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Home-based cognitive-behavioral therapy aids IBS
ORLANDO – A 10-week program of home-based cognitive-behavioral therapy led to significantly better improvements in irritable bowel syndrome than did a control education program in a prospective, randomized, single-center trial with 436 patients.
Study data also showed that the improvements produced by the home-based cognitive-behavioral therapy (CBT) program were durable, persisting in 63% of high responders out to 6 months after treatment, Jeffrey M. Lackner, PsyD, said at the World Congress of Gastroenterology at ACG 2017.
He suggested that the minimal contact, home-based approach actually enhanced the efficacy of the CBT training that patients received.
“Patients are given tasks to carry out. Responsibility is placed on them. It changes the dynamic between the clinician and patient,” Dr. Lackner said. Skills patients learned during the minimal contact sessions included self-monitoring, muscle relaxation, worry control, problem solving, and modification of core beliefs.
The study enrolled adults up to 70 years old with at least moderately severe IBS symptoms at least twice weekly who met the Rome III diagnostic criteria. When patients performed a self-assessment 2 weeks after the end of the 10-week intervention, 61% of those in the home-based CBT program group rated themselves as much or very much improved, compared with 55% of patients who received standard CBT and 44% of patients in the control group, who attended generic education sessions. The differences between each of the two CBT groups and the controls were statistically significant. Patient assessments performed by blinded gastroenterologists rated 56% of the home-based CBT patients as much or very much improved, compared with 51% of those who received standard CBT and 40% of the controls.
When reassessed 3 and 6 months later, the edge that home-based CBT patients showed over the control patients persisted. After 6 months off treatment, 57% of those who received home-based CBT continued to say they were much or very much improved over their baseline status, compared with 47% of the controls.
Dr. Lackner’s analysis also examined whether patients treated with CBT, either standard or home based, went into remission. He defined remission as having no or only mild symptoms during an assessment 2 weeks after the end of the intervention and then maintaining this response out to 6 months. No or only mild symptoms were reported by 35% of all CBT patients soon after treatment, compared with 23% of the controls. Six months later, 63% of the high-responding patients on CBT and 52% of the high responders with education maintained their high response.
“CBT appears to have an enduring effect that protects against subsequent relapse and recurrence in a sizable subsample of patients,” he concluded. The findings “suggest possible disease modification by CBT.”
Dr. Lackner had no relevant financial disclosures.
[email protected]
On Twitter @mitchelzoler
ORLANDO – A 10-week program of home-based cognitive-behavioral therapy led to significantly better improvements in irritable bowel syndrome than did a control education program in a prospective, randomized, single-center trial with 436 patients.
Study data also showed that the improvements produced by the home-based cognitive-behavioral therapy (CBT) program were durable, persisting in 63% of high responders out to 6 months after treatment, Jeffrey M. Lackner, PsyD, said at the World Congress of Gastroenterology at ACG 2017.
He suggested that the minimal contact, home-based approach actually enhanced the efficacy of the CBT training that patients received.
“Patients are given tasks to carry out. Responsibility is placed on them. It changes the dynamic between the clinician and patient,” Dr. Lackner said. Skills patients learned during the minimal contact sessions included self-monitoring, muscle relaxation, worry control, problem solving, and modification of core beliefs.
The study enrolled adults up to 70 years old with at least moderately severe IBS symptoms at least twice weekly who met the Rome III diagnostic criteria. When patients performed a self-assessment 2 weeks after the end of the 10-week intervention, 61% of those in the home-based CBT program group rated themselves as much or very much improved, compared with 55% of patients who received standard CBT and 44% of patients in the control group, who attended generic education sessions. The differences between each of the two CBT groups and the controls were statistically significant. Patient assessments performed by blinded gastroenterologists rated 56% of the home-based CBT patients as much or very much improved, compared with 51% of those who received standard CBT and 40% of the controls.
When reassessed 3 and 6 months later, the edge that home-based CBT patients showed over the control patients persisted. After 6 months off treatment, 57% of those who received home-based CBT continued to say they were much or very much improved over their baseline status, compared with 47% of the controls.
Dr. Lackner’s analysis also examined whether patients treated with CBT, either standard or home based, went into remission. He defined remission as having no or only mild symptoms during an assessment 2 weeks after the end of the intervention and then maintaining this response out to 6 months. No or only mild symptoms were reported by 35% of all CBT patients soon after treatment, compared with 23% of the controls. Six months later, 63% of the high-responding patients on CBT and 52% of the high responders with education maintained their high response.
“CBT appears to have an enduring effect that protects against subsequent relapse and recurrence in a sizable subsample of patients,” he concluded. The findings “suggest possible disease modification by CBT.”
Dr. Lackner had no relevant financial disclosures.
[email protected]
On Twitter @mitchelzoler
ORLANDO – A 10-week program of home-based cognitive-behavioral therapy led to significantly better improvements in irritable bowel syndrome than did a control education program in a prospective, randomized, single-center trial with 436 patients.
Study data also showed that the improvements produced by the home-based cognitive-behavioral therapy (CBT) program were durable, persisting in 63% of high responders out to 6 months after treatment, Jeffrey M. Lackner, PsyD, said at the World Congress of Gastroenterology at ACG 2017.
He suggested that the minimal contact, home-based approach actually enhanced the efficacy of the CBT training that patients received.
“Patients are given tasks to carry out. Responsibility is placed on them. It changes the dynamic between the clinician and patient,” Dr. Lackner said. Skills patients learned during the minimal contact sessions included self-monitoring, muscle relaxation, worry control, problem solving, and modification of core beliefs.
The study enrolled adults up to 70 years old with at least moderately severe IBS symptoms at least twice weekly who met the Rome III diagnostic criteria. When patients performed a self-assessment 2 weeks after the end of the 10-week intervention, 61% of those in the home-based CBT program group rated themselves as much or very much improved, compared with 55% of patients who received standard CBT and 44% of patients in the control group, who attended generic education sessions. The differences between each of the two CBT groups and the controls were statistically significant. Patient assessments performed by blinded gastroenterologists rated 56% of the home-based CBT patients as much or very much improved, compared with 51% of those who received standard CBT and 40% of the controls.
When reassessed 3 and 6 months later, the edge that home-based CBT patients showed over the control patients persisted. After 6 months off treatment, 57% of those who received home-based CBT continued to say they were much or very much improved over their baseline status, compared with 47% of the controls.
Dr. Lackner’s analysis also examined whether patients treated with CBT, either standard or home based, went into remission. He defined remission as having no or only mild symptoms during an assessment 2 weeks after the end of the intervention and then maintaining this response out to 6 months. No or only mild symptoms were reported by 35% of all CBT patients soon after treatment, compared with 23% of the controls. Six months later, 63% of the high-responding patients on CBT and 52% of the high responders with education maintained their high response.
