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Article ; Online: Effectiveness of Tofacitinib in Ulcerative Proctitis Compared to Left Sided Colitis and Pancolitis.

Singh, Arshdeep / Mahajan, Ramit / Midha, Vandana / Kaur, Kirandeep / Singh, Dharmatma / Kaur, Ramandeep / Garg, Shreya / Arora, Kirti / Bansal, Namita / Sood, Ajit

Digestive diseases and sciences

2024 Volume 69, Issue 4, Page(s) 1389–1402

Abstract: Background: Ulcerative proctitis (UP), though associated with high symptom burden and poor quality of life, is excluded from most of the randomized controlled trials in UC, including the OCTAVE trials. We aimed to analyse the effectiveness of ... ...

Abstract	Background: Ulcerative proctitis (UP), though associated with high symptom burden and poor quality of life, is excluded from most of the randomized controlled trials in UC, including the OCTAVE trials. We aimed to analyse the effectiveness of tofacitinib in UP, and compare it to that in left sided colitis (LSC) and pancolitis (PC). Methods: This was a prospective cohort study. Patients with either steroid-dependent or refractory ulcerative colitis, who received tofacitinib, were divided into three groups based on the disease extent [UP, LSC and PC]. The primary outcome was comparison of proportion of patients in clinical remission in the three groups, at weeks 8, 16 and 48. Safety outcomes were reported using incidence rate per patient year of exposure. Results: Clinical remission was achieved in 47%(15/32), 24%(23/94), and 43%(23/54) of patients at week 8, 56%(18/32), 37%(35/94), and 56%(30/54) of patients at week 16, and 59%(19/32), 38%(36/94), and 24%(13/54) of patients at week 48 in groups UP, LSC and PC, respectively. Corticosteroid-free clinical remission rates were significantly higher in patients in groups UP at week 48. Five (15%) patients with UP were primary non-responders to tofacitinib at week 16, while three (9%) patients had secondary loss of response at week 48. The probability of sustained clinical response was highest in patients with UP. Patients with UP had the lowest incidence of adverse effects. Conclusion: The effectiveness of tofacitinib in inducing and maintaining clinical remission is greater in patients with UP compared to LSC and PC.
MeSH term(s)	Humans ; Colitis, Ulcerative/epidemiology ; Quality of Life ; Prospective Studies ; Proctitis ; Piperidines ; Pyrimidines
Chemical Substances	tofacitinib (87LA6FU830) ; Piperidines ; Pyrimidines
Language	English
Publishing date	2024-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	304250-9
ISSN	1573-2568 ; 0163-2116
ISSN (online)	1573-2568
ISSN	0163-2116
DOI	10.1007/s10620-024-08276-1
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Article ; Online: Tofacitinib in Acute Severe Ulcerative Colitis (TACOS): A Randomized Controlled Trial.

Singh, Arshdeep / Goyal, Manjeet Kumar / Midha, Vandana / Mahajan, Ramit / Kaur, Kirandeep / Gupta, Yogesh Kumar / Singh, Dharmatma / Bansal, Namita / Kaur, Ramandeep / Kalra, Shivam / Goyal, Omesh / Mehta, Varun / Sood, Ajit

The American journal of gastroenterology

2024

Abstract: Introduction: Intravenous corticosteroids are the mainstay of treatment of patients hospitalized with acute severe ulcerative colitis (ASUC). However, 30%-40% of the patients are refractory to corticosteroids. We investigated whether addition of ... ...

