bluuebunny/crossref_metadata_2025_split huggingface dataset:
SMOKING IS NOT AN INDEPENDENT RISK FACTOR FOR SURGERY IN PATIENTS WITH CROHN'S DISEASE ON BIOLOGIC THERAPY
Authors: Shmais Manar , Alrazim Ayman , Hablablab Saleem , Sadaka Christian , Slika Hasan , Adra Nour , Ghusn Wissam , Sharara Ala 
Published: January 2023

Abstract

INTRODUCTION
The development and course of inflammatory bowel disease (IBD) appears to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn’s disease (CD) and a protective role in ulcerative colitis (UC). This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe Crohn’s disease (CD) receiving biologic therapy.

METHODS
Retrospective study of adult patients with CD at a University Medical Center over a 20-year period.

RESULTS
A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and non-smokers: 44.2%,11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (&gt;2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) vs. non-smokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to non-smokers (OR = 10.6, 95% CI = 2.0, 57.4; p=0.006).

CONCLUSION
In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.
THIRD TIME’S THE CHARM? INDICATIONS AND LONG-TERM OUTCOMES AFTER REDO-REDO ILEAL POUCH ANAL ANASTOMOSIS
Authors: Maspero Marianna , Lavryk Olga , Holubar Stefan , Lipman Jeremy , Steele Scott , Hull Tracy 
Published: January 2023

Abstract

BACKGROUND
Pouch failure after redo ileal pouch anal anastomosis (IPAA) occurs in 20-40% of cases. The decision to offer a second redo procedure to maintain intestinal continuity is controversial, and scarce evidence exists regarding long-term pouch survival and functional outcomes after redo-redo IPAA.

METHODS
We retrospectively analyzed our prospectively collected pouch registry for redo IPAA procedures and identified all patients who underwent a second redo IPAA procedure from 2004 to 2021. Our primary outcome was pouch survival, defined as no pouch excision or rediversion. Figures are frequency (percentage) and median (interquartile range).

RESULTS
Twenty-three patients met inclusion criteria (65% female, 4% of all redo IPAAs). The index diagnosis was ulcerative colitis in 20 (87%) cases and indeterminate colitis in 3 (13%). The median interval between the index pouch and the second redo was 36 (24 – 90) months, while the median time between the first and second redo was 16 (9 – 36.5) months. Only 8 (35%) of patients had their stoma closed between the first and second redo. In 15 (65%) cases both redo procedures were done at our center. The indication for pouch salvage was the same for the first and second redo in 21 (91%) cases (Figure 1): 20 (87%) patients both redo for septic complications. Second redos were done transabdominally in 21 (91%) of cases, and 14 (61%) involved pouch excision and construction of a neo-pouch. All were handsewn, and the final pouch configuration was “J” in 18 (78%) and “S” in 5 (22%) cases (Figure 2). Twenty (87%) had their stoma closed after the second redo. After a median follow up of 39 months (18.5 – 95.5), 10 (44%) patients experienced pouch failure (due to sepsis in 9 cases of which 3 never had their stoma closed, and poor function in 1). Pouch survival was 81% at 1-year, and 76% at 3-years. The median interval between second redo and pouch failure was 12 months (3 – 50.5). Postoperative Cleveland Global Quality of Life surveys were available for 17 (74%) patients. After a median interval of 14 (6 – 40) months, the overall quality of life score (0 -1) was 0.6 (0.5 – 0.8). The median number of bowel movements was 6 (5 – 8) during daytime, 2 (2 – 4) at night, for a total of 8 (6.5 – 12.5) per 24 hours. Urgency occurring most days of the week was reported by 30%, frequency by 14%, seepage during the day by 71% and at night by 86%. Dietary restrictions were reported by 50% of patients, social restrictions by 44%, work restrictions by 62.5%, and sexual restrictions by 50%.

CONCLUSION
A second redo pouch procedure may be offered with acceptable outcomes to a very select group of patients who are highly motivated to maintain intestinal continuity.
ASSOCIATION BETWEEN ANTIBIOTIC USE AND INFLAMMATORY BOWEL DISEASE OUTCOMES
Authors: Liu Luke , O'Charoen Sirimon , Fehlmann Tara , Roedder Silke , Wendt Emily , Billin Andrew , Younis Islam , Iqbal Shahed 
Published: January 2023

Abstract

OBJECTIVE
Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data.