“CBT appears to have an enduring effect that protects against subsequent relapse and recurrence in a sizable subsample of patients,” he concluded. The findings “suggest possible disease modification by CBT.”
Dr. Lackner had no relevant financial disclosures.
[email protected]
On Twitter @mitchelzoler
AT THE WORLD CONGRESS OF GASTROENTEROLOGY
Key clinical point:
Major finding: After completion of a 10-week treatment, 61% of CBT patients and 44% of controls showed either much or very much improvement.
Data source: A prospective, randomized, single-center study with 436 patients.
Disclosures: Dr. Lackner had no relevant financial disclosures.
Vedolizumab improves social satisfaction among IBD patients
ORLANDO – Vedolizumab therapy was associated with significant improvements in social satisfaction scores and steroid-free remission rates in biologic-naive patients with inflammatory bowel diseases (IBD) in a large prospective cohort.
The Internet-based cohort – Crohn’s & Colitis Foundation of America (CCFA) Partners – includes more than 15,000 IBD patients. For the current study, researchers evaluated 348 participants with Crohn’s disease or ulcerative colitis who initiated vedolizumab therapy between 2014 and 2017 and who had at least 6 months’ follow-up.
The difference in social satisfaction T scores was also improved among biologic-exposed patients (45.8 vs. 47.2, respectively), but the difference did not reach statistical significance, said Dr. Long of the University of North Carolina, Chapel Hill.
Improvements were also seen for numerous other measures, including anxiety, depression, fatigue, pain interference, and sleep disturbance – for both biologic-naive and -exposed patients – but the differences were not significant.
“But these [patient-reported outcomes] are clearly improving,” she said, explaining that trends toward minimally clinically important differences were seen for multiple measures.
As for steroid-free remission, the rate improved from 20% to 45% from baseline to 6-12 months among biologic-naive patients, and from 24% to 30% among biologic-exposed patients, Dr. Long said.
Vedolizumab in this real-world cohort was predominantly used in patients with refractory disease and prior biologic exposure.
The CCFA cohort provides an important glimpse into the effects of vedolizumab on patient-reported outcomes in real-world settings, Dr. Long said, noting that while vedolizumab has demonstrated important quality of life improvements in IBD clinical trials, little has been known about the effects of vedolizumab on quality of life in real-world settings.
The finding with respect to social satisfaction is particularly important, she said.
“These are sick patients. [These scores show that] they’re able to leave the house, they’re able to do the things they want to do,” she said. “It has made a big impact to be able to address this.”
This study was funded by Takeda Pharmaceuticals USA. CCFA Partners is supported by the Crohn’s & Colitis Foundation and the Patient Centered Outcomes Research Institute.
ORLANDO – Vedolizumab therapy was associated with significant improvements in social satisfaction scores and steroid-free remission rates in biologic-naive patients with inflammatory bowel diseases (IBD) in a large prospective cohort.
The Internet-based cohort – Crohn’s & Colitis Foundation of America (CCFA) Partners – includes more than 15,000 IBD patients. For the current study, researchers evaluated 348 participants with Crohn’s disease or ulcerative colitis who initiated vedolizumab therapy between 2014 and 2017 and who had at least 6 months’ follow-up.
The difference in social satisfaction T scores was also improved among biologic-exposed patients (45.8 vs. 47.2, respectively), but the difference did not reach statistical significance, said Dr. Long of the University of North Carolina, Chapel Hill.
Improvements were also seen for numerous other measures, including anxiety, depression, fatigue, pain interference, and sleep disturbance – for both biologic-naive and -exposed patients – but the differences were not significant.
“But these [patient-reported outcomes] are clearly improving,” she said, explaining that trends toward minimally clinically important differences were seen for multiple measures.
As for steroid-free remission, the rate improved from 20% to 45% from baseline to 6-12 months among biologic-naive patients, and from 24% to 30% among biologic-exposed patients, Dr. Long said.
Vedolizumab in this real-world cohort was predominantly used in patients with refractory disease and prior biologic exposure.
The CCFA cohort provides an important glimpse into the effects of vedolizumab on patient-reported outcomes in real-world settings, Dr. Long said, noting that while vedolizumab has demonstrated important quality of life improvements in IBD clinical trials, little has been known about the effects of vedolizumab on quality of life in real-world settings.
The finding with respect to social satisfaction is particularly important, she said.
“These are sick patients. [These scores show that] they’re able to leave the house, they’re able to do the things they want to do,” she said. “It has made a big impact to be able to address this.”
This study was funded by Takeda Pharmaceuticals USA. CCFA Partners is supported by the Crohn’s & Colitis Foundation and the Patient Centered Outcomes Research Institute.
ORLANDO – Vedolizumab therapy was associated with significant improvements in social satisfaction scores and steroid-free remission rates in biologic-naive patients with inflammatory bowel diseases (IBD) in a large prospective cohort.
The Internet-based cohort – Crohn’s & Colitis Foundation of America (CCFA) Partners – includes more than 15,000 IBD patients. For the current study, researchers evaluated 348 participants with Crohn’s disease or ulcerative colitis who initiated vedolizumab therapy between 2014 and 2017 and who had at least 6 months’ follow-up.
The difference in social satisfaction T scores was also improved among biologic-exposed patients (45.8 vs. 47.2, respectively), but the difference did not reach statistical significance, said Dr. Long of the University of North Carolina, Chapel Hill.
Improvements were also seen for numerous other measures, including anxiety, depression, fatigue, pain interference, and sleep disturbance – for both biologic-naive and -exposed patients – but the differences were not significant.
“But these [patient-reported outcomes] are clearly improving,” she said, explaining that trends toward minimally clinically important differences were seen for multiple measures.
As for steroid-free remission, the rate improved from 20% to 45% from baseline to 6-12 months among biologic-naive patients, and from 24% to 30% among biologic-exposed patients, Dr. Long said.
Vedolizumab in this real-world cohort was predominantly used in patients with refractory disease and prior biologic exposure.
The CCFA cohort provides an important glimpse into the effects of vedolizumab on patient-reported outcomes in real-world settings, Dr. Long said, noting that while vedolizumab has demonstrated important quality of life improvements in IBD clinical trials, little has been known about the effects of vedolizumab on quality of life in real-world settings.
The finding with respect to social satisfaction is particularly important, she said.
“These are sick patients. [These scores show that] they’re able to leave the house, they’re able to do the things they want to do,” she said. “It has made a big impact to be able to address this.”
This study was funded by Takeda Pharmaceuticals USA. CCFA Partners is supported by the Crohn’s & Colitis Foundation and the Patient Centered Outcomes Research Institute.