Abstract	Introduction: Intravenous corticosteroids are the mainstay of treatment of patients hospitalized with acute severe ulcerative colitis (ASUC). However, 30%-40% of the patients are refractory to corticosteroids. We investigated whether addition of tofacitinib to corticosteroids improved the treatment responsiveness in patients with ASUC. Methods: This single-center, double-blind, placebo-controlled trial randomized adult patients with ASUC (defined by the Truelove Witts severity criteria) to receive either tofacitinib (10 mg thrice daily) or a matching placebo for 7 days while continuing intravenous corticosteroids (hydrocortisone 100 mg every 6 hours). The primary end point was response to treatment (decline in the Lichtiger index by >3 points and an absolute score <10 for 2 consecutive days without the need for rescue therapy) by day 7. The key secondary outcome was the cumulative probability of requiring initiation of infliximab or undergoing colectomy within 90 days following randomization. All analyses were performed in the intention-to-treat population. Results: A total of 104 patients were randomly assigned to a treatment group (53 to tofacitinib and 51 to placebo). At day 7, response to treatment was achieved in 44/53 (83.01%) patients receiving tofacitinib vs 30/51 (58.82%) patients receiving placebo (odds ratio 3.42, 95% confidence interval 1.37-8.48, P = 0.007). The need for rescue therapy by day 7 was lower in the tofacitinib arm (odds ratio 0.27, 95% confidence interval 0.09-0.78, P = 0.01). The cumulative probability of need for rescue therapy at day 90 was 0.13 in patients who received tofacitinib vs 0.38 in patients receiving placebo (log-rank P = 0.003). Most of the treatment-related adverse effects were mild. One patient, receiving tofacitinib, developed dural venous sinus thrombosis. Discussion: In patients with ASUC, combination of tofacitinib and corticosteroids improved treatment responsiveness and decreased the need for rescue therapy.
Language	English
Publishing date	2024-01-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	390122-1
ISSN	1572-0241 ; 0002-9270
ISSN (online)	1572-0241
ISSN	0002-9270
DOI	10.14309/ajg.0000000000002635
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Article ; Online: Burden of Anxiety, Depression and Perceived Stress in Patients with Inflammatory Bowel Disease: A Cohort Study from North India.

Singh, Arshdeep / Bhardwaj, Arshia / Tripathi, Ashish / Ranjan, Mukesh Kumar / Singh, Dharmatma / Sachdeva, Ashi / Marwah, Mahima / Sadana, Kriti Sood / Bansal, Namita / Mahajan, Ramit / Kaur, Kirandeep / Midha, Vandana / Sood, Ajit

Digestive diseases and sciences

2024 Volume 69, Issue 3, Page(s) 775–790

Abstract: Background: Patients with Inflammatory bowel disease (IBD) are susceptible to psychiatric co-morbidities. We aimed to ascertain the burden of anxiety, depression, and perceived stress in patients with IBD from north India.: Methods: Consenting adult ... ...

Abstract	Background: Patients with Inflammatory bowel disease (IBD) are susceptible to psychiatric co-morbidities. We aimed to ascertain the burden of anxiety, depression, and perceived stress in patients with IBD from north India. Methods: Consenting adult patients with an established diagnosis of IBD were enrolled. The enrolled patients filled the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS) questionnaires. The patient and disease characteristics were analyzed to determine the correlations and predictors of psychiatric comorbidities. Results: A total of 318 patients (255 UC, 63 CD; mean age 40.13 ± 12.06 years, 168 [52.8%] males; mean partial Mayo score 2.10 ± 2.35; and mean HBI 2.77 ± 2.13) were enrolled. The prevalence of anxiety, depression and moderate to high perceived stress was 14%, 12%, and 41%, respectively. Females had higher mean perceived stress, anxiety and depression scores compared to males. The partial Mayo score (PMS) correlated poorly with anxiety (ρ = 0.083, p = 0.187), depression (ρ = 0.123, p = 0.49) and perceived stress (ρ = 0.169; p = 0.007). The Harvey Bradshaw index (HBI) correlated fairly with anxiety (ρ = 0.336, p = 0.007) and poorly with depression (ρ = 0.287, p = 0.022) and perceived stress (ρ = 0.20; p = 0.117). Younger age (OR 0.93, 95% CI 0.90-0.97; p = 0.001) and hand-grip strength (OR 4.63, 95% CI 1.88-11.42; p = 0.001) predicted anxiety in patients with UC while rural area of residence (OR 4.75, 95% CI 1.03-21.98; p = 0.046) and HBI (OR 1.60, 95% CI 1.12-2.29; p = 0.009) were significant predictors of anxiety in patients with CD. Conclusion: Psychiatric comorbidities are common in patients with IBD, with higher prevalence in females. Young adults with UC and sarcopenia; and individuals with active CD living in rural areas are at an increased risk of anxiety.
MeSH term(s)	Male ; Young Adult ; Female ; Humans ; Adult ; Middle Aged ; Crohn Disease/diagnosis ; Colitis, Ulcerative/diagnosis ; Cohort Studies ; Depression/diagnosis ; Depression/epidemiology ; Inflammatory Bowel Diseases/diagnosis ; Anxiety/epidemiology ; Anxiety/etiology ; Stress, Psychological/diagnosis ; Stress, Psychological/epidemiology ; Severity of Illness Index ; Psychological Tests ; Self Report
Language	English
Publishing date	2024-01-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	304250-9
ISSN	1573-2568 ; 0163-2116
ISSN (online)	1573-2568
ISSN	0163-2116
DOI	10.1007/s10620-023-08242-3
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Article ; Online: Early fecal microbiome transfer after donor defecation determines response in patients with moderate to severe ulcerative colitis.

