Intestinal Research

Original Articles

IBD/ Endoscopy

Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study: Sameet Tariq Patel, Anuraag Jena, Sanjay Chandnani, Shubham Jain, Pankaj Nawghare, Saurabh Bansal, Harsh Gandhi, Rishikesh Malokar, Jay Chudasama, Prasanta Debnath, Seemily Kahmei, Rima Kamat, Sangeeta Kini, Qais Q Contractor, Pravin M Rathi; Intest Res 2024;22(3):310-318. Published online May 16, 2024; DOI: https://doi.org/10.5217/ir.2023.00174

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Patients of ulcerative colitis (UC) on follow-up are routinely evaluated by sigmoidoscopy. There is no prospective literature to support this practice. We assessed agreement between sigmoidoscopy and colonoscopy prospectively in patients with disease extent beyond the sigmoid colon.
Methods
We conducted a prospective observational study at a tertiary care institute for agreement between sigmoidoscopy and colonoscopy. We assessed endoscopic activity using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histological activity using the Nancy Index (NI), Robarts Histopathology Index (RHI), and Simplified Geboes Score (SGS).
Results
Sigmoidoscopy showed a strong agreement with colonoscopy for MES and UCEIS with a kappa (κ) of 0.96 and 0.94 respectively. The misclassification rate for MES and UCEIS was 3% and 5% respectively. Sigmoidoscopy showed perfect agreement (κ = 1.00) with colonoscopy for assessment of the presence of endoscopic activity in the colon using MES ≥ 1 as activity criteria and strong agreement (κ = 0.93) using MES > 1 as activity criteria. Sigmoidoscopy showed strong agreement with colonoscopy for assessment of the presence of endoscopic activity using UCEIS (κ = 0.92). Strong agreement was observed between sigmoidoscopy and colonoscopy using NI (κ = 0.86), RHI (κ = 1.00), and SGS (κ = 0.92) for the detection of histological activity. The misclassification rate for the detection of histological activity was 2%, 0%, and 1% for NI, RHI, and SGS respectively.
Conclusions
Sigmoidoscopy showed strong agreement with colonoscopy for endoscopic and histologic disease activity. Sigmoidoscopy is adequate for assessment of disease activity in patients with UC during follow-up evaluation.

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Defining management strategies for acute severe ulcerative colitis using predictive models: a simulation-modeling study: Danny Con, Peter De Cruz; Received November 17, 2023 Accepted February 15, 2024 Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00175 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Robust management algorithms are required to reduce the residual risk of colectomy in acute severe ulcerative colitis (ASUC) refractory to standard infliximab salvage therapy. The aim of this study was to evaluate the performance and benefits of alternative ASUC management strategies using simulated prediction models of varying accuracy.
Methods
This was a simulation-based modeling study using a hypothetical cohort of 5,000 steroid-refractory ASUC patients receiving standard infliximab induction. Simulated predictive models were used to risk-stratify patients and escalate treatment in patients at high risk of failing standard infliximab induction. The main outcome of interest was colectomy by 3 months.
Results
The 3-month colectomy rate in the base scenario where all 5,000 patients received standard infliximab induction was 23%. The best-performing management strategy assigned high-risk patients to sequential Janus kinase inhibitor inhibition and mediumrisk patients to accelerated infliximab induction. Using a 90% area under the curve (AUC) prediction model and optimistic treatment efficacy assumptions, this strategy reduced the 3-month colectomy rate to 8% (65% residual risk reduction). Using an 80% AUC prediction model with only modest treatment efficacy assumptions, the 3-month colectomy rate was reduced to 15% (35% residual risk reduction). Overall management strategy efficacy was highly dependent on predictive model accuracy and underlying treatment efficacy assumptions.
Conclusions
This is the first study to simulate predictive model-based management strategies in steroid-refractory ASUC and evaluate their effect on short-term colectomy rates. Future studies on predictive model development should incorporate simulation studies to better understand their expected benefit.

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IBD

Sarcopenia is common in ulcerative colitis and correlates with disease activity: Pardhu B Neelam, Rimesh Pal, Pankaj Gupta, Anupam K Singh, Jimil Shah, Harshal S Mandavdhare, Harjeet Singh, Aravind Sekar, Sanjay K Bhadada, Usha Dutta, Vishal Sharma; Intest Res 2024;22(2):162-171. Published online January 22, 2024; DOI: https://doi.org/10.5217/ir.2023.00090

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Association of sarcopenia with disease severity in ulcerative colitis (UC) is not clearly defined. We planned to estimate the prevalence of sarcopenia in patients with UC as per the revised definition and its relation with the disease severity.
Methods
A cross-sectional assessment of sarcopenia in patients with UC was performed. Disease activity was graded according to complete Mayo score. Hand grip strength was assessed with Jamar hand dynamometer, muscle mass using a dual energy X-ray absorptiometry scan, and physical performance with 4-m walk test. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed in presence of sarcopenia.
Results
Of 114 patients (62 males, mean age: 36.49±12.41 years), 32 (28%) were in remission, 46 (40.4%) had mild-moderate activity, and 36 (31.6%) had severe UC. Forty-three patients (37.7%) had probable sarcopenia, 25 (21.9%) had sarcopenia, and 14 (12.2%) had severe sarcopenia. Prevalence of sarcopenia was higher in active disease (2 in remission, 6 in active, and 17 in severe, P<0.001). Of 14 with severe sarcopenia, 13 had severe UC while 1 had moderate UC. On multivariate analysis, lower body mass index and higher Mayo score were associated with sarcopenia. Of 37 patients with acute severe colitis, 16 had sarcopenia. Requirement of second-line therapy was similar between patients with and without sarcopenia. On follow-up (median: 18 months), there was a non-significant higher rate of major adverse events in those with sarcopenia (47.4% vs. 33.8%, P=0.273).
Conclusions
Sarcopenia and severe sarcopenia in UC correlate with the disease activity.

Citations

Citations to this article as recorded by

Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence
Pardhu B Neelam, Alka Sharma, Vishal Sharma
JGH Open.2024;[Epub] CrossRef
Utility of SARC‐F for screening for sarcopenia in ulcerative colitis
Pardhu B. Neelam, Vishal Sharma
Nutrition in Clinical Practice.2024; 39(5): 1270. CrossRef
Response to “Utility of SARC‐F for screening for sarcopenia in ulcerative colitis”
Ilkay Ergenc, Chasan Ismail Basa, Alper Uzum, Sevval Sahin, Haluk Tarık Kani, Rahmi Aslan, Aslı Tufan, Özgür Kasımay, Özlen Atuğ, Yeşim Özen Alahdab
Nutrition in Clinical Practice.2024; 39(5): 1272. CrossRef

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Review

IBD

The practice of fecal microbiota transplantation in inflammatory bowel disease: Umang Arora, Saurabh Kedia, Vineet Ahuja; Intest Res 2024;22(1):44-64. Published online November 21, 2023; DOI: https://doi.org/10.5217/ir.2023.00085

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