AT THE WORLD CONGRESS OF GASTROENTEROLOGY
Key clinical point:
Major finding: T scores in biologic-naive patients improved significantly (46.1 before treatment vs. 51.0 after 6 months).
Data source: A prospective cohort study of 348 patients.
Disclosures: This study was funded by Takeda Pharmaceuticals USA. CCFA Partners is supported by the Crohn’s and Colitis Foundation and the Patient Centered Outcomes Research Institute.
VIDEO: IBD epidemiology provides clues into disease underpinnings
ORLANDO – The incidence of Crohn’s disease and ulcerative colitis has stabilized in the Western world, but is rising rapidly in newly industrialized countries, according to a systematic review of population-based studies.
The findings could provide important new insights into the environmental, genetic, and microbiome-related factors and interactions that form the underpinnings of IBD, Gilaad Kaplan, MD, of the University of Calgary (Alta.) said at the World Congress of Gastroenterology at ACG 2017.
In turn, that information could lead to approaches to reduce IBD incidence, he said in a video interview.
It has been known that Crohn’s disease and ulcerative colitis are “modern diseases of modern times,” but few studies have addressed the epidemiology of IBD in newly industrialized countries in Asia, Africa, and South America, he said.
“We see a pattern that as newly industrialized countries transition toward a westernized society, IBD emerges and its incidence rises, and there are many different explanations for that,” he said, noting that in part, the increase is due to improved health care infrastructure and advances in adoption of medical technology that lead to better identification of new cases.
“But probably one of the most important factors is that there are environmental exposures linked to the westernization of society that are creating this pressure that’s driving incidence of IBD up in many of the countries of the world,” he said. “I think if we do a lot more research focused on how environment influences microbiome, we might start to see things we could do that could potentially stem the tide of IBD.”
Dr. Kaplan reported having no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ORLANDO – The incidence of Crohn’s disease and ulcerative colitis has stabilized in the Western world, but is rising rapidly in newly industrialized countries, according to a systematic review of population-based studies.
The findings could provide important new insights into the environmental, genetic, and microbiome-related factors and interactions that form the underpinnings of IBD, Gilaad Kaplan, MD, of the University of Calgary (Alta.) said at the World Congress of Gastroenterology at ACG 2017.
In turn, that information could lead to approaches to reduce IBD incidence, he said in a video interview.
It has been known that Crohn’s disease and ulcerative colitis are “modern diseases of modern times,” but few studies have addressed the epidemiology of IBD in newly industrialized countries in Asia, Africa, and South America, he said.
“We see a pattern that as newly industrialized countries transition toward a westernized society, IBD emerges and its incidence rises, and there are many different explanations for that,” he said, noting that in part, the increase is due to improved health care infrastructure and advances in adoption of medical technology that lead to better identification of new cases.
“But probably one of the most important factors is that there are environmental exposures linked to the westernization of society that are creating this pressure that’s driving incidence of IBD up in many of the countries of the world,” he said. “I think if we do a lot more research focused on how environment influences microbiome, we might start to see things we could do that could potentially stem the tide of IBD.”
Dr. Kaplan reported having no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ORLANDO – The incidence of Crohn’s disease and ulcerative colitis has stabilized in the Western world, but is rising rapidly in newly industrialized countries, according to a systematic review of population-based studies.
The findings could provide important new insights into the environmental, genetic, and microbiome-related factors and interactions that form the underpinnings of IBD, Gilaad Kaplan, MD, of the University of Calgary (Alta.) said at the World Congress of Gastroenterology at ACG 2017.
In turn, that information could lead to approaches to reduce IBD incidence, he said in a video interview.
It has been known that Crohn’s disease and ulcerative colitis are “modern diseases of modern times,” but few studies have addressed the epidemiology of IBD in newly industrialized countries in Asia, Africa, and South America, he said.
“We see a pattern that as newly industrialized countries transition toward a westernized society, IBD emerges and its incidence rises, and there are many different explanations for that,” he said, noting that in part, the increase is due to improved health care infrastructure and advances in adoption of medical technology that lead to better identification of new cases.
“But probably one of the most important factors is that there are environmental exposures linked to the westernization of society that are creating this pressure that’s driving incidence of IBD up in many of the countries of the world,” he said. “I think if we do a lot more research focused on how environment influences microbiome, we might start to see things we could do that could potentially stem the tide of IBD.”
Dr. Kaplan reported having no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE 13TH WORLD CONGRESS OF GASTROENTEROLOGY
More IBD remissions with higher induction vedolizumab levels
ORLANDO – Higher vedolizumab levels during induction were associated with better responses to therapy at 22 weeks in patients with inflammatory bowel diseases in a prospective cohort study.
The findings suggest that therapeutic drug monitoring and early optimization could play an important role in improving outcomes in patients with Crohn’s disease or ulcerative colitis who are receiving treatment with the monoclonal antibody, Andres J. Yarur, MD, reported in a poster at the World Congress of Gastroenterology at ACG 2017.
Patients with a VTL of 24 mcg/mL or greater at week 2, and 10.6 mcg/mL or greater at week 6, were more likely to be in remission at week 22 (odds ratios, 5 and 13.5, respectively).
Of note, VTLs were numerically higher in patients receiving combination therapy, compared with those receiving vedolizumab monotherapy, but the difference was statistically significant only at week 2 (24.7 vs. 21.8 mcg/mL, respectively), he said.
Similar correlations between trough levels and response rates have been seen with other biologics, but data on such correlations has been lacking for vedolizumab. Since some patients develop primary or secondary nonresponse, Dr. Yarur and his colleagues assessed the relationship between serum VTLs during induction and disease remission after 22 weeks, he explained in an interview.
They also investigated the presence of antibodies to vedolizumab .
The primary outcome of deep remission at 22 weeks was defined as normal C-reactive protein levels and Simple Endoscopic Score for Crohn’s Disease of 2 or less in patients with Crohn’s disease, and Mayo Endoscopic score of 1 or less in patients with ulcerative colitis, plus clinical remission (Harvey-Bradshaw Index score of less than 5 in patients with Crohn’s disease and Mayo Clinical Score of less than 3 in ulcerative colitis).
Three patients developed antibodies to vedolizumab during induction, but the antibodies were undetectable by week 14 in all three, he said.
“The findings open the question of whether higher doses during induction will improve the rate of remission,” he said, noting that such early optimization is currently being evaluated in ongoing studies.
Dr. Yarur reported having no relevant disclosures.
ORLANDO – Higher vedolizumab levels during induction were associated with better responses to therapy at 22 weeks in patients with inflammatory bowel diseases in a prospective cohort study.
The findings suggest that therapeutic drug monitoring and early optimization could play an important role in improving outcomes in patients with Crohn’s disease or ulcerative colitis who are receiving treatment with the monoclonal antibody, Andres J. Yarur, MD, reported in a poster at the World Congress of Gastroenterology at ACG 2017.
