The following link is the same as the QR code below (from twitter feed) and provides PDF access to ~30 influential articles from the journal, Gastroenterology, this past year (many reviewed on this blog previously):
I’ve included screenshots of many of the articles below.
D Turner, SB Hanauer. Editorial on DINE-CD studyKrugliak et al. In press.
Also, recent data indicate that the omicron strain of SARS-CoV-2 is much less likely to affect sense of smell or taste but more likely to cause a sore throat –from Eric Topol twitter feed:
Using national registries, the authors identified all patients with IBD (>15 years of age) and all cases of urolithiasis in Denmark during 1977-2018. Key findings:
2,549 (3%) of 75,236 IBD patients and 11,258 (2%) of 767,403 non-IBD individuals developed urolithiasis, resulting in a 2-fold increased risk of urolithiasis (HR, 2.27; 95% CI, 2.17-2.38) in patients with IBD
The authors note that a small risk of urolithiasis preceded the diagnosis of IBD: with OR, 1.42; 95% CI: 1.34-1.50 prior to diagnosis
After IBD diagnosis, risk of urolithiasis was associated with anti-TNF therapy and surgery (increased disease severity appears to be associated with increased risk). Anti-TNF therapy had a RR of 2.68 in patients with ulcerative colitis and a RR of 3.56 in patients with Crohn’s disease; for surgery, the RR were 3.14 and 2.74 respectively
One limitation is detection bias as patients with IBD may have more asymptomatic stones identified due to more frequent imaging
My take: This confirms an increased risk of urolithiaiss in patients with IBD and is a good reminder to consider this when patients present with severe abdominal pain/possible flare-up.
Key finding: A post hoc analysis of data from a phase 4 trial (the MOMENTUM trial) found that, even in patients (n=593 at week 8, n=305 at week 52) with complete endoscopic healing of UC, FC concentration can be used to discriminate patients with ongoing microscopic inflammation from patients with histologic remission. The optimal FC cut-off concentrations for identification of patients with histologic remission were 75 μg/g at week 8 and 99 μg/g at week 52.
Key finding: In this prospective study, 57 patients in deep remission stopped azathioprine after a median of 7 years. 26 (46%) relapsed within a median of 15 months. Fecal calprotectin (FC) levels were >50 mcg/g in all patients with relapse (FC specificity 100%) but the sensitivity was only 50%. Thus, having a normal FC does not preclude relapse but elevated FC is associated with relapse.
In this retrospective study, 75 patients, 9.9% of all patients, who had been changed from originator infliximab to a biosimilar had clinical worsening. Key finding: Improvement of reported symptoms was seen in 73.3% of patients after reverse switching back to originator infliximab; alsor 7 out of 9 patients (77.8%) with loss of response regained response
Key finding: Clinical remission rates with vedolizumab among patients with CD (n=80) and patients with UC (n=78) were 44.1% and 44.0%. Among patients with UC, the endoscopic remission rate was 32.4%
Methods: This was a retrospective case-control study based on a national registry. Cases included children diagnosed with both IBD and Celiac Disease (CeD). Two matched IBD controls without CeD, and 2 matched CeD controls were selected for each case.
Key findings:
Forty-nine (1.75%) patients with IBD and CeD were identified out of 2800 patients with IBD. CeD was diagnosed before IBD in 37 (75.5%)
Compared with patients with IBD alone, patients with IBD and CeD presented more frequently with autoimmune diseases (odds ratio, 2.81; 95% CI, 0.97–8.37; P = 0.04) (mainly thyroiditis 6.1% vs 0%)
Children with ulcerative colitis and CeD had an increased risk of colectomy despite similar medical treatments compared with patients with ulcerative colitis alone (13.0% vs 0%); however, this was based on a small number (3 surgeries out of 23 patients)
Anti-TNF biologics (46.2% vs 69.2%) were less commonly administered in patients with Crohn’s disease and CeD than in patients with Crohn’s disease alone
Pubertal delay was more common in patients with IBD and CeD compared with patients with IBD alone (14.9% vs 3.2%; odds artio, 5.24)
The discussion emphasizes the need to consider the risk of developing IBD in children with CeD and to recognize the increased risk of autoimmune diseases. Children with both UC and CeD may have a more severe phenotype. The authors recognize the possibility of misdiagnosis of CeD as patients with IBD could present with similar upper GI findings; however, this is likely infrequent as most cases of CeD preceded the diagnosis of IBD.