METHODS
Data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) of Crohn’s & Colitis Foundation’s IBD Plexus program were used. Patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) since 2000 were included. The use of antibiotics (ciprofloxacin, metronidazole, rifaximin and vancomycin) for ≥7 days after enrollment was identified from electronic health records and case report forms. Disease activity scores were assessed at the time of enrollment (baseline) and during follow-up using 6-point Mayo score (6-pt MS) and short Clinical Disease Activity Index (sCDAI) for UC and CD, respectively. Patients’ demographic and clinical characteristics were also collected. Remission was defined as 6-pt MS of 0-1 for UC and sCDAI&lt;150 for CD. The association between antibiotic use and outcome during follow-up was assessed in a subset of patients without remission at baseline using a multivariable Cox proportional hazards model. The model included the following covariates for adjustment: age, gender, race, family history of IBD, IBD surgery, disease activity at enrollment and other IBD drug use during follow-up.

RESULTS
A total of 2,959 IBD patients (UC=1,060; CD=1,899) were included. Mean age at diagnosis was 30±14 years (UC=32±15; CD=28±14). Forty-four percent of the patients were male (UC=49%; CD=41%) and 79% were White (UC=82%; CD=78%). Antibiotic use after enrollment was observed in 29% of the patients (UC=26%; CD=30%). About 60% of UC or CD patients were in remission at baseline. The antibiotic use group had significantly higher baseline disease activity (UC 6-pt MS: 1.7±1.8; CD sCDAI: 167±96) than patients without antibiotic use (UC 6-pt MS: 1.3±1.7; CD sCDAI: 137±89). In the subset of patients with mild, moderate or severe baseline IBD (6-pt MS&gt;1 for UC; sCDAI≥150 for CD), the baseline disease activity scores were largely comparable between patients who used antibiotic and who did not (UC 6-pt MS: 3.6±1.3 vs 3.3±1.3, p-value=0.063; CD sCDAI: 248±83 vs 238±83, p-value=0.169), while patients who used antibiotics were less likely to experience remission during follow-up compared to those who did not use antibiotics (UC adjusted remission hazard ratio [aRHR] 0.39, 95% confidence interval [CI] 0.26-0.60; CD aRHR 0.60, 95% CI 0.46-0.79).

CONCLUSION
In this study, antibiotic use in patients with IBD was negatively associated with remission during follow-up. The effect of antibiotics on gut microbiome and optimal use of antibiotics in IBD patients need to be further explored.
ASSOCIATION OF CYCLING BETWEEN ANTI-TNFS VERSUS SWITCHING TO USTEKINUMAB WITH MEDICATION PERSISTENCE IN ANTI-TNF EXPERIENCED PATIENTS WITH CROHN'S DISEASE
Authors: Zhdanava Maryia , Ding Zhijie , Manceur Ameur , Zhao Ruizhi , Holiday Christopher , Godwin Bridget , Pilon Dominic , Kachroo Sumesh 
Published: January 2023

Abstract

BACKGROUND
Anti-tumor necrosis factor inhibitors (anti-TNFs) are biologics commonly used for the treatment of Crohn’s disease (CD). Over time, patients may require adjustment to anti-TNF therapy, including cycling to a different anti-TNF or switching to a biologic with an alternate mechanism of action. Choice of a treatment strategy could be key to managing symptoms on a sustained basis. This study aimed to compare real-world persistence among patients with CD who cycled to another anti-TNF agent or switched to ustekinumab.