Singh, Arshdeep / Mahajan, Ramit / Kahlon, Bhavjeet Kaur / Dhaliwal, Ashvin Singh / Midha, Vandana / Mehta, Varun / Bansal, Namita / Singh, Dharmatma / Sood, Ajit

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

2022 Volume 41, Issue 4, Page(s) 389–396

Abstract: Background: Fecal microbiome transfer (FMT) targeting gut microbiome dysbiosis is an emerging therapy for ulcerative colitis (UC). There is however no consensus on protocols for performing FMT in UC, especially in relation to time after donor feces ... ...

Abstract	Background: Fecal microbiome transfer (FMT) targeting gut microbiome dysbiosis is an emerging therapy for ulcerative colitis (UC). There is however no consensus on protocols for performing FMT in UC, especially in relation to time after donor feces defecation. Methods: This is a single-center retrospective analysis of patients with moderate-severe UC (total Mayo Clinic score ≥6 and endoscopic Mayo Clinic subscore of ≥2) treated with FMT between September 2017 and December 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Fresh fecal samples from unrelated healthy voluntary donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. Time interval between donor feces defecation and FMT procedure was recorded for each FMT session and the mean time of seven sessions was designated aika. Impact of aika on clinical response and safety of FMT was evaluated. Results: During the study period, 123 adult patients (mean age 33.75±11.97 years, 61.8% [n=76] males) with moderate-severe UC (mean total Mayo Clinic and endoscopic Mayo Clinic scores 7.49±1.60 and 2.50±0.50, respectively) were treated with FMT. The mean aika was 2.29±0.75 h. The aika was smaller in patients who responded to FMT as compared to non-responders (2.13±0.75 h vs. 2.71±0.76 h, p=0.0002) as well as in patients achieving clinical remission (2.15±0.76 h vs. 2.42±0.76 h, p=0.05). There was no significant impact of aika on adverse effects except for the incidence of borborygmi after FMT, which was higher in patients with aika ≤2 h. Conclusion: Early FMT after donor feces defecation favorably impacts the clinical response rates in patients with active UC.
MeSH term(s)	Adult ; Colitis, Ulcerative/etiology ; Colitis, Ulcerative/therapy ; Defecation ; Fecal Microbiota Transplantation/methods ; Feces ; Humans ; Male ; Microbiota ; Middle Aged ; Remission Induction ; Retrospective Studies ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2022-09-19
Publishing country	India
Document type	Journal Article
ZDB-ID	632595-6
ISSN	0975-0711 ; 0254-8860
ISSN (online)	0975-0711
ISSN	0254-8860
DOI	10.1007/s12664-022-01257-0
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Article ; Online: Tofacitinib Versus Oral Prednisolone for Induction of Remission in Moderately Active Ulcerative Colitis [ORCHID]: A Prospective, Open-Label, Randomized, Pilot Study.

Singh, Arshdeep / Midha, Vandana / Kaur, Kirandeep / Mahajan, Ramit / Singh, Dharmatma / Kaur, Ramandeep / Kohli, Aditya / Chawla, Avantika / Sood, Kriti / Bansal, Namita / Sood, Ajit

Journal of Crohn's & colitis

2023 Volume 18, Issue 2, Page(s) 300–307

Abstract: Background: Oral corticosteroids are first-line agents to induce remission in moderately active ulcerative colitis [UC], but are associated with adverse effects. We compared the efficacy and safety of tofacitinib and prednisolone for induction of ... ...

