bluuebunny/crossref_metadata_2025_split huggingface dataset:
VEDOLIZUMAB DOES NOT ALTER IMMUNOGLOBULIN LEVELS IN BREASTMILK OF MOTHERS WITH IBD
Authors: Urrete Josef , Mitra Taniya , Bertrand Kerri , Chambers Christina , Rivera-Nieves Jesus 
Published: January 2024

Abstract
Diarrheal diseases are a major cause of infant mortality worldwide. Breastfeeding helps prevent such diseases by passive transfer of maternal antibodies against gastrointestinal pathogens previously encountered by the mother. The antibody secreting cells (ASC) that populate the lactating mammary gland (LMG) are educated in gastrointestinal lymphoid tissues, thus they express integrin a4b7. To recruit these ASC, the LMG expresses MAdCAM-1 and CCL28. Vedolizumab (vedo) blocks a combinatorial epitope on integrin a4b7, interfering with lymphocyte recruitment to the gut. Given the shared homing determinants between the gut and LMG, we investigated whether vedo might interfere with ASC trafficking to the LMG, therefore decreasing immunoglobulin (Ig) levels in breast milk.
We measured Ig levels by ELISA in cryopreserved breast milk from mothers enrolled in Mommy’s Milk biorepository at the University of California, San Diego without and with Ulcerative Colitis(UC) or Crohn’s Disease(CD) and lactating mothers with UC and CD treated with vedo for more than 18 months. Milk samples were collected between 1 month and 15.45 months after childbirth.
The levels of secretory IgA (SIgA) in breast milk of mothers without IBD (n=45) was not different from those of mothers with CD not on vedo (n=15) (301 ± 147 ug/mL vs. 322 ± 207 ug/mL). However, milk SIgA from mothers with UC not on vedo (n=7) were lower than non-IBD controls (213 ± 149 ug/mL vs. 301 ± 147ug/mL, p&lt;0.01). We then compared milk SIgA from patients with CD and UC treated with vedo (CD: n= 9; 256 ± 80ug/mL, UC: n=10; 283 ± 87 ug/mL) with those from non-IBD controls (n=45; 301 ± 147ug/mL) and found no differences. Similarly, SIgA levels were not different between CD with or without vedo (256 ± 80 ug/mL vs. 322 ± 207 ug/mL) and as compared with non-IBD controls SIgA in patients with UC with vedo were unexpectedly higher than UC without vedo (283 ±87 ug/mL vs 213 ± 149 ug/mL, p&lt;0.05).
The levels of secretory IgM (SIgM) in milk were not different between mothers with UC or CD treated with vedo compared with non-IBD controls (65 ± 34 ug/mL, 69 ± 32 ug/mL, and 56 ± 37 ug/mL, respectively). Similarly, no significant difference was seen between patients with UC or CD not treated with vedo compared with the non-IBD controls (58±26 ug/mL, and 46 ± 24 ug/mL respectively).
We conclude that vedo does not reduce SIgA nor SIgM levels in lactating mothers with IBD. We speculate that the higher SIgA in patients with UC treated with vedo is due to the small sample size. Vedo does not interfere with passive immunity during the lactation period, thus ASC must be able to use another integrin to arrest on microvessels of the LMG during the final stages of pregnancy.
THE PRACTICE AND PERCEPTION OF LOW RESIDUE DIETS IN ADULT PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Wang Jingzhou , Constant Brad , Morrow Ryan , Funk Sarah , Marden Tyson , Scott Frank 
Published: January 2024

Abstract

BACKGROUND
Low residue diets have been traditionally recommended during disease flares or post-operatively in patients with inflammatory bowel disease (IBD) for the purported benefits of reduced pain or lower risk of bowel obstruction. However, these diets may not be healthy if consumed long-term and can adversely impact quality of life. It remains controversial whether such diets are truly beneficial, and the scale of such dietary practice remains unknown.

METHODS
A survey was conducted to better understand the practice and the perception related to low residue diet recommendations among patients with IBD at a large academic medical system in the United States. Adult patients (age ≥18) with an established diagnosis of IBD were identified using ICD-10 codes in the electronic medical record system. The survey contained 23 questions and was disseminated electronically from August 2023 to October 2023.