METHODS
Adults with CD treated with an anti-TNF, whose first switching to ustekinumab or cycling to a new anti-TNF (index date) occurred between 09/23/2016 and 08/01/2019 were selected from the IBM® MarketScan® Commercial Database. Patients had ≥12 months of continuous insurance eligibility before the initiation of the first anti-TNF, discontinued the first anti-TNF within 12 months before the index date (baseline), and had no other immune disorders during baseline. Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. Persistence on index biologic (ustekinumab or a new anti-TNF) was defined as absence of therapy exposure gaps &gt;120 days (ustekinumab, infliximab) or &gt;60 days (adalimumab, certolizumab) between days of supply. Composite endpoints were persistence while on monotherapy (no immunomodulators/non-index biologics), and persistence and being corticosteroid-free (no corticosteroids with ≥14 days of supply after day 90 post-index). Weighted Kaplan-Meier and Cox models were used to assess outcomes at 12 months post-index.

RESULTS
The weighted sample included 325 patients in the ustekinumab cohort and 328 in the cycling cohort (Fig. 1). At 12 months post-index, 76.6% versus 67.5% persisted on the index biologic in the ustekinumab versus the cycling cohort (Fig. 2a); the rate of persistence was 47% higher in the ustekinumab cohort (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.08-2.01; p-value 0.0158). Moreover, 61.6% versus 44.1% persisted on the index biologic while on monotherapy, respectively (Fig. 2b); the rate of persistence while on monotherapy was 68% higher in the ustekinumab cohort (HR: 1.68; 95% CI: 1.33-2.13; p-value &lt;0.001). Finally, 54.8% vs 50.2% were persistent and corticosteroid-free, respectively (Fig. 2c); the rate of being persistent and corticosteroid free numerically trended 9% higher in the ustekinumab cohort but statistical significance was not reached (HR: 1.09; 95% CI: 0.87-1.38; p-value 0.4527).

CONCLUSIONS
After discontinuation of the first anti-TNF, persistence on therapy was better among patients with CD who switched to ustekinumab compared to those who cycled to a new anti-TNF. These findings may inform treatment strategies for patients on the first anti-TNF agent who require treatment adjustment.
HOSPITALIZATION TRENDS IN INFLAMMATORY BOWEL DISEASE PATIENTS WITH POUCHITIS: A POPULATION-BASED STUDY
Authors: Nawaz Ahmad , Chaar Abdelkader , Rizwan Rabia , Al-Bawardy Badr 
Published: January 2023

Abstract

INTRODUCTION
Pouchitis is a complication of total colectomy and ileal pouch-anal anastomosis for ulcerative colitis that can lead to hospitalization. We aimed to assess trends of hospitalization rates and health care utilization in patients with pouchitis from 2010 – 2019.

METHODS
We performed a retrospective cohort study using the National Inpatient Sample database from 2010 to 2019 of hospitalized patients with a primary discharge diagnosis of pouchitis and a secondary diagnosis of inflammatory bowel disease (IBD), or primary diagnosis of IBD and a secondary diagnosis of pouchitis. We compared baseline characteristics and outcomes of patients admitted from 2010-2014 to 2015-2019. The primary outcome was the rate of hospitalization for pouchitis between the two five-year periods. Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. We applied discharge weights to generate national estimates.

RESULTS
A total of 8215 hospitalizations with pouchitis were identified for IBD patients, with 3856 hospitalizations in the 2010 – 14 group and 4359 in the 2015- 19 group. The 2015-2019 group had less females (54.54% vs 46.67%, p =0.002) and increased hospitalization in urban teaching hospitals (71.95% vs 85.67%, p&lt; 0.001) (Table 1). Hospitalizations with a primary diagnosis of pouchitis were lower in the 2015-2019 group (58.91% vs 53.21%, p= 0.024). Over the study period (2010-2019), there was a numeric increase in the pouchitis incidence among hospitalized IBD patients (2.68 in 2010 to 2.87 in 2019 per 1000 discharges, p=0.459), and the number of patients undergoing inpatient pouchoscopy (25.67% in 2010 and 26.55% in 2019, p=0.803). The average inflation-adjusted total hospitalization charges were $12,555 higher in 2019 compared to 2010 (p=0.045). However, there was a decrease in LOS over this period (5.99 days in 2010 to 5.39 in 2019, p=0.182) (Figure 1).