Abstract	Background: Oral corticosteroids are first-line agents to induce remission in moderately active ulcerative colitis [UC], but are associated with adverse effects. We compared the efficacy and safety of tofacitinib and prednisolone for induction of remission in moderately active UC. Methods: This was a single-centre, prospective, open-label, randomized, active-controlled pilot study. Eligible patients [aged ≥18 years] had moderately active UC. Participants were randomly assigned to receive either prednisolone [40 mg daily, tapered by 5 mg every week] or tofacitinib [10 mg twice daily] for 8 weeks. The primary endpoint was composite remission [defined as total Mayo clinic score ≤2, with endoscopic sub-score of 0 and faecal calprotectin <100 µg/g] at 8 weeks. Results: Seventy-eight patients were randomly assigned to either of the treatment groups. At week 8, the proportion of patients achieving composite remission in the tofacitinib [7/43, 16.28%] and prednisolone groups [3/35, 8.57%] were not significantly different (odds ratio [OR] 2.07, 95% confidence interval [CI] 0.49-8.70; p = 0.31). The time to achieve symptomatic remission [normal stool frequency with absence of rectal bleeding] was similar (10 days, interquartile range [IQR 7-18.75] and 10 days [IQR 5-12.5] for tofacitinib and prednisolone, respectively; p = 0.25) in the two groups. One patient each in the tofacitinib and prednisolone group discontinued treatment due to development of pulmonary tuberculosis and pustular acne, respectively. One patient receiving tofacitinib developed herpes zoster, but did not require cessation of therapy. No serious adverse events or major adverse cardiovascular events were observed. Conclusion: In patients with moderately active UC, there was no difference in the efficacy and safety of tofacitinib and oral prednisolone for induction of remission at 8 weeks. Trail registration: Clinical Trials Registry of India [CTRI/2021/10/037641].
MeSH term(s)	Humans ; Adolescent ; Adult ; Colitis, Ulcerative/drug therapy ; Pilot Projects ; Prospective Studies ; Prednisolone/therapeutic use ; Remission Induction ; Treatment Outcome ; Piperidines ; Pyrimidines
Chemical Substances	tofacitinib (87LA6FU830) ; Prednisolone (9PHQ9Y1OLM) ; Piperidines ; Pyrimidines
Language	English
Publishing date	2023-09-01
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjad153
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Article ; Online: Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn's disease: A cohort study from northern India.

Singh, Arshdeep / Kakkar, Chandan / Garg, Shreya / Arora, Kirti / Midha, Vandana / Mahajan, Ramit / Virk, Satpal Singh / Jain, Narender Pal / Singh, Dharmatma / Sood, Kriti / Tripathi, Ashish / Gupta, Dhruv / Kaushal, Ishita Gupta / Galhotra, Ritu Dhawan / Saggar, Kavita / Sood, Ajit

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

2023 Volume 42, Issue 5, Page(s) 668–676

Abstract: Background: Fistulizing perianal Crohn's disease (CD) is a debilitating condition associated with significant morbidity and reduction in the quality of life. Magnetic resonance imaging (MRI) of the pelvis is the preferred imaging modality for the ... ...