RESULTS
132 patients (Crohn’s disease: 59, ulcerative colitis: 68, IBD-unclassified: 5) completed the online survey. The median age was 54 years (IQR 41, 67), with a median disease duration of 15 years (IQR 8, 30). Sixty percent of respondents were female. The majority of respondents (57%) reported currently receiving a biologic therapy. 14 (11%) patients reported currently following a low residue diet, and 34 (25%) reported following the diet in the past. Subjects followed the diet for a median duration of 18 months (IQR 6, 72). Among the 48 patients who followed a low residue diet, 33 (69%) reported using the diet to help with disease flare, while 23 (48%) did so to improve IBD symptoms and an additional 9 patients (19%) reported using a low residue diet post-operatively. 32 (67%) were instructed by their healthcare providers to follow this diet; however, only 4 of them were told not to continue this diet indefinitely. Low residue diets were reported to be “very helpful” (n=14, 29%) or “helpful” (n=18, 38%) in improving IBD symptoms. This benefit consisted of reducing pain (65%), bloating (60%), bowel movement frequency (44%), or urgency (38%). However, respondents noted significant adverse impact on quality of life from a low residue diet: 96% reported that the diet at least moderately limited them from eating foods they enjoyed, and 90% reported that it prevented them from eating what they perceived to be a healthy diet.

CONCLUSION
Within this cohort of individuals with IBD, 36% of survey respondents either followed or had followed a low residue diet. While up to 65% of individuals felt that this may improve abdominal pain, bloating, or other symptoms, almost all individuals felt such a diet limited their intake of foods they enjoy and from eating a healthy diet. Further education is required for providers regarding screening for low residue diet use and its appropriate indications to reduce its negative impact on quality of life.
THE RELATIONSHIP OF DIET INTERVENTIONS TO QUALITY OF LIFE IN ADULTS WITH INFLAMMATORY BOWEL DISEASE: A NARRATIVE REVIEW
Authors: Preston Rebekah , Knol Linda , Douglas Joy 
Published: January 2024

Abstract

BACKGROUND
Inflammatory bowel disease (IBD) can negatively impact quality of life (QOL) due to symptoms associated with chronic inflammation within the gastrointestinal (GI) tract. Dietary changes may offer some symptom relief, thus increasing QOL; however, the optimal dietary pattern to improve symptoms in IBD is unknown. The purpose of this review was to investigate the association between various dietary interventions and QOL in adults with IBD.

METHODS
A search strategy was developed using PRISMA guidelines. EBSCOhost was used to simultaneously search eight databases using key terms including ‘inflammatory bowel disease’ or ‘IBD’ or ‘ulcerative colitis’ or ‘Crohn’s disease’ AND ‘dietary interventions’ or ‘dietary advice’ or’ dietary recommendations.’ Relevant publications were hand-searched to identify additional studies. Included studies reported a dietary pattern intervention with QOL as an outcome measure. Studies that did not include adults, a dietary intervention, or a QOL measure were excluded.

RESULTS
After reviewing abstracts of 1,054 studies identified in the initial search, 13 studies met the inclusion criteria. Among these studies, dietary interventions differed and included the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (n=4), Immunoglobulin G (IgG) diet (n=2), Autoimmune Protocol Diet (AIP) (n=1), Dietary Modified Program (DMP) (n=1), Dietary Modified Framework (DMF) (n=1), Mediterranean diet (n=2), and a high fiber diet (n=2). QOL was measured using various validated questionnaires. Results were inconsistent across studies. Significant improvements in QOL were found using the AIP, DMP, Mediterranean diet, and a high fiber diet. Two of the four low FODMAP studies and one of the two IgG diet studies found significant improvements in QOL, whereas the other three did not. Additionally, the DMF did not significantly improve QOL. It should be noted that the reviewed studies were limited to small sample sizes, a lack of diversity among participants, and short durations. Only one study assessed changes after elimination and reintroduction of suspected trigger foods. A nutrition professional was involved with the dietary intervention in 12 of the 13 studies.