DISCUSSION
Over the past decade, the overall number of hospitalizations for IBD patients with pouchitis remained stable with a slight numeric increase, but the rate of hospitalization primarily for pouchitis has significantly decreased. Although LOS has numerically decreased, the overall cost of hospitalization has increased for IBD patients with pouchitis. This may be partly due to increased endoscopic evaluation performed during more recent years.
TREATMENT PATTERNS OF PEDIATRIC AND ADULT PATIENTS WITH CROHN’S DISEASE
Authors: Chan Wai Man , Tinsley Debbie , Crandall Wallace , Du Yu , Choong Casey , Hunter Theresa 
Published: January 2023

Abstract

OBJECTIVE
Crohn’s Disease (CD) is a chronic disease characterized by transmural inflammation and may involve any portion of the gastrointestinal tract. Children with CD are more likely to present with extensive disease and have more rapid clinical progression than adults.1 This study aimed to compare the treatment patterns between pediatric and adult patients with CD.

METHODS
This is a retrospective claims-based study using the Merative L.P Marketscan® Research database (January 1, 2014 through December 31, 2021). Pediatric (≤ 17 years) and adult (≥ 18 years) patients with a CD diagnosis code and ≥12 months continuous enrollment with medical and pharmacy benefits before and after the first diagnosis of CD (index date) were included. Descriptive statistics described treatment patterns for pediatric and adult CD cohorts.

RESULTS
There were 2810 pediatric and 25,934 adult patients with CD included in the analysis. The mean (SD) ages in years for pediatric and adult patients were 13.5 (3.1) and 46.0 (15.9), respectively (Table 1). While females (53.6%) were slightly predominant in the adult cohort, there was a numerically higher proportion of males (59.5%) in the pediatric cohort. The most common monotherapy in children was corticosteroids (22.9%) or biologics (34.9%), while adult monotherapy was primarily corticosteroids (29.6%) or aminosalicylates (32.9%). The time from diagnosis to initiation of corticosteroids and immunomodulators was numerically shorter in children than adults (median days between index and corticosteroids or immunomodulators initiations: 14 vs. 54 and 26 vs 34, respectively). Combination therapies, including biologics and/or immunomodulators with corticosteroids, were numerically more often used in children than in adults (32.4% vs 15.0%). Among all biologic users, adalimumab (18.1%) was numerically more commonly prescribed for adults while infliximab (38.2%) was numerically more common in children. Pediatric patients showed numerically higher 6-month persistence from initiation of a biologic when compared with adult patients (persistence rate: 94.6% vs 87.2%; Table 2). Notably, a small proportion of pediatric patients were on either ustekinumab or vedolizumab (0.1% and 0.2%, respectively) as add-on therapy despite those medications not being currently approved in this population.

CONCLUSION
The study suggests that children with newly diagnosed CD receive combination therapies more frequently than adults. This may be related to greater disease severity in children. Children treated with biologics had numerically greater persistence, suggesting similar efficacy compared to adults.

REFERENCE
1. Freeman H.J., Natural history and long-term clinical course of Crohn’s disease. World J Gastroenterol. 2014 Jan 7;20(1):31-6.
TREATMENT PATTERNS OF PEDIATRIC AND ADULT PATIENTS WITH ULCERATIVE COLITIS
Authors: Chan Wai Man , Tinsley Debbie , Crandall Wallace , Du Yu , Choong Casey , Hunter Theresa 
Published: January 2023

Abstract

OBJECTIVE
Ulcerative Colitis (UC) is a chronic disease characterized by continuous inflammation of the colonic and rectal mucosa. Children with UC are more likely to present with extensive disease and have more rapid clinical progression than adults.1 This study compared treatment patterns between pediatric and adult patients with UC.

METHODS
This retrospective, claims-based, cohort study used data from the Merative L.P Marketscan® Research Database to identify newly diagnosed patients with a confirmed UC diagnosis from January 1, 2014 through December 31, 2021. Pediatric (≤ 17 years) and adult (≥ 18 years) patients with continuous enrollment for 12 months before and 12 months following the first UC diagnosis (index date) who also received at least 1 medication related to inflammatory bowel disease (aminosalicylates, corticosteroids, immunomodulators, or biologics) after the first diagnosis date, were included. Descriptive statistics described treatment patterns for both cohorts.