Patients with a VTL of 24 mcg/mL or greater at week 2, and 10.6 mcg/mL or greater at week 6, were more likely to be in remission at week 22 (odds ratios, 5 and 13.5, respectively).
Of note, VTLs were numerically higher in patients receiving combination therapy, compared with those receiving vedolizumab monotherapy, but the difference was statistically significant only at week 2 (24.7 vs. 21.8 mcg/mL, respectively), he said.
Similar correlations between trough levels and response rates have been seen with other biologics, but data on such correlations has been lacking for vedolizumab. Since some patients develop primary or secondary nonresponse, Dr. Yarur and his colleagues assessed the relationship between serum VTLs during induction and disease remission after 22 weeks, he explained in an interview.
They also investigated the presence of antibodies to vedolizumab .
The primary outcome of deep remission at 22 weeks was defined as normal C-reactive protein levels and Simple Endoscopic Score for Crohn’s Disease of 2 or less in patients with Crohn’s disease, and Mayo Endoscopic score of 1 or less in patients with ulcerative colitis, plus clinical remission (Harvey-Bradshaw Index score of less than 5 in patients with Crohn’s disease and Mayo Clinical Score of less than 3 in ulcerative colitis).
Three patients developed antibodies to vedolizumab during induction, but the antibodies were undetectable by week 14 in all three, he said.
“The findings open the question of whether higher doses during induction will improve the rate of remission,” he said, noting that such early optimization is currently being evaluated in ongoing studies.
Dr. Yarur reported having no relevant disclosures.
ORLANDO – Higher vedolizumab levels during induction were associated with better responses to therapy at 22 weeks in patients with inflammatory bowel diseases in a prospective cohort study.
The findings suggest that therapeutic drug monitoring and early optimization could play an important role in improving outcomes in patients with Crohn’s disease or ulcerative colitis who are receiving treatment with the monoclonal antibody, Andres J. Yarur, MD, reported in a poster at the World Congress of Gastroenterology at ACG 2017.
Patients with a VTL of 24 mcg/mL or greater at week 2, and 10.6 mcg/mL or greater at week 6, were more likely to be in remission at week 22 (odds ratios, 5 and 13.5, respectively).
Of note, VTLs were numerically higher in patients receiving combination therapy, compared with those receiving vedolizumab monotherapy, but the difference was statistically significant only at week 2 (24.7 vs. 21.8 mcg/mL, respectively), he said.
Similar correlations between trough levels and response rates have been seen with other biologics, but data on such correlations has been lacking for vedolizumab. Since some patients develop primary or secondary nonresponse, Dr. Yarur and his colleagues assessed the relationship between serum VTLs during induction and disease remission after 22 weeks, he explained in an interview.
They also investigated the presence of antibodies to vedolizumab .
The primary outcome of deep remission at 22 weeks was defined as normal C-reactive protein levels and Simple Endoscopic Score for Crohn’s Disease of 2 or less in patients with Crohn’s disease, and Mayo Endoscopic score of 1 or less in patients with ulcerative colitis, plus clinical remission (Harvey-Bradshaw Index score of less than 5 in patients with Crohn’s disease and Mayo Clinical Score of less than 3 in ulcerative colitis).
Three patients developed antibodies to vedolizumab during induction, but the antibodies were undetectable by week 14 in all three, he said.
“The findings open the question of whether higher doses during induction will improve the rate of remission,” he said, noting that such early optimization is currently being evaluated in ongoing studies.
Dr. Yarur reported having no relevant disclosures.
AT THE WORLD CONGRESS OF GASTROENTEROLOGY
Key clinical point:
Major finding: Vedolizumab trough levels at weeks 2 and 6 were higher among those who achieved remission at week 22, compared with those who did not (25 vs. 21.8 mcg/mL and 26.1 vs. 12.7 mcg/mL, respectively).
Data source: A prospective cohort study of 45 patients.
Disclosures: Dr. Yarur reported having no relevant disclosures.
Simple rule boosted yield of molecular tests for enteric pathogens
SAN DIEGO – For adult outpatients with diarrhea, consider limiting molecular testing for enteric pathogens to cases in which patients are immunocompromised or have abdominal pain or fever without vomiting, said Stephen Clark, MD.
“This simple clinical decision rule would reduce testing by 43% while retaining a high sensitivity for clinically relevant infections,” Dr. Clark said at an annual meeting on infectious diseases. In a single-center retrospective cohort study, the decision rule covered 96% of patients with molecular evidence of clinically relevant pathogens.
Several Food and Drug and Administration–approved molecular diagnostic panels for enteric pathogens have become available in the United States during the past 4 years. These panels are fast and sensitive, but costly and not clinically relevant unless they detect a pathogen that merits a change in treatment, such as titrating immunosuppressive drugs or prescribing a course of antimicrobial therapy, said Dr. Clark, a third-year resident at the department of medicine at the University of Virginia in Charlottesville.
Physicians at the University of Virginia often order the FilmArray Gastrointestinal Panel (Biofire Diagnostics) for adult outpatients, especially if they have persistent diarrhea, Dr. Clark said. However, medical records from 452 tested patients showed that only 88 (20%) tested positive for an enteric pathogen and only 4% had an infection clearly meriting antimicrobial therapy. Therefore, the researchers sought predictors of clinically relevant FilmArray results.
Among 376 immunocompetent patients in this cohort, only 12 (3%) had a treatable pathogen detected. None of these 12 patients reported vomiting, while 11 (92%) reported fever or abdominal pain without vomiting, compared with only 47% of immunocompetent patients with no treatable pathogen (P = .002). For immunocompetent patients, the combination of subjective fever or abdominal pain without vomiting was the only demographic or clinical predictor of a clinically relevant positive test result, Dr. Clark said.
Importantly, the FilmArray GI panel showed a much higher clinical yield (about 20%) in immunocompromised patients, who often lacked clinical signs of gastrointestinal infection. “Thinking about this overall, we would recommend testing if patients are either immunocompromised, or if they have abdominal pain or fever in the absence of vomiting,” Dr. Clark said. For this cohort, this decision rule had a sensitivity of 96% (95% confidence interval [CI], 81%-100%) and a negative predictive value of 99% (95% CI, 97%-100%). Specificity was only 45% (95% CI, 41%-51%), but “the aim of this rule was more to help clinicians think about whether it’s possible that there could be a detection, instead of pinpointing what it might be,” Dr. Clark said.
Applying guidelines from the American College of Gastroenterology did not increase testing efficiency, Dr. Clark said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers are now reviewing another 6 months of medical records to create a validation cohort for the decision rule.
Dr. Clark and his associates reported having no conflicts of interest.