CONCLUSION
Overall, adults with IBD reported improved QOL using a variety of dietary approaches. These approaches aimed to reduce symptoms by reducing foods that may increase inflammation, adding specific foods known to reduce inflammation, or a combination of the two approaches. These dietary approaches are complex and may be difficult to implement. Thus, the Registered Dietitian is needed to tailor dietary approaches to meet the nutrient needs and accommodate the lifestyles of adults with IBD. Additionally, there is a need for additional studies with larger samples sizes, more diverse populations, and additional follow-up periods.
WESTERN DIET DEPLETES SMALL INTESTINAL INTRAEPITHELIAL LYMPHOCYTES VIA FXR-INTERFERON PATHWAY
Authors: Ma Changqing , Trsan Tihana , Mishra Richa , Frein Jennifer , Kern Justin , Jain Umang , Colonna Marco , Stappenbeck Thaddeus , Liu Ta-Chiang 
Published: January 2024

Abstract

BACKGROUND
The prevalence of obesity has continued to increase over the past several decades. Understanding how diet-induced obesity modulates mucosal immunity is of clinical relevance. We previously showed that consumption of a high fat, high sugar “Western” diet (WD) reduces the density and function of small intestinal Paneth cells, a small intestinal epithelial cell type with innate immune function. We hypothesized that obesity could also result in repressed adaptive immunity.

METHODS
Small intestine samples from non-inflammatory bowel disease (IBD) subjects who underwent resection were used for CD3 immunohistochemistry (IHC), and the CD3+ intraepithelial lymphocytes (IEL) densities were correlated with the patients’ body mass index (BMI). Mice were fed with either standard diet (SD) or WD for various durations, and IELs were isolated for flow cytometry analysis.

RESULTS
In non-IBD subjects, high BMI correlated with reduced IEL density. We recapitulated this in wild type (WT) mice fed with WD. A 4-week WD consumption was able to deplete IEL (including major subsets CD4+, CD8+, CD8α+8β-CD4+, and γδCD8+ T cells) but not splenic lymphocytes, and the effect was reversible after another 4 weeks of SD washout. ob/ob mice that spontaneously developed obesity while fed with SD did not show IEL depletion, suggesting that the quality, not the quantity of the diet is key to this phenotype. Importantly, WD-associated IEL depletion was not dependent on the presence of gut microbiota, as WD-fed germ-free mice also showed IEL depletion. We previously showed that a key molecular pathway activated by WD in the ileum is the FXR pathway. Phagocyte-specific Fxr conditional knockout (cKO) mice were protected from WD-mediated IEL depletion, suggesting that FXR activation in the phagocytes is critical in mediating this phenotype. Activated FXR signaling stimulated phagocytes to secrete type I interferon (IFN), and inhibition of type I IFN signaling within the phagocytes (type I IFN monoclonal antibody treatment and Stat1 cKO mice) prevented WD-mediated IEL loss.

CONCLUSION
WD consumption depletes IEL by a FXR-IFN pathway mediated by gut phagocytes. These findings have significant clinical implications in understanding the pathogenesis of gut inflammatory disorders such as IBD.
CONTINUOUS MONITORING OF CRP, IL-6, AND CALPROTECTIN IN INFLAMMATORY BOWEL DISEASE USING A PERSPIRATION BASED WEARABLE
Authors: Shahub Sarah , Kumar Ruchita Mahesh , Lin Kai-chun , Banga Ivneet Kaur , Choi Natalie , Garcia Nicole , Muthukumar Sriram , Rubin David , Prasad Shalini 
Published: January 2024

Abstract

BACKGROUND
Wearable sensor devices represent a noninvasive technology to continuously track biomarkers linked to inflammatory bowel disease (IBD). We assessed the inflammatory markers associated with IBD in human perspiration.

METHODS
Participants with IBD were monitored for 40-130 minutes with a proprietary wearable sensor device used to measure C-reactive protein (CRP), interleukin-6 (IL-6), and calprotectin. Sensor response using Electrochemical Impedance Spectroscopy (EIS) and serum samples were measured on the same day. Mann Whitney test was used to analyze the relationship between active and remission IBD in serum and perspiration, classified according to endoscopic reports and serum biomarker levels. Asynchronously collected fecal calprotectin from a subset of the population was similarly analyzed.

RESULTS
A total of 33 subjects were enrolled. Expression of CRP in perspiration and serum were comparable between Active and Remission cohorts (p&gt;0.05). Median expression of IL-6 in perspiration was elevated in the Active cohort compared to Remission cohort, and significantly elevated in serum (p&lt;0.05). Expression of calprotectin in perspiration, serum, and stool were significantly elevated in the Active cohort compared to Remission cohort (p&lt;0.05). Temporal data for three ulcerative colitis and Crohn’s disease patients provided insight into the basal levels of the markers across different disease states.

CONCLUSIONS
We demonstrate the clinical utility of perspiration as a noninvasive medium for continuous measurement of inflammatory markers in IBD and find that the measures correlate with serum and stool markers across a range of disease activity.

