Evolution after Anti-TNF Discontinuation in Patients with Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

OBJECTIVES:The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.METHODS:This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.RESULTS:A total of 1, 055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn''s disease and ulcerative colitis patients, respectively. In both Crohn''s disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn''s disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.CONCLUSIONS:The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe

Incidence, clinical characteristics and management of inflammatory bowel disease in Spain: large-scale epidemiological study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100, 000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

La esofagitis eosinofílica como causa de impactación por cuerpo extraño: análisis de nuestra experiencia

Introduction: food bolus impaction in the esophagus, is a frequent symptom debut in patients with eosinophilic esophagitis (EEO). This may mean a change in the epidemiology and clinical management of this emergency endoscopy. Methods: Retrospective analysis of 131 emergency endoscopic foreign body impaction (FB). We studied the epidemiological characteristics, endoscopic findings, type of FB, the rate of impaction and history of the 3 years preceding the survey. Statistical analysis was performed using t-student and tests ×2. Results: 131 patients, 65% male, mean age 56 years. Endoscopic findings: normal esophagus 34.4% (45/131) and 20% endoscopic findings of EEO (26/131). Meat bolus was the most common FB (60.3%, 79/131). Patients hit by suspected food EEO was the most frequent endoscopic finding. The subgroup of patients with impacted food bolus with a final diagnosis of EEO presented a lower mean age than those with causes of impaction (36.47 vs. 64.45, P = 0.00) and a higher percentage of background previous impaction (38% vs. 6%, RR = 15.70 95% (from 3.60 to 62.50), p = 0.00). Conclusion: Emergency FB impaction is a common event in our clinical practice. EEO is a case to be considered in such patients, so we suspected in patients impacted food bolus, young and with a history of previous impaction.Introduccion: La impactacion del bolo alimentario en el esofago, supone un sintoma de debut frecuente en los pacientes con esofagitis eosinofilica (EEo). Este hecho, puede suponer un cambio en la epidemiologia y en el manejo clinico de esta urgencia endoscopica. Material y metodos: Analisis retrospectivo sobre 131 urgencias endoscopicas por impactacion de cuerpo extrano (CE). Se estudiaron las caracteristicas epidemiologicas, hallazgos endoscopicos, el tipo de CE, la tasa de desimpactacion y antecedentes de impactacion los 3 anos previos al 2 estudio. El analisis estadistico se realizo mediante los test de �Ô y t-student. Resultados: 131 pacientes, 65% varones; edad media 56 anos. Hallazgos endoscopicos: 34,4% esofago normal (45/131) y el 20% esofago de caracteristicas endocopicas de EEo (26/131). El bolo de carne fue el CE mas frecuente (60,3%; 79/131). En los pacientes impactados por alimento la sospecha de EEo fue el hallazgo endoscopico mas frecuente. El subgrupo de pacientes impactados con bolo alimentario y con diagnostico final de EEo presento una edad media menor, que aquellos con otras causas de impactacion (36,47 vs. 64,45; p=0,00), asi como un mayor porcentaje de antecedentes de impactacion previos (38% vs. 6%; RR= 15,70 IC95%(3,60- 62,50; p=0,00). Conclusion: La urgencia por impactacion de CE es un hecho frecuente en nuestra practica clinica. La EEo es una causa a tener en cuenta en este tipo de pacientes, por lo que debemos sospecharla ante enfermos impactados por bolos alimentarios, jovenes y con antecedentes de impactacion previa

Factores predictores de esofagitis eosinofílica en impactación esofágica por bolo alimenticio

Antecedentes: La impactación esofágica por bolo alimenticio es un síntoma de debut en pacientes diagnosticados de esofagitis eosinofílica, lo cual supone un cambio en la epidemiología y el manejo de esta urgencia. Objetivo: Detectar factores predictores de esofagitis eosinofílica en pacientes con impactación esofágica por bolo alimenticio. Métodos: Se analizaron de forma retrospectiva pacientes atendidos por impactación por cuerpo extraño. Se estudiaron las características epidemiológicas, los hallazgos endoscópicos y los antecedentes de impactación. El análisis estadístico se realizó mediante los test de la t de Student y de la χ2. Se elaboró un modelo de regresión logística. Resultados: Ciento treinta y un pacientes, 65% varones, con una edad media de 56 años. En los pacientes con impactación por bolo alimenticio (n = 89), la sospecha endoscópica de esofagitis eosinofílica fue el hallazgo más frecuente. De estos, aquellos sin confirmación histológica fueron excluidos (n = 7); el resto de los pacientes (n = 82) se dividió en 2 grupos: esofagitis eosinofílica confirmada (grupo A) (n = 18) y otros hallazgos endoscópicos (grupo B) (n = 64). El grupo A presentaba una menor edad media (36.47 vs. 64.45; p = 0.001) e historia de impactación previa más frecuente que el grupo B (38 vs. 6%; OR = 15.70; IC del 95%, 3.60-62.50; p = 0.001). Edad e historia de impactación se comportaron como predictores de esofagitis eosinofílica con una sensibilidad del 82%, una especificidad del 80% y un rendimiento del 84% (p < 0.001). Conclusión: Edad y antecedentes de impactación predicen la presencia de esofagitis eosinofílica en pacientes con impactación por bolo alimenticio

Trends in Targeted Therapy Usage in Inflammatory Bowel Disease : TRENDY Study of ENEIDA

Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn's disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment