Reappraisal of COVID-19 Risk for Patients with Inflammatory Bowel Disease (IBD): Withdrawal of the British Society of Gastroenterology IBD Risk Grid

Early in the pandemic, there was significant concern about how COVID-19 may impact patients with inflammatory bowel disease (IBD). Would IBD, as a chronic immune-mediated condition, be a risk factor for more severe COVID-19? Would medications used to treat IBD, in particularly immunosuppressants, increase the likelihood of hospitalization or death due to COVID-19? However, at the start of the pandemic there was a paucity of data to guide decision making for patients with IBD. In this setting, many national and international societies issued statements on management of IBD to provide initial guidance to gastroenterologists and patients with IBD. The British Society of Gastroenterology (BSG) published an IBD risk grid for COVID-19 severity in April 2020 that proposed a framework for categorizing patients with IBD into those more likely to be vulnerable to COVID-19 primarily based on co-morbidities and disease characteristics. Patients deemed at moderate risk were advised to practice stringent social distancing while those at high risk were recommended to practice “shielding,” the strictest advice for isolating from others. The authors of the BSG IBD risk grid recently issued a statement withdrawing this guidance noting a number of factors including that the vast majority of IBD patients are not at increased risk of adverse COVID-19 outcomes, the reduced severity of disease with recent variants, and the effectiveness of COVID-19 vaccines

Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database

Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the U.S.

Prevalence of a Gluten-free Diet and Improvement of Clinical Symptoms in Patients with Inflammatory Bowel Diseases:

Background—Maintaining a gluten free diet (GFD) without an underlying diagnosis of celiac disease has enjoyed widespread acceptance in the USA. Methods—We performed a cross-sectional study utilizing a GFD questionnaire in 1647 patients with inflammatory bowel diseases (IBD) participating in the CCFA Partners longitudinal, Internet-based cohort. Results—A diagnosis of celiac disease (CD) and non-celiac gluten sensitivity (NCGS) were reported by 10 (0.6%) and 81 (4.9%) respondents, respectively. Three hundred fourteen (19.1%) participants reported having previously tried a GFD and 135 (8.2%) reported current use of GFD. Overall 65.6% of all patients, who attempted a GFD described an improvement of their GI-symptoms and 38.3% reported fewer or less severe IBD flares. In patients currently attempting a GFD, excellent adherence was associated with significant improvement of fatigue (p<0.03). Conclusion—In this large group of patients with IBD, a substantial number had attempted a GFD, of whom the majority had some form of improvement in GI-symptoms. Testing a GFD in clinical practice in patients with significant intestinal symptoms, which are not solely explained by the degree of intestinal inflammation, has the potential to be a safe and highly efficient therapeutic approach. Further prospective studies into mechanisms of gluten sensitivity in IBD are