My take: One point that the authors neglect is the need to consider an underlying monogenetic disorder (eg. CTLA4B) in children with multiple immune-mediated diseases. The main message for children with this double whammy, though, is to consider the need for more aggressive treatment (especially with UC) and the need to screen for other autoimmune conditions (especially thyroiditis).
In this multicenter, observational, international study conducted between April and July 2020 at six different referral centers, the authors studied two groups:
Children diagnosed with FAPDs between October 2019 and February 2020 were enrolled and prospectively interviewed at 4 months of follow-up during the first pandemic phase (Quarantine group, n=180, mean age 14 yrs)
A cohort of children diagnosed with FAPDs between October 2018 and February 2019 was used as a Control group, n=176, mean age 13 yrs)
Key findings:
At 4 months of follow-up, both groups had a significant reduction of children reporting >5 episodes of abdominal pain per month when compared to baseline. Quarantine group: 63.9% vs 42.2%, P < 0.001; Control group: 83.5% vs 50%, P < 0.001.
Overall, 57% of the Quarantine group and 63.5% of the Control group had improvement of all symptoms.
My take: This study shows that the majority of patients with functional abdominal pain have improvement (at least temporarily) and reinforce the benefit of reassurance/conservative approach for many even during the pandemic. It is possible that school closures and additional parental attention mitigated some of the improvement in the Quarantine group.
In this study, the author’s examine the ordering of serum IgE food allergy tests at a single hospital in 2018. In total 12,345 tests were ordered by 400 physicians.
Key findings:
Allergists ordered 8986 tests, of which only 1.2% were food panels.
Nonallergists ordered 3368 tests, of which 37.5% were food panels.
Food panel ordering had dropped by 55% in absolute numbers since 2013.
In the commentary, it is noted that food serum IgE panels are not recommended “because more individuals will have detectable IgE sensitization than true symptoms” (aka false positives). “There is still a long way to go regarding educating families and nonallergist provideres on approaches to diagnosis of IgE-mediated food allergies.”
My take: This is a constant struggle. Everyday families want allergy testing on the assumption that it will be useful in treating their GI symptoms. Though dietary changes are frequently helpful in patients with GI problems, food allergy panels are likely to lead to more trouble than benefit.
In this prospective cohort of infants (in France) with food protein-induced allergic proctocolitis (FPIAP) (n=76), all infants had rectal bleeding (RB) which resolved with cow’s milk protein (CMP) elimination. After the initial oral food challenge (OFC) which took place 2 to 8 weeks after resolution of rectal bleeding, OFC was repeated every 2 months.
Key findings:
Only 31% failed the initial OFC
The median age of tolerance, for those with a confirmed FPIAP based on OFC, was 6.8 months, with >75% of the cohort tolerant by 10 months of age
My take:
This study shows that the majority of infants with RB probably do not have FPIAP. In those that do have FPIAP, earlier challenge is reasonable in the majority.
FPIAP is generally mild and self-limited. Diagnosis is hampered by lack of validated criteria.
Background:: Cystic fibrosis (CF) screen-positive infants with an inconclusive diagnosis (CFSPID) are infants in whom sweat testing and genetic analysis does not resolve a CF diagnosis
Methods: Prospective, longitudinal, multicenter, Canada-wide cohort study of CFSPID for a mean of 7.7 years
Key findings:
A CF diagnosis was established for 24 of the 115 children with CFSPID (21%) — either because of reinterpretation of the cystic fibrosis transmembrane conductance regulator genotype or because of increase in sweat chloride concentration ≥60 mmol/L. Those with initial sweat chloride concentration ≥40 mmol/L were most likely to receive a diagnosis of cystic fibrosis.
Children with CFSPID were pancreatic sufficient and showed normal growth until school age and had good pulmonary outcomes (similar to healthy controls)
In the associated commentary by P Chakraborty et al (Maximizing Benefits and Minimizing Harms: Diagnostic Uncertainty Arising From Newborn Screening), the authors note that while newborn screening (NBS) offers benefit of early diagnosis, some families can be harmed by false-positive tests or inconclusive results. Furthermore, “these issues of uncertainty are increasingly important to consider as the scope of NBS programs and their use of genomic technologies expands.”
My take: With CF, this study shows the need to monitor those with inconclusive studies. More broadly, the use of genomic testing is leading to more frequent inconclusive results in many areas and sometimes leaving more questions than answers.
I am happy to say that this is the last nightcall that I will have this year!
Today, I’ve compiled some of my favorite posts from the past year. I started this blog a little more than 10 years ago. I am grateful for the encouragement/suggestions from many people to help make this blog better. Also, I want to wish everyone a Happy New Year.
gutsandgrowth 