RESULTS
This analysis included 1343 pediatric and 37,617 adult patients with UC. The mean (SD) ages (years) for pediatric and adult patients were 13.7 (3.3) and 48.8 (15.3) years, respectively (Table 1). The time from diagnosis to initiation of corticosteroids was numerically shorter in children in contrast to adults (median days between index date and corticosteroids initiation: 15 vs 56). Among all UC patients, aminosalicylates (74.0% adults vs 72.5% children) were the most prescribed monotherapy, followed by corticosteroids (16.6% adults vs 15.3% children) and immunomodulators (5.1% adults vs. 7.4% children). Additionally, children were started on combination therapies numerically more often than adults (32.3% vs 16.7%). The most used combination therapies for both cohorts were aminosalicylates plus corticosteroids (63.0% adults vs 62.4% children), followed by aminosalicylates and immunomodulators (15.3% adults vs 8.3% children). Children had numerically higher utilization of biologics than adults (22.6% vs 10.8%). The persistence rates of all drug therapies within 6 months following initiation in both cohorts were similar (Table 2). Notably, a small proportion of pediatric patients were on ustekinumab, vedolizumab, or tofacitinib as add-on therapy (0.2%, 2.0%, and 0.2%, respectively), despite those medications not being currently approved in this population.

CONCLUSION
More children with newly diagnosed UC receive combination therapies and have higher utilization of biologics compared to adults. This may reflect greater disease progression and complications in children.

REFERENCE
1. Ruemmele, F., Turner, D. Differences in the management of pediatric and adult-onset ulcerative colitis – lessons from the joint ECCO and ESPGHAN consensus guidelines for the management of pediatric ulcerative colitis. Journal of Crohn’s and Colitis, 8(1), January 2014, pages 1-4.
DELAYED ONSET OF TREATMENT IN A PATIENT WITH ULCERATIVE COLITIS: A CASE OF HOW DISPARITIES AFFECT HEALTHCARE ACCESS
Authors: Ibarra Maria , Guzman Adalberto , Ravichander Benjamin , Sangha Lillian , Mishagina Irina 
Published: January 2023

Abstract

INTRODUCTION
Most of the literature available on Inflammatory Bowel Disease (IBD) comes from studies performed in white population. Recent studies indicate a potential shift in the epidemiology of IBD in the United States, with significantly greater increases in incidence rates noted in non-White patients. (1) However, the burden of this disease on black and non-black Hispanic is unknown. This prompts a re-examination of the challenges these populations face including access to care issues and financial barriers. (2) Patients and health outcomes are impacted by multiple social and community factors often referred to as Social Determinants of Health (SDOH). SDOH are defined as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”(1) The concept of social determinants of health contributing to poor healthcare outcomes in certain populations comes from the recognition that race and economic factors are linked to awareness of disease and access to care. In this abstract, we describe a case that exhibits the mechanism in which social determinants of health lead to a poor health outcome.

CASE DESCRIPTION
An 18-year-old female college student from Hispanic background who presented with diarrhea associated with weight loss for 6 months, seen by a local gastroenterologist who performed a colonoscopy that depicted patchy inflammatory changes throughout the colon with microscopic evidence of ulcerative colitis for which she was prescribed Infliximab, however, she was unable to afford the medication due to the high out-of-pocket cost and she did not receive and alternative medication nor follow up from her physician. For the next few months, the patient was not receiving treatment which resulted in a course of protracted diarrhea and gastrointestinal bleed with hypovolemic shock and ICU admission. At that time, abdominopelvic CT scan demonstrated inflammatory changes of the transverse and left colon. During admission she was started on the aforementioned drug and on discharge she was again prescribed Infliximab, however this time our patient started working as part time and was able to obtain the medication through her private insurance. Since the onset of treatment she has improved, her bowel frequency went from about 20 bowel movements daily to 4-5. She is still having minimal rectal bleeding, but the volume of blood has decreased considerably.

DISCUSSION
This case illustrates one of the many examples of how health disparities impact disease course. Although recently literature that discusses health disparities in IBD patients is increasing, it is essential to focus on social determinants of health as the cause of inequities in patient care in order to improve disease outcome on these underrepresented populations.