SAN DIEGO – For adult outpatients with diarrhea, consider limiting molecular testing for enteric pathogens to cases in which patients are immunocompromised or have abdominal pain or fever without vomiting, said Stephen Clark, MD.
“This simple clinical decision rule would reduce testing by 43% while retaining a high sensitivity for clinically relevant infections,” Dr. Clark said at an annual meeting on infectious diseases. In a single-center retrospective cohort study, the decision rule covered 96% of patients with molecular evidence of clinically relevant pathogens.
Several Food and Drug and Administration–approved molecular diagnostic panels for enteric pathogens have become available in the United States during the past 4 years. These panels are fast and sensitive, but costly and not clinically relevant unless they detect a pathogen that merits a change in treatment, such as titrating immunosuppressive drugs or prescribing a course of antimicrobial therapy, said Dr. Clark, a third-year resident at the department of medicine at the University of Virginia in Charlottesville.
Physicians at the University of Virginia often order the FilmArray Gastrointestinal Panel (Biofire Diagnostics) for adult outpatients, especially if they have persistent diarrhea, Dr. Clark said. However, medical records from 452 tested patients showed that only 88 (20%) tested positive for an enteric pathogen and only 4% had an infection clearly meriting antimicrobial therapy. Therefore, the researchers sought predictors of clinically relevant FilmArray results.
Among 376 immunocompetent patients in this cohort, only 12 (3%) had a treatable pathogen detected. None of these 12 patients reported vomiting, while 11 (92%) reported fever or abdominal pain without vomiting, compared with only 47% of immunocompetent patients with no treatable pathogen (P = .002). For immunocompetent patients, the combination of subjective fever or abdominal pain without vomiting was the only demographic or clinical predictor of a clinically relevant positive test result, Dr. Clark said.
Importantly, the FilmArray GI panel showed a much higher clinical yield (about 20%) in immunocompromised patients, who often lacked clinical signs of gastrointestinal infection. “Thinking about this overall, we would recommend testing if patients are either immunocompromised, or if they have abdominal pain or fever in the absence of vomiting,” Dr. Clark said. For this cohort, this decision rule had a sensitivity of 96% (95% confidence interval [CI], 81%-100%) and a negative predictive value of 99% (95% CI, 97%-100%). Specificity was only 45% (95% CI, 41%-51%), but “the aim of this rule was more to help clinicians think about whether it’s possible that there could be a detection, instead of pinpointing what it might be,” Dr. Clark said.
Applying guidelines from the American College of Gastroenterology did not increase testing efficiency, Dr. Clark said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers are now reviewing another 6 months of medical records to create a validation cohort for the decision rule.
Dr. Clark and his associates reported having no conflicts of interest.
SAN DIEGO – For adult outpatients with diarrhea, consider limiting molecular testing for enteric pathogens to cases in which patients are immunocompromised or have abdominal pain or fever without vomiting, said Stephen Clark, MD.
“This simple clinical decision rule would reduce testing by 43% while retaining a high sensitivity for clinically relevant infections,” Dr. Clark said at an annual meeting on infectious diseases. In a single-center retrospective cohort study, the decision rule covered 96% of patients with molecular evidence of clinically relevant pathogens.
Several Food and Drug and Administration–approved molecular diagnostic panels for enteric pathogens have become available in the United States during the past 4 years. These panels are fast and sensitive, but costly and not clinically relevant unless they detect a pathogen that merits a change in treatment, such as titrating immunosuppressive drugs or prescribing a course of antimicrobial therapy, said Dr. Clark, a third-year resident at the department of medicine at the University of Virginia in Charlottesville.
Physicians at the University of Virginia often order the FilmArray Gastrointestinal Panel (Biofire Diagnostics) for adult outpatients, especially if they have persistent diarrhea, Dr. Clark said. However, medical records from 452 tested patients showed that only 88 (20%) tested positive for an enteric pathogen and only 4% had an infection clearly meriting antimicrobial therapy. Therefore, the researchers sought predictors of clinically relevant FilmArray results.
Among 376 immunocompetent patients in this cohort, only 12 (3%) had a treatable pathogen detected. None of these 12 patients reported vomiting, while 11 (92%) reported fever or abdominal pain without vomiting, compared with only 47% of immunocompetent patients with no treatable pathogen (P = .002). For immunocompetent patients, the combination of subjective fever or abdominal pain without vomiting was the only demographic or clinical predictor of a clinically relevant positive test result, Dr. Clark said.
Importantly, the FilmArray GI panel showed a much higher clinical yield (about 20%) in immunocompromised patients, who often lacked clinical signs of gastrointestinal infection. “Thinking about this overall, we would recommend testing if patients are either immunocompromised, or if they have abdominal pain or fever in the absence of vomiting,” Dr. Clark said. For this cohort, this decision rule had a sensitivity of 96% (95% confidence interval [CI], 81%-100%) and a negative predictive value of 99% (95% CI, 97%-100%). Specificity was only 45% (95% CI, 41%-51%), but “the aim of this rule was more to help clinicians think about whether it’s possible that there could be a detection, instead of pinpointing what it might be,” Dr. Clark said.
Applying guidelines from the American College of Gastroenterology did not increase testing efficiency, Dr. Clark said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers are now reviewing another 6 months of medical records to create a validation cohort for the decision rule.
Dr. Clark and his associates reported having no conflicts of interest.
AT IDWEEK 2017
Key clinical point:
Major finding: This approach would have identified 26 of 27 (96%) infections of clinically relevant pathogens, while cutting testing by 43%.
Data source: A single-center retrospective study of 452 adult outpatients with diarrhea.
Disclosures: Dr. Clark and his associates reported having no conflicts of interest.
FISH and PCR aid in diagnosis of human intestinal spirochetosis
Fluorescence in situ hybridization (FISH) combined with 16S rRNA gene amplification and sequencing allowed researchers to make a definitive diagnosis of human intestinal spirochetosis (HIS) and further identify the causative pathogens.
Pablo Rojas, PhD, of Charité Universitätsmedizin Berlin, and his colleagues evaluated 149 paraffin-embedded or native intestinal biopsies from 91 consecutive patients with histologically diagnosed HIS. The reasons for endoscopy and histological investigation included chronic diarrhea, cancer/adenoma screening, inflammatory bowel disease, and endoscopic detection of polyps or colitis. In all, 12 patients were HIV-positive.
The researchers used a FISH probe to confirm Brachyspira spp. HIS for 77 of the 91 patients. A polymerase chain reaction (PCR) analysis of part of the bacterial 16S rRNA gene confirmed the presence of Brachyspira spp. in 75 patients. The sequencing allowed the researchers to drill down on the pathogen, identifying both the B. aalborgi and B. pilosicoli species lineage among the samples.