Abstract	Background: Fistulizing perianal Crohn's disease (CD) is a debilitating condition associated with significant morbidity and reduction in the quality of life. Magnetic resonance imaging (MRI) of the pelvis is the preferred imaging modality for the comprehensive assessment of the perianal fistula. There is a paucity of data from India on the MRI spectrum of complex perianal fistula in CD. Methods: A single-centre cross-sectional analysis of patients with fistulizing perianal CD, who underwent pelvic MRI between January 2020 and December 2021, was performed. The clinical (age, sex, disease duration, disease location and behavior, disease activity [Perianal Disease Activity Index, PDAI] and treatment received) and radiological (number and location of fistulae, extensions, number and location of internal and external openings, fistula activity, presence or absence of perianal abscess and associated proctitis) characteristics of complex perianal fistula (defined according to the American Gastroenterological Association classification) were recorded. Results: Of total 175 patients with CD who attended the gastroenterology clinic during the study period, 27 (15.42%) (mean age 42±15.5 years, 62.96% females and median disease duration four years) had complex perianal fistula and were included in the analysis. The mean PDAI was 5.48±2.53. The median Van Assche Index was 17 (interquartile range [IQR] 13-19). A majority (96.29%) of the fistulae were trans-sphincteric and four (14.81%) fistulae extended into the supralevator space. All fistulae were active on MRI. Concomitant perianal abscess and proctitis were seen in 59.26% (n=16) and 62.96% (n=17) of patients, respectively. Combination therapy with biologics and antibiotics/immune-suppressants were the most commonly prescribed medical therapy. Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment. Conclusion: The cumulative risk of the development of fistulizing perianal CD in a northern Indian cohort was similar to the western populations. Complex perianal fistulae were predominantly trans-sphincteric and commoner in females. MRI evaluation is pivotal for the delineation of fistula anatomy, assessment of disease extent and activity and the evaluation of concomitant perianal abscess and other complications.
MeSH term(s)	Female ; Humans ; Adult ; Middle Aged ; Male ; Infliximab/therapeutic use ; Crohn Disease/drug therapy ; Antibodies, Monoclonal/therapeutic use ; Cohort Studies ; Abscess/complications ; Abscess/drug therapy ; Quality of Life ; Cross-Sectional Studies ; Treatment Outcome ; Retrospective Studies ; Rectal Fistula/diagnostic imaging ; Rectal Fistula/etiology ; Magnetic Resonance Imaging/adverse effects
Chemical Substances	Infliximab (B72HH48FLU) ; Antibodies, Monoclonal
Language	English
Publishing date	2023-08-07
Publishing country	India
Document type	Journal Article
ZDB-ID	632595-6
ISSN	0975-0711 ; 0254-8860
ISSN (online)	0975-0711
ISSN	0254-8860
DOI	10.1007/s12664-023-01399-9
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Article: Clinical spectrum of elderly-onset inflammatory bowel disease in India.

Gupta, Yogesh Kumar / Singh, Arshdeep / Narang, Vikram / Midha, Vandana / Mahajan, Ramit / Mehta, Varun / Singh, Dharmatma / Bansal, Namita / Durairaj, Madeline Vithya Barnaba / Dutta, Amit Kumar / Sood, Ajit

Intestinal research

2022 Volume 21, Issue 2, Page(s) 216–225

Abstract: Background/aims: Inflammatory bowel disease (IBD) is increasingly being recognized in elderly patients. Data on clinical spectrum of elderly-onset IBD patients is lacking from India.: Methods: A cross-sectional retrospective analysis of a ... ...

Abstract	Background/aims: Inflammatory bowel disease (IBD) is increasingly being recognized in elderly patients. Data on clinical spectrum of elderly-onset IBD patients is lacking from India. Methods: A cross-sectional retrospective analysis of a prospectively maintained database of patients diagnosed with IBD was conducted at 2 centers in India. The clinical spectrum of elderly-onset IBD including demographic profile (age and sex), clinical presentation, disease characteristics (disease behavior and severity, extent of disease), and treatment were recorded and compared with adult-onset IBD. Results: During the study period, 3,922 (3,172 ulcerative colitis [UC] and 750 Crohn's disease [CD]) patients with IBD were recorded in the database. A total of 186 patients (4.74%; 116 males [62.36%]) had elderly-onset IBD (69.35% UC and 30.64% CD). Diarrhea, blood in stools, nocturnal frequency and pain abdomen were the commonest presentations for UC, whereas pain abdomen, weight loss and diarrhea were the most frequent symptoms in CD. For both elderly onset UC and CD, majority of the patients had moderately severe disease. Left-sided colitis was the commonest disease location in UC. Isolated ileal disease and inflammatory behavior were the most common disease location and behavior, respectively in CD. 5-Aminosalicylates were the commonest prescribed drug for both elderly onset UC and CD. Thiopurines and biologics were used infrequently. Prevalence of colorectal cancer was higher in elderly onset IBD. Conclusions: Elderly onset IBD is not uncommon in India. Both the elderly onset UC and CD were milder, with no significant differences in disease characteristics (disease extent, location and behavior) when compared to adult-onset IBD. Colorectal cancer was more common in elderly onset IBD.
Language	English
Publishing date	2022-08-08
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3018469-1
ISSN	2288-1956 ; 1598-9100
ISSN (online)	2288-1956
ISSN	1598-9100
DOI	10.5217/ir.2021.00177
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Article: Inflammatory bowel disease (IBD)-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD.

