October 2016: IBD Studies

Briefly noted:

E Zittan et al. Inflamm Bowel Dis 2016; 22: 2442-47.  In this study with 773 patients with history of ulcerative colitis/ileal pouch-anal anastomosis, there was no significant difference in complications/leak among the 196 with preoperative anti-TNF exposure (n=26, 13.2%) compared with the control group (n=66, 11.7%). Preoperative anti-TNF exposure does not appear to worsen outcomes after surgery.

C Hartman et al. JPGN 2016; 63: 437-444. This cross-sectional survey of 68 children with IBD (57 Crohn’s disease) found frequent nutrient deficiencies based on 3 day diet records.  Interestingly, children on exclusive enteral nutrition were much less likely to have inadequate intakes of energy, minerals, or micronutrients. This article provides plenty of reasons for children with IBD, particularly Crohn’s disease, to work with a nutritionist.

M Fischer et al. Inflamm Bowel Dis; 2016; 22: 2402-09. In a cohort study of 67 patients (35 with Crohn’s, 31 with ulcerative colitis, and 1 indeterminate colitis), fecal microbiota transplantation (FMT) for refractory Clostridium difficile infection was successful in 53 (79%) with a single infusion.  Four of the 14 failures, subsequently responded to anti-CDI antibiotics. Of the 8 who had a 2nd FMT, 6 were successful; and 1 of 2 responded to 3rd FMT.  Thus, 60 of 67 responded overall to FMT.  After FMT, IBD disease activity was reported as improved in 25 (37%), no change in 20 (30%) and worse in 9 (13%).  In this cohort, 1 needed colectomy and 1 needed diversion.  This article indicates that FMT for CDI in IBD was associated with high cure rates and low risk of IBD flare.

A Khoruts et al. Clin Gastroenterol Hepatol 2016; 14: 1433-38. This was a study of 272 consecutive patients that underwent FMT for recurrent CDI. 15% had established IBD and 2.6% were determined to have IBD at time of FMT.  74.4% of IBD patients responded to a single FMT compared with 92.1% of patients without IBD.  More than one quarter of IBD patients experienced a clinical flare after FMT.

MA Conrad et al. Inflamm Bowel Dis; 2016: 22: 2425-31.  This review of early pediatric experience with vedolizumab in 21 subjects (16 with Crohn’s disease) identified a clinical response in 6/19 (31.6%) evaluable subjects at week 6 and 11/19 (57.9%) by week 22. Steroid-free remission was noted in 3/20 at 14 weeks (15%) and 4/20 (20.0%) at 22 weeks.  Overall, this shows a fairly low response rate to vedolizumab in this highly selected cohort.  Prospective pediatric studies of vedolizumab are needed to identify which patients are most likely to benefit.

University of Virginia Rotunda

University of Virginia Rotunda


What’s Often Missing in Vegan Diets

From NPR: Can A Vegan Diet Give You All You Need? German Nutritionists Say ‘Nein’

An excerpt:

“With a pure plant-based diet, it is difficult or impossible to attain an adequate supply of some nutrients,” states the German Nutrition Society’s new position on the vegan diet. “The most critical nutrient is B-12,” which is found in eggs and meat. The group says if you follow a vegan diet, you should take supplements to protect against deficiencies.

According to the German nutritionists, other “potentially critical nutrients” that may be a challenge to get in a vegan diet include omega-3s — found in fatty fish — as well as minerals such as calcium, iron, iodine, zinc and selenium. So the group recommends that vegans get advice from a nutrition counselor and be “regularly checked by a physician.” In addition, the society recommends against a vegan diet for pregnant women, women who are breast-feeding, children and adolescents…

“B-12 only comes from animal products,” says Cimperman. “It’s necessary for proper red blood cell formation, as well as normal neurological function.”

Many foods — including some breakfast cereals, as well as some nondairy creamers and milks — are fortified with B-12. So it’s possible to get all the nutrition you need this way, if you eat enough of these fortified foods regularly.

But to make sure you’re covering all your bases, “I would recommend [taking] a standard multivitamin,” Cimperman says. It’s a good insurance policy for vegans.

Pat O'Brien's Patio, New Orleans

Pat O’Brien’s Patio, New Orleans