There were 14 cases in which researchers could not confirm the diagnosis of HIS with either FISH or RNA sequencing, but they noted that these cases were likely misdiagnosed by histopathology.
“FISH at the interface of histopathology and molecular biology is a valuable diagnostic tool for the diagnosis of HIS. The bright FISH signal in most cases already allowed rapid localization of Brachyspira spp. at 400 magnification. All samples that could be tested via PCR were consistent with the FISH results, whereas 14 cases were diagnosed false positive by histopathology,” the researchers wrote. “On these grounds, we propose to include FISH for the diagnosis and follow-up observation of HIS in routine practice.”
Find the full study in Anaerobe (2017 Oct. doi: 10.1016/j.anaerobe.2017.03.012).
Fluorescence in situ hybridization (FISH) combined with 16S rRNA gene amplification and sequencing allowed researchers to make a definitive diagnosis of human intestinal spirochetosis (HIS) and further identify the causative pathogens.
Pablo Rojas, PhD, of Charité Universitätsmedizin Berlin, and his colleagues evaluated 149 paraffin-embedded or native intestinal biopsies from 91 consecutive patients with histologically diagnosed HIS. The reasons for endoscopy and histological investigation included chronic diarrhea, cancer/adenoma screening, inflammatory bowel disease, and endoscopic detection of polyps or colitis. In all, 12 patients were HIV-positive.
The researchers used a FISH probe to confirm Brachyspira spp. HIS for 77 of the 91 patients. A polymerase chain reaction (PCR) analysis of part of the bacterial 16S rRNA gene confirmed the presence of Brachyspira spp. in 75 patients. The sequencing allowed the researchers to drill down on the pathogen, identifying both the B. aalborgi and B. pilosicoli species lineage among the samples.
There were 14 cases in which researchers could not confirm the diagnosis of HIS with either FISH or RNA sequencing, but they noted that these cases were likely misdiagnosed by histopathology.
“FISH at the interface of histopathology and molecular biology is a valuable diagnostic tool for the diagnosis of HIS. The bright FISH signal in most cases already allowed rapid localization of Brachyspira spp. at 400 magnification. All samples that could be tested via PCR were consistent with the FISH results, whereas 14 cases were diagnosed false positive by histopathology,” the researchers wrote. “On these grounds, we propose to include FISH for the diagnosis and follow-up observation of HIS in routine practice.”
Find the full study in Anaerobe (2017 Oct. doi: 10.1016/j.anaerobe.2017.03.012).
Fluorescence in situ hybridization (FISH) combined with 16S rRNA gene amplification and sequencing allowed researchers to make a definitive diagnosis of human intestinal spirochetosis (HIS) and further identify the causative pathogens.
Pablo Rojas, PhD, of Charité Universitätsmedizin Berlin, and his colleagues evaluated 149 paraffin-embedded or native intestinal biopsies from 91 consecutive patients with histologically diagnosed HIS. The reasons for endoscopy and histological investigation included chronic diarrhea, cancer/adenoma screening, inflammatory bowel disease, and endoscopic detection of polyps or colitis. In all, 12 patients were HIV-positive.
The researchers used a FISH probe to confirm Brachyspira spp. HIS for 77 of the 91 patients. A polymerase chain reaction (PCR) analysis of part of the bacterial 16S rRNA gene confirmed the presence of Brachyspira spp. in 75 patients. The sequencing allowed the researchers to drill down on the pathogen, identifying both the B. aalborgi and B. pilosicoli species lineage among the samples.
There were 14 cases in which researchers could not confirm the diagnosis of HIS with either FISH or RNA sequencing, but they noted that these cases were likely misdiagnosed by histopathology.
“FISH at the interface of histopathology and molecular biology is a valuable diagnostic tool for the diagnosis of HIS. The bright FISH signal in most cases already allowed rapid localization of Brachyspira spp. at 400 magnification. All samples that could be tested via PCR were consistent with the FISH results, whereas 14 cases were diagnosed false positive by histopathology,” the researchers wrote. “On these grounds, we propose to include FISH for the diagnosis and follow-up observation of HIS in routine practice.”
Find the full study in Anaerobe (2017 Oct. doi: 10.1016/j.anaerobe.2017.03.012).
FROM ANAEROBE
Synbiotic didn’t top placebo for gastrointestinal symptoms in HIV/AIDS
Adding a synbiotic (supplement that contains both pre- and probiotics) to nutritional treatment didn’t significantly beat placebo at reducing gastrointestinal symptoms in patients with HIV/AIDS, a small Brazilian study showed.
The human immunodeficiency virus targets the intestinal immune system, causing gastrointestinal symptoms such as diarrhea, nausea, heartburn, and constipation. Antiretroviral therapy (ART) may exacerbate those symptoms, potentially leading to poor medication adherence and discontinued treatment.
The randomized, double-blind PRECOR-NUT (Treatment With Nutritional Eating Plan and Dietary Fibers in Adult Patients With HIV/AIDS) trial assessed a synbiotic’s ability to reduce gastrointestinal symptoms such as diarrhea and nausea. A total of 64 patients living with HIV/AIDS, taking ART, and experiencing gastrointestinal symptoms were randomized to nutritional treatment paired with either a synbiotic or with placebo. Synbiotic patients took two sachets daily containing fructooligosaccharides, Lactobacillus paracasei, Lactobacillus rhamnosus, Lactobacillus acidophilus, and Bifidobacterium lactis. Both patient groups received nutritional counseling.
Compared with baseline, synbiotic patients saw significant reductions in diarrhea (21.8%), nausea and/or vomiting (28.8%), constipation (13.2%), and dyspepsia (24.5%). Placebo patients saw significant declines from baseline in diarrhea and heartburn (52.8% and 14.8%, respectively).
However, there were no significant differences in symptom reduction between synbiotic and placebo patients for any symptom except heartburn, in which placebo patients experienced a greater decrease.
“Although statistical significance is not observed in some occasions in the present study, the changes in the incidence of gastrointestinal disorders implies substantial benefit for HIV/AIDS patients,” the researchers asserted. The symptom improvements may lead to “better adherence to the pharmacological treatment.”
The Brazilian National Scientific and Technological Development Council and the state of Goias Foundation for Research Support funded the study. SKL Functional Nutrition provided the synbiotic. The study authors had no conflicts of interest.
This story was updated on 10/19/2017.
Adding a synbiotic (supplement that contains both pre- and probiotics) to nutritional treatment didn’t significantly beat placebo at reducing gastrointestinal symptoms in patients with HIV/AIDS, a small Brazilian study showed.
The human immunodeficiency virus targets the intestinal immune system, causing gastrointestinal symptoms such as diarrhea, nausea, heartburn, and constipation. Antiretroviral therapy (ART) may exacerbate those symptoms, potentially leading to poor medication adherence and discontinued treatment.