Positive linear relationship between serum and sweat of all markers.
Serum and sweat levels of both Calprotectin and CRP demonstrate strong linear relationship between mediums.
Serum and sweat levels of IL6 demonstrate moderate linear relationship and high homoscedasticity.
EXPLORING THE RELATIONSHIP BETWEEN PATIENT SYMPTOMS AND PROVIDER GOALS FOR MUCOSAL HEALING IN IBD: INSIGHTS FROM THE IBD QORUS SURVEY DATA
Authors: Troia Angela , Kiparizoska Sara , Harvey Sarah , Weaver Alandra , Oberai Ridhima , Melmed Gil , Siegel Corey , Singh Siddharth , Mattar Mark 
Published: January 2024

Abstract

INTRODUCTION
Patients with inflammatory bowel disease (IBD) often experience symptoms such as abdominal pain, diarrhea, and bloody bowel movements. While these symptoms traditionally guided treatment, their predictive value for disease progression is limited. The latest STRIDE-II guidelines recommend a comprehensive IBD management approach, with an emphasis on short-term symptom relief, intermediate-term biomarker normalization, and long-term achievement of endoscopic remission. This treat-to-target strategy necessitates collaboration between physicians and patients. Our study aims to investigate the relationship between patient-reported outcomes and physician efforts to achieve mucosal healing (MH) using IBD QORUS patient and provider survey data.

METHODS
This was a multi-center prospective study that used patient and provider matched survey data from the Crohn’s & Colitis Foundation IBD QORUS program. Surveys completed between June 2021-October 2022 were analyzed. Univariate and multivariate analyses were performed to determine the relationship between severity of patient reported symptoms and frequency of MH assessment with modalities including endoscopy and fecal calprotectin, as well as to determine how symptoms and MH status influence treatment.

RESULTS
In total 5,460 paired patient and provider surveys (Crohn’s disease (CD), n=3,276; ulcerative colitis (UC), n=2,184) were included in the analysis. Demographic information including age, sex and steroid-free MH, as well as severity of patient-reported symptoms were similar between CD and UC patients (Table 1). Abdominal pain severity reported by both IBD populations significantly impacted plans for future endoscopy (CD, p=0.000019; UC, p=0.000055) but not for fecal calprotectin testing. Reported stool frequency in both IBD populations significantly impacted future endoscopy plans (CD, p=0.000001; UC, p=0.000001) and future fecal calprotectin testing (CD, p=0.000304; UC, p=0.000001). Reported blood in stool had no effect on MH assessment in CD patients whereas it significantly affected plans for endoscopy (p=0.000001) and fecal calprotectin testing (p=0.000001) in UC patients. Provider discussions regarding MH occurred with 82.4% of CD patients and 85.3% of UC patients, and treatment plans in those without steroid free MH were influenced by severity of symptoms (p=0.000001).

DISCUSSION
Patient reported symptoms influenced fecal calprotectin and endoscopy plans in both IBD groups. Similarly, severity of symptoms in those without steroid-free MH significantly affected treatment management. These findings suggest that target-based treatment for IBD is feasible in the clinical setting and holds the potential to enhance patient outcomes.
FREE AIR FROM WHERE? SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA IN A PATIENT WITH ULCERATIVE COLITIS IN THE ABSENCE OF COLONIC OR ESOPHAGEAL PERFORATION
Authors: Tai Lorraine Chong , Makarevich Edwin , Alvarez Andrea , Rubenstein Ivana , Singh Satya 
Published: January 2024

Abstract

INTRODUCTION
The development of Spontaneous Pneumomediastinum and Subcutaneous Emphysema in patients with Inflammatory Bowel Disease (IBD) has often been associated with perforation related to toxic megacolon or prior endoscopic procedures. We describe a case of Ulcerative Colitis complicated by Clostridium difficile (C diff) colitis in which Spontaneous Pneumomediastinum and Subcutaneous Emphysema developed without any evidence of perforation.

