Volume 26, Issue 2, February 2020

Opportunities exist within mobile health to improve care for IBD patients. In this review, we highlight features of several original IBD digital health platforms and suggest ideal features of an application that will optimize IBD care for patients and providers.

Inflammatory bowel disease (IBD) patients are at increased risk of developing colorectal cancer. However, histologically, it is challenging to distinguish between IBD-associated dysplasia from sporadic adenomas. We have molecularly characterized these precursor lesions and show that IBD-associated dysplasia lesions are genomically much more unstable.

Understanding the role of diet in the management of IBD is important to both patients and physicians. This review provides a summary to improve understanding and promote discussions on diet with the goal of improving patient care and satisfaction.

We demonstrate that PHD1 is overexpressed in pouchitis in patients with ulcerative colitis and correlates with disease activity. PHD small-molecule inhibition mitigates pouchitis in a preclinical rodent IPAA model, thus establishing a strong therapeutic rationale for targeting PHD1 in pouchitis.

There is a paucity of studies examining inflammatory bowel disease (IBD)–associated costs in children with IBD. Although the majority of studies have evaluated direct costs, the methodology used was too heterogeneous and the studies could not be pooled.

Sphingosine-1-phosphate (S1P) receptor agonists are a promising therapeutic alternative to anti-integrin antibodies in inflammatory bowel disease. Here, we report that modulation of tissue S1P levels via inhibition of the S1P lyase might be an effective alternative, acting by interference with thymocyte maturation.

In this report, we describe a novel model of progressive T-cell-driven colitis in mice with deficient TGFβ signaling in dendritic cells, which requires both CD4⁺ and CD8⁺ lymphocytes and is dependent on CD40L expression by CD4⁺ T cells.

Inactive rhomboid 2 (iRhom2) is an essential molecule required for the maturation of tumor necrosis factor–α–converting enzyme in immune cells, which regulates TNF-α release. The aim of this study was to investigate the role of iRhom2 in intestinal inflammation.

Surgical admissions occurring over the weekend have worse clinical outcomes compared with weekday admissions. This study is the first to demonstrate weekend admission as an independent risk factor for in-hospital complication in both pediatric CD and UC hospitalizations.

In patients with inflammatory bowel disease, proactive therapeutic drug monitoring of infliximab over a 2-year period was associated with higher rates of mucosal healing and lower surgical requirements compared with a conventional cohort treated without therapeutic drug monitoring.

Results of this age- and gender- matched case-control study show that the prevalence of apical periodontitis, diagnosed as radiolucent periapical lesions, is higher in patients with inflammatory bowel disease than in healthy control subjects (OR = 5.71; p = 0.0048).

Portomesenteric venous thrombosis (PMVT) occurred in 8% of postoperative ulcerative colitis patients despite the administration of venous thromboembolism prophylaxis. The most common presenting symptom was abdominal pain. Preoperative C-reaction protein values >45 mg/L were significantly associated with PMVT development.

Our study demonstrates significantly higher rates of bacterial, fungal and viral infections in IBD patients when compared to the controls without IBD. Overall, viral infections were numerically more common, whereas bacterial infections had the highest risk in IBD patients.

The stool frequency component of the Crohn’s Disease Activity Index was moderately correlated with the Simple Endoscopic Score for Crohn’s Disease. Proportion of mucosa that was inflamed and the proportion of mucosa with ulceration were independently positively correlated with stool frequency, whereas presence of strictures was inversely correlated with stool frequency.

This study evaluated adherence to self-injectable biologic medications in patients with inflammatory bowel disease and found several factors that increase risk of nonadherence. In Crohn’s disease, these risk factors were additive, meaning as the number of risk factors increased, the likelihood of adherence decreased significantly.

Weekend surgical hospitalizations for pediatric IBD have increased risk for complications as compared with weekdays per a new study by Egberg et al. Further research may elicit the prevalence and etiology of this weekend effect. Appropriately utilizing emergency departments might decrease complications.

Therapeutic drug monitoring (TDM) for anti-TNFα agents hass gained an increased momentum; although it is surely recommended in case of loss of response, its usefulness during maintenance therapy is still debated. Fernandes et al have added useful information in this regard.

Apical periodontitis in patients affected by inflammatory bowel disease (IBD) needs to be considered carefully, and it is important to treat the disease. Larger prospective studies should be conducted to confirm if there is a causal relationship between periapical status and IBD.

Venous thromboembolism is increased in inflammatory bowel disease surgical patients. Optimal management and prevention of portomeseteric venous thromboembolism is largely unknown, as are risk factors for development in the postoperative period.

Given the significant increase in opportunistic infections among patients with inflammatory bowel disease as compared with the general population, gastroenterologists should take action to prevent these infections when possible.

The study exploited autologous microfragmented fat to treat refractory complex Crohn’s perianal fistula, obtaining 66.7% of combined remission at 6 months in patients already treated without success using combined biosurgical approaches and multiple repair surgeries following the failure of biological therapy.

Anti-tumor necrosis factor biologics are a mainstay of Crohn’s disease treatment, however up to 40% of patients have a loss of response over time. In patients with Crohn’s disease and loss of response to adalimumab, 78% achieve remission with infliximab.

Almost 50% of patients who switch to a second anti–tumor necrosis factor (anti-TNF) drug after failure of a first anti-TNF will achieve remission. However, a high proportion of these patients will experience loss of response. Before deciding to switch to a second anti-TNF, the reason for switching and the probability of loss of response should be taken into account.

We demonstrate presence of senescent (p16⁺, p21⁺) epithelial cells in the stem and transient amplifying cell niches of the intestine in Crohn’s disease. This may explain why Crohn’s lesions recur in the same places.