The randomized, double-blind PRECOR-NUT (Treatment With Nutritional Eating Plan and Dietary Fibers in Adult Patients With HIV/AIDS) trial assessed a synbiotic’s ability to reduce gastrointestinal symptoms such as diarrhea and nausea. A total of 64 patients living with HIV/AIDS, taking ART, and experiencing gastrointestinal symptoms were randomized to nutritional treatment paired with either a synbiotic or with placebo. Synbiotic patients took two sachets daily containing fructooligosaccharides, Lactobacillus paracasei, Lactobacillus rhamnosus, Lactobacillus acidophilus, and Bifidobacterium lactis. Both patient groups received nutritional counseling.
Compared with baseline, synbiotic patients saw significant reductions in diarrhea (21.8%), nausea and/or vomiting (28.8%), constipation (13.2%), and dyspepsia (24.5%). Placebo patients saw significant declines from baseline in diarrhea and heartburn (52.8% and 14.8%, respectively).
However, there were no significant differences in symptom reduction between synbiotic and placebo patients for any symptom except heartburn, in which placebo patients experienced a greater decrease.
“Although statistical significance is not observed in some occasions in the present study, the changes in the incidence of gastrointestinal disorders implies substantial benefit for HIV/AIDS patients,” the researchers asserted. The symptom improvements may lead to “better adherence to the pharmacological treatment.”
The Brazilian National Scientific and Technological Development Council and the state of Goias Foundation for Research Support funded the study. SKL Functional Nutrition provided the synbiotic. The study authors had no conflicts of interest.
This story was updated on 10/19/2017.
Adding a synbiotic (supplement that contains both pre- and probiotics) to nutritional treatment didn’t significantly beat placebo at reducing gastrointestinal symptoms in patients with HIV/AIDS, a small Brazilian study showed.
The human immunodeficiency virus targets the intestinal immune system, causing gastrointestinal symptoms such as diarrhea, nausea, heartburn, and constipation. Antiretroviral therapy (ART) may exacerbate those symptoms, potentially leading to poor medication adherence and discontinued treatment.
The randomized, double-blind PRECOR-NUT (Treatment With Nutritional Eating Plan and Dietary Fibers in Adult Patients With HIV/AIDS) trial assessed a synbiotic’s ability to reduce gastrointestinal symptoms such as diarrhea and nausea. A total of 64 patients living with HIV/AIDS, taking ART, and experiencing gastrointestinal symptoms were randomized to nutritional treatment paired with either a synbiotic or with placebo. Synbiotic patients took two sachets daily containing fructooligosaccharides, Lactobacillus paracasei, Lactobacillus rhamnosus, Lactobacillus acidophilus, and Bifidobacterium lactis. Both patient groups received nutritional counseling.
Compared with baseline, synbiotic patients saw significant reductions in diarrhea (21.8%), nausea and/or vomiting (28.8%), constipation (13.2%), and dyspepsia (24.5%). Placebo patients saw significant declines from baseline in diarrhea and heartburn (52.8% and 14.8%, respectively).
However, there were no significant differences in symptom reduction between synbiotic and placebo patients for any symptom except heartburn, in which placebo patients experienced a greater decrease.
“Although statistical significance is not observed in some occasions in the present study, the changes in the incidence of gastrointestinal disorders implies substantial benefit for HIV/AIDS patients,” the researchers asserted. The symptom improvements may lead to “better adherence to the pharmacological treatment.”
The Brazilian National Scientific and Technological Development Council and the state of Goias Foundation for Research Support funded the study. SKL Functional Nutrition provided the synbiotic. The study authors had no conflicts of interest.
This story was updated on 10/19/2017.
FROM CLINICAL NUTRITION
Key clinical point:
Major finding: Adding a synbiotic to nutritional treatment didn’t significantly beat placebo at reducing gastrointestinal symptoms in patients with HIV/AIDS.
Data source: A randomized, double-blind trial with 64 patients.
Disclosures: The Brazilian National Scientific and Technological Development Council and the state of Goias Foundation for Research Support funded the study. SKL Functional Nutrition provided the synbiotic. The study authors had no conflicts of interest.
G. lamblia assemblage B more common in HIV-positive people
The intestinal parasite Giardia lamblia assemblage B was more likely in people with HIV than in people without HIV, according to research published in Acta Tropica.
Of the 65 patients with G. lamblia included in a study undertaken by Clarissa Perez Faria, PhD, and her associates at the University of Coimbra (Portugal), 38 were HIV positive, 27 were HIV negative, and 60 patients were microscopy-positive for G. lamblia. In the HIV-positive group, 19 of the 34 microscopy-positive samples were assemblage B, and 15 were assemblage A. In the HIV-negative group, 9 of the 26 microscopy-positive samples were assemblage B, and 17 were assemblage A.
“HIV infection increases the risk of having intestinal parasitic infections, including G. lamblia. The detection and treatment of infections are important measures to improve the quality of life of HIV-infected patients,” the investigators concluded.
Find the full study in Acta Tropica (doi: 10.1016/j.actatropica.2017.04.026).
The intestinal parasite Giardia lamblia assemblage B was more likely in people with HIV than in people without HIV, according to research published in Acta Tropica.
Of the 65 patients with G. lamblia included in a study undertaken by Clarissa Perez Faria, PhD, and her associates at the University of Coimbra (Portugal), 38 were HIV positive, 27 were HIV negative, and 60 patients were microscopy-positive for G. lamblia. In the HIV-positive group, 19 of the 34 microscopy-positive samples were assemblage B, and 15 were assemblage A. In the HIV-negative group, 9 of the 26 microscopy-positive samples were assemblage B, and 17 were assemblage A.
“HIV infection increases the risk of having intestinal parasitic infections, including G. lamblia. The detection and treatment of infections are important measures to improve the quality of life of HIV-infected patients,” the investigators concluded.
Find the full study in Acta Tropica (doi: 10.1016/j.actatropica.2017.04.026).
The intestinal parasite Giardia lamblia assemblage B was more likely in people with HIV than in people without HIV, according to research published in Acta Tropica.
Of the 65 patients with G. lamblia included in a study undertaken by Clarissa Perez Faria, PhD, and her associates at the University of Coimbra (Portugal), 38 were HIV positive, 27 were HIV negative, and 60 patients were microscopy-positive for G. lamblia. In the HIV-positive group, 19 of the 34 microscopy-positive samples were assemblage B, and 15 were assemblage A. In the HIV-negative group, 9 of the 26 microscopy-positive samples were assemblage B, and 17 were assemblage A.