CASE REPORT
A 20-year-old male with a past medical history of recently diagnosed Ulcerative Colitis presented for evaluation of rectal pain, dysphagia, hematochezia, fecal incontinence, and urinary hesitancy. He endorsed dysphagia with the inability to tolerate solids or liquids for 4 days. He was diagnosed with Ulcerative Colitis 5 months prior to presentation and had unintentionally lost 90 lbs over the past 2 months. His home medication regimen included infliximab started 2 weeks prior, mesalamine PO tablets and suppositories, and a prednisone taper initiated at 10 mg TID. Laboratory tests confirmed anemia, leukocytosis, thrombocytosis, and elevated ESR and CRP levels. Chest X-ray and CT scans of the neck and chest showed moderate pneumomediastinum and subcutaneous emphysema. Given the symptoms of dysphagia along with the imaging findings of pneumomediastinum and subcutaneous emphysema, there was concern for esophageal perforation. However, an Esophagram and Upper GI series were both unremarkable. Abdominal CT revealed colitis of the descending and sigmoid colon without any evidence of free air or free fluid. Fecal Occult Blood Test and C diff antigen and toxin assays were positive. He was treated with oral vancomycin, IV fluids, IV methylprednisolone, and total parenteral nutrition (TPN). His symptoms significantly improved with a decrease in stool frequency and bloody stools. TPN was weaned and he was able to tolerate an oral diet. A repeat CT scan of the chest showed a complete resolution of the pneumomediastinum.

CONCLUSION
There are only a few reported cases in the literature of spontaneous pneumomediastinum and subcutaneous emphysema in patients with IBD in the absence of colonic or esophageal perforation. The spontaneous isolated presentation of air leaking from a chronically diseased hollow organ remains rare. In our patient there was no evidence of perforation, therefore the pneumomediastinum and subcutaneous emphysema likely resulted from the release of free air from colonic micro-perforations caused by the severe inflammation related to his Ulcerative Colitis flare and C. diff infection.

CT Chest demonstrating pneumomediastinum and subcutaneous emphysema of the neck

CT Neck demonstrating subcutaneous emphysema
INDOLENT SYSTEMIC MASTOCYTOSIS MASQUERADING AS CHRONIC ANEMIA IN ULCERATIVE COLITIS: A CASE STUDY
Authors: Hassan Syed Adeel , Flomenhoft Deborah 
Published: January 2024

Abstract

BACKGROUND
Anemia is a frequent systemic/extra-intestinal manifestation of inflammatory bowel disease (IBD). It has a complex multifactorial etiology which suppresses erythropoiesis due to pro-inflammatory mediators, myelosuppression, iron and micronutrient deficiency. It significantly impacts quality of life (QoL) and increases hospitalizations, length of hospital stays and mortality rates. It Is commonly thought to arise as a consequence of IBD or it’s related therapy. Current strategies are aimed at correction of anemia with low priority towards identifying a specific cause. Here, we represent a case of UC with chronic anemia secondary to systemic mastocytosis (SM).

CASE
A 41 y/o female with UC presents to the outpatient clinic with complaints of fatigue. Further questioning revealed a baseline of 1-2 formed bowel movements per day. She did not report any hematochezia or weight loss. She was managed on 300 mg of vedolizumab every 4 weeks. Prior failure to medications includes anti-tumor necrosis factor inhibitors and tofacitinib. Labs were consistent with albumin 4.5 mg/dL and CRP &lt; 1 mg/dL. Iron studies revealed low iron, TIBC and ferritin levels. Fecal calprotectin measurements were not available due to patient non-compliance. Patient (Pt) was thought to have experienced a UC flare and colonoscopy was recommended. Colonoscopy was unrevealing with no sign of active disease on examination (Mayo Endo 0). Pt was referred to hematology where she underwent a bone marrow biopsy revealing multifocal dense infiltrates of mast cells (≥15 mast cells in aggregates) expressing CD2+ and CD 25+ with 25% showing atypical morphology in bone marrow biopsies. KIT D816V mutation was also positive. The serum tryptase level in this pt was 47.1ug/L. She was then placed on anti-histamines, proton pump inhibitors and steroid therapy.

CONCLUSION
SM is a clonal disorder of MC that infiltrates one or more organs. It almost always involves the bone marrow. Gastrointestinal (GI) symptoms are present in up to 80% patients. These symptoms are secondary to systemic effects of MC mediators. Incidence of SM in UC has never been established. SM has been shown to mimic Crohn’s disease and is difficult to differentiate based on clinical and endoscopic features. Furthermore, little is known regarding histopathological features of GI involvement in SM. The presence of chronic anemia despite adequate therapy in a clinically/endoscopically inactive UC patient should raise suspicion of other pathologic causes of anemia. Our case highlights the importance of diagnosing the specific cause of anemia in IBD as it may lead to inaccurate clinical judgements of disease flares leading to undue alteration in therapy.