S. Day
International Journal of Inflammation.2021; 2021: 1. CrossRef
Long‐term outcomes of anti‐tumor necrosis factor therapy and surgery in nonperianal fistulizing Crohn's disease
Sudheer K Vuyyuru, Devendra Desai, Saurabh Kedia, Pavan Dhoble, Pabitra Sahu, Bhaskar Kante, Samagra Agarwal, Sawan Bopanna, Rajan Dhingra, Pratap Mouli Venigalla, Raju Sharma, Siddhartha Datta Gupta, Govind Makharia, Peush Sahni, Vineet Ahuja
JGH Open.2021; 5(4): 420. CrossRef
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
Intestinal Research.2021; 19(3): 291. CrossRef
Monitoring frequency of interferon gamma release assay for tuberculosis surveillance following infliximab therapy in patients with Crohn's disease
Qin Yu Yang, Yi Juan Liu, Ye Xu, Lin Zhang, Cheng Dang Wang
Journal of Digestive Diseases.2021; 22(8): 473. CrossRef
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Amir Abdoli, Shahab Falahi, Azra Kenarkoohi
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Efficacy and Safety of Fecal Transplantation Versus Targeted Therapies in Ulcerative Colitis: Network Meta-Analysis
Sudheer K Vuyyuru, Saurabh Kedia, Mani Kalaivani, Pabitra Sahu, Bhaskar Kante, Peeyush Kumar, Mukesh K Ranjan, Govind Makharia, Ashwin Ananthakrishnan, Vineet Ahuja
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Sudha K. Ganesh, Divya Thatikonda
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Sukrit Sud, Sanjeev Sachdeva, Amarender Singh Puri
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Prasanta Debnath, Pravin M. Rathi
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Akshita Gupta, Venigalla Pratap Mouli, Srikant Mohta, Bhaskar Kante, Mani Kalaivani, Deepak Madhu, Pabitra Sahu, Sudheer Kumar, Raju Sharma, Peush Sahni, Prasenjit Das, Siddharth Datta Gupta, Govind Makharia, Saurabh Kedia, Vineet Ahuja
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Long-term outcomes in perianal fistulizing Crohn’s disease in a resource-limited setting: A cohort analysis
Sudheer K. Vuyyuru, Pabitra Sahu, Saurabh Kedia, Bhaskar Kante, Peeyush Kumar, Mukesh Kumar Ranjan, Raju Sharma, Govind Makharia, S. D. Gupta, Peush Sahni, Vineet Ahuja
Indian Journal of Gastroenterology.2020; 39(5): 435. CrossRef
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Rupa Banerjee, Partha Pal, Joyce Wing Yan Mak, Siew C Ng
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Nagesh Kamat, Saurabh Kedia, Uday C. Ghoshal, Abhimanyu Nehra, Govind Makharia, Ajit Sood, Vandana Midha, Varun Gupta, Gourdas Choudhuri, Vineet Ahuja
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The Korean Journal of Gastroenterology.2019; 74(3): 168. 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
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Optimal management of acute severe ulcerative colitis
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Familial aggregation of inflammatory bowel disease in patients with ulcerative colitis: Akshita Gupta, Sawan Bopanna, Saurabh Kedia, Dawesh Prakash Yadav, Sandeep Goyal, Saransh Jain, Govind Makharia, Vineet Ahuja; Intest Res 2017;15(3):388-394. Published online June 12, 2017; DOI: https://doi.org/10.5217/ir.2017.15.3.388

Abstract PDF PubReader ePub

Background/Aims

Familial occurrence of inflammatory bowel disease (IBD) is well documented. Reports from Western countries have shown a higher familial occurrence of ulcerative colitis (UC) in first- and second-degree relatives than that in the Asian UC population. No data are currently available from the Indian subcontinent in this regard. We present our data on the familial aggregation of UC.

Methods

Records of patients with UC followed at the Inflammatory Bowel Disease Clinic at the All India Institute of Medical Sciences, New Delhi from August 2004 to January 2016 were reviewed. Details regarding the prevalence of family history and characteristics of these patients were recorded. Affected family members were contacted and disease characteristics were noted for assessment of familial aggregation.

Results

Of the 2,058 UC patients included in the analysis, a positive family history of IBD was confirmed in 31 patients (1.5%), 24 (77.4%) of whom had only first-degree relatives affected. All the affected relatives had UC and none had Crohn's disease. Among first-degree relatives, siblings were found to have the highest prevalence of IBD (53.3%), followed by parents (26.7%).

Conclusions

The probability of occurrence of IBD in family members of affected North Indian UC patients is lower than that reported in Western populations.

Citations

Citations to this article as recorded by

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