“HIV infection increases the risk of having intestinal parasitic infections, including G. lamblia. The detection and treatment of infections are important measures to improve the quality of life of HIV-infected patients,” the investigators concluded.
Find the full study in Acta Tropica (doi: 10.1016/j.actatropica.2017.04.026).
FROM ACTA TROPICA
Watch for our breaking news coverage
GI & Hepatology News will be in Orlando next week at the Orange County Convention Center reporting the latest news from the World Congress of Gastroenterology at ACG 2017. Studies slated for presentation will detail new findings in every area of clinical concern to the gastroenterologist.
Our onsite reporters will cover new drugs and treatment regimens in inflammatory bowel disease, endoscopic advances for treatment along the GI tract, and novel tests and biomarkers for various disease states.
Highly anticipated presentations include:
- Risk of metachronous high-risk adenomas and large (greater than or equal to 1 cm) serrated polyps in individuals with serrated polyps on index colonoscopy: Longitudinal data from the New Hampshire Colonoscopy Registry.
- Enhanced recovery in acute pancreatitis (RAPTor): A randomized controlled trial.
- A prospective validation of deep learning for polyp autodetection during colonoscopy.
GI & Hepatology News will be in Orlando next week at the Orange County Convention Center reporting the latest news from the World Congress of Gastroenterology at ACG 2017. Studies slated for presentation will detail new findings in every area of clinical concern to the gastroenterologist.
Our onsite reporters will cover new drugs and treatment regimens in inflammatory bowel disease, endoscopic advances for treatment along the GI tract, and novel tests and biomarkers for various disease states.
Highly anticipated presentations include:
- Risk of metachronous high-risk adenomas and large (greater than or equal to 1 cm) serrated polyps in individuals with serrated polyps on index colonoscopy: Longitudinal data from the New Hampshire Colonoscopy Registry.
- Enhanced recovery in acute pancreatitis (RAPTor): A randomized controlled trial.
- A prospective validation of deep learning for polyp autodetection during colonoscopy.
GI & Hepatology News will be in Orlando next week at the Orange County Convention Center reporting the latest news from the World Congress of Gastroenterology at ACG 2017. Studies slated for presentation will detail new findings in every area of clinical concern to the gastroenterologist.
Our onsite reporters will cover new drugs and treatment regimens in inflammatory bowel disease, endoscopic advances for treatment along the GI tract, and novel tests and biomarkers for various disease states.
Highly anticipated presentations include:
- Risk of metachronous high-risk adenomas and large (greater than or equal to 1 cm) serrated polyps in individuals with serrated polyps on index colonoscopy: Longitudinal data from the New Hampshire Colonoscopy Registry.
- Enhanced recovery in acute pancreatitis (RAPTor): A randomized controlled trial.
- A prospective validation of deep learning for polyp autodetection during colonoscopy.
Consider PBC in diagnosing hepatobiliary disorders in UC patients
While primary sclerosing cholangitis (PSC) is the most common hepatobiliary disorder associated with ulcerative colitis, primary biliary cholangitis (PBC) should not be forgotten, according to Erietta Polychronopoulou, MD, and her associates.
In two case studies, a 67-year-old woman and a 71-year-old man presented with long-standing cases of asymptomatic elevation of cholestatic enzymes. Both patients had long histories of ulcerative colitis, but both were in remission. Both patients had previous clinical diagnoses of either small duct PSC or drug-induced liver injury. Both patients denied drug use, and imaging studies revealed nothing in either patient.
In testing for hepatobiliary disorders, both patients showed high titers of antimitochondrial antibodies, the hallmark of PBC. Despite the asymptomatic nature of the PBC, both patients were treated with 13 mg/kg per day ursodeoxycholic acid and have remained stable for 17 and 18 months, respectively.
“The relationship of PBC with UC [ulcerative colitis] remains obscure as there are few reported cases regarding the combined presentation of these diseases. Although the pathogenesis of either disease has not yet been completely clarified, environmental and genetic factors are considered important in the susceptibility to both diseases, suggesting that the two diseases may share common immunopathogenetic pathways,” the investigators noted.
Find the full report in BMJ Case Reports (2017 Sep 25. doi: 10.1136/bcr-2017-220824).
While primary sclerosing cholangitis (PSC) is the most common hepatobiliary disorder associated with ulcerative colitis, primary biliary cholangitis (PBC) should not be forgotten, according to Erietta Polychronopoulou, MD, and her associates.
In two case studies, a 67-year-old woman and a 71-year-old man presented with long-standing cases of asymptomatic elevation of cholestatic enzymes. Both patients had long histories of ulcerative colitis, but both were in remission. Both patients had previous clinical diagnoses of either small duct PSC or drug-induced liver injury. Both patients denied drug use, and imaging studies revealed nothing in either patient.
In testing for hepatobiliary disorders, both patients showed high titers of antimitochondrial antibodies, the hallmark of PBC. Despite the asymptomatic nature of the PBC, both patients were treated with 13 mg/kg per day ursodeoxycholic acid and have remained stable for 17 and 18 months, respectively.
“The relationship of PBC with UC [ulcerative colitis] remains obscure as there are few reported cases regarding the combined presentation of these diseases. Although the pathogenesis of either disease has not yet been completely clarified, environmental and genetic factors are considered important in the susceptibility to both diseases, suggesting that the two diseases may share common immunopathogenetic pathways,” the investigators noted.
Find the full report in BMJ Case Reports (2017 Sep 25. doi: 10.1136/bcr-2017-220824).
While primary sclerosing cholangitis (PSC) is the most common hepatobiliary disorder associated with ulcerative colitis, primary biliary cholangitis (PBC) should not be forgotten, according to Erietta Polychronopoulou, MD, and her associates.
In two case studies, a 67-year-old woman and a 71-year-old man presented with long-standing cases of asymptomatic elevation of cholestatic enzymes. Both patients had long histories of ulcerative colitis, but both were in remission. Both patients had previous clinical diagnoses of either small duct PSC or drug-induced liver injury. Both patients denied drug use, and imaging studies revealed nothing in either patient.
In testing for hepatobiliary disorders, both patients showed high titers of antimitochondrial antibodies, the hallmark of PBC. Despite the asymptomatic nature of the PBC, both patients were treated with 13 mg/kg per day ursodeoxycholic acid and have remained stable for 17 and 18 months, respectively.
“The relationship of PBC with UC [ulcerative colitis] remains obscure as there are few reported cases regarding the combined presentation of these diseases. Although the pathogenesis of either disease has not yet been completely clarified, environmental and genetic factors are considered important in the susceptibility to both diseases, suggesting that the two diseases may share common immunopathogenetic pathways,” the investigators noted.
Find the full report in BMJ Case Reports (2017 Sep 25. doi: 10.1136/bcr-2017-220824).
FROM BMJ CASE REPORTS