Singh, Arshdeep / Gupta, Yogesh Kumar / Dhaliwal, Ashvin Singh / Kahlon, Bhavjeet Kaur / Bansal, Vasu / Mahajan, Ramit / Mehta, Varun / Singh, Dharmatma / Kaur, Ramandeep / Bansal, Namita / Midha, Vandana / Sood, Ajit

Intestinal research

2022 Volume 21, Issue 3, Page(s) 375–384

Abstract: Background/aims: The inflammatory bowel disease (IBD)-disk is a validated, visual, 10-item, self-administered questionnaire used to evaluate IBD-related disability. The present study aimed to evaluate IBD-disk in assessment of IBD daily life burden and ... ...

Abstract	Background/aims: The inflammatory bowel disease (IBD)-disk is a validated, visual, 10-item, self-administered questionnaire used to evaluate IBD-related disability. The present study aimed to evaluate IBD-disk in assessment of IBD daily life burden and its relation with disease activity. Methods: A cross-sectional study was conducted between June 2021 and December 2021. Patients with IBD were asked to complete the IBD-disk and a visual analogue scale of IBD daily-life burden (scored from 0-10, score >5 indicative of high burden). The internal consistency of IBD-disk, correlation with IBD daily life burden and disease activity (assessed by partial Mayo score and Harvey Bradshaw Index in patients with ulcerative colitis [UC] and Crohn's disease [CD], respectively) and diagnostic performance of IBD-disk to detect high burden were analyzed. Results: Out of the 546 patients (mean age 40.33±13.74 years, 282 [51.6%] males) who completed the IBD-disk, 464 (84.98%) had UC and the remaining (n=82, 15.02%) had CD. A total of 311 patients (291 UC and 20 CD; 56.95%) had active disease. The mean IBD-disk total score and IBD daily life burden were 18.39±15.23 and 2.45±2.02, respectively. The IBD-disk total score correlated strongly with the IBD daily life burden (ρ=0.94, P<0.001), moderately with partial Mayo score (ρ=0.50) and weakly with Harvey Bradshaw Index (ρ=0.34). The IBD-disk total score >30 predicted high IBD daily-life burden. Conclusions: The IBD-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD and can be applied in clinical practice. (Intest Res, Published online).
Language	English
Publishing date	2022-10-18
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3018469-1
ISSN	2288-1956 ; 1598-9100
ISSN (online)	2288-1956
ISSN	1598-9100
DOI	10.5217/ir.2022.00037
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Article ; Online: Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn's Disease.

Singh, Arshdeep / Midha, Vandana / Mahajan, Ramit / Verma, Shruti / Kakkar, Chandan / Grover, Jasmine / Singh, Dharmatma / Kaur, Ramandeep / Masih, Abhishek / Bansal, Namita / Wall, Catherine / Sood, Ajit

Digestive diseases and sciences

2022 Volume 68, Issue 2, Page(s) 580–595

Abstract: Background: Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia.: Aims: To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional ...

Abstract	Background: Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia. Aims: To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional assessment to identify malnutrition. Methods: This was a single-centre cross-sectional analysis of adult patients with IBD [ulcerative colitis (UC) and Crohn's disease (CD)] who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)]. Age- and gender-matched healthy adults served as controls. Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. Results: A total of 406 patients [336 (82.76%) UC and 70 (17.24%) CD; mean age 40.56 ± 13.67 years; 215 (52.95%) males] with IBD and 100 healthy controls (mean age 38.69 ± 10.90 years; 56 (56%) males) were enrolled. The mean BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to controls. The prevalence of malnutrition was similar in UC and CD [24.40% (n = 82) and 28.57% (n = 20), respectively (p = 0.46)]. Thresholds for fat mass in females (15.8 kg) and visceral fat index in males (0.26) were both sensitive and specific to detect malnutrition. The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25 cm and 25.25 cm, and 16.50 mm and 8.50 mm, in females and males, respectively. Conclusion: Malnutrition and sarcopenia were common in patients with IBD, with the prevalence being similar in patients with both UC and CD.
MeSH term(s)	Adult ; Male ; Female ; Humans ; Middle Aged ; Crohn Disease/complications ; Colitis, Ulcerative/complications ; Sarcopenia ; Cross-Sectional Studies ; Prevalence ; Malnutrition/diagnosis ; Nutritional Status ; Inflammatory Bowel Diseases/complications
Language	English
Publishing date	2022-09-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	304250-9
ISSN	1573-2568 ; 0163-2116
ISSN (online)	1573-2568
ISSN	0163-2116
DOI	10.1007/s10620-022-07652-z
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Article ; Online: Correlation between magnetic resonance enterography and ileo-colonoscopy for assessment of disease activity in terminal ileal Crohn's disease.

Kakkar, Chandan / Singh, Arshdeep / Mahajan, Ramit / Midha, Vandana / Goyal, Shriya / Narang, Vikram / Gupta, Kamini / Singh, Dharmatma / Bansal, Namita / Saggar, Kavita / Sood, Ajit

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

2022 Volume 41, Issue 5, Page(s) 465–474

Abstract: Background: Magnetic resonance enterography (MRE) has emerged as a novel tool for the assessment of disease activity in Crohn's disease (CD). Real world data from Indian subcontinent on performance of MRE in terminal ileal CD are lacking.: Methods: ... ...

Abstract	Background: Magnetic resonance enterography (MRE) has emerged as a novel tool for the assessment of disease activity in Crohn's disease (CD). Real world data from Indian subcontinent on performance of MRE in terminal ileal CD are lacking. Methods: Retrospective analysis of patients with terminal ileal CD who underwent both ileo-colonoscopy and MRE was performed. Ileo-colonoscopy was considered the gold standard for assessment of disease activity. On ileo-colonoscopy, a simple endoscopic score for Crohn's disease (SES-CD) ≥2 was considered active disease; presence of ulcers indicated severe disease. MRE scoring of the disease activity was performed using magnetic resonance index of activity (MARIA) and simplified MARIA (MARIAs). The measure of agreement between ileo-colonoscopy and MRE and comparison of MARIA and MARIAs for assessment of disease activity and sensitivity of MRE to detect mucosal ulcerations were calculated. Results: Seventy patients with terminal ileal CD (mean age 40.74±15.56 years; 71.4% males [n=50]) were evaluated. The sensitivities of MARIA and MARIAs scores to detect active disease were 0.76 and 0.84, respectively. The area under the receiver operating characteristic curve (AUROC) for detecting severe disease was 0.836 (p<0.0001) for MARIA and 0.861 (p<0.0001) for MARIAs. For mild active disease, there was no agreement between SES-CD and MARIA or MARIAs; however, for severe disease, the agreement was fair and moderate for MARIA and MARIAs, respectively. MARIA and MARIAs were comparable for identification of active and severe disease (κ 0.759, p<0.0001 and κ 0.840, p<0.0001, respectively). MRE was 68.18% sensitive to detect mucosal ulcers. Conclusion: MRE is a reliable and sensitive tool for detection of endoscopically severe, but not mild, terminal ileal CD.
MeSH term(s)	Male ; Humans ; Adult ; Middle Aged ; Female ; Crohn Disease/pathology ; Retrospective Studies ; Ulcer/diagnostic imaging ; Ulcer/etiology ; Severity of Illness Index ; Colonoscopy ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy
Language	English
Publishing date	2022-11-11
Publishing country	India
Document type	Journal Article
ZDB-ID	632595-6
ISSN	0975-0711 ; 0254-8860
ISSN (online)	0975-0711
ISSN	0254-8860
DOI	10.1007/s12664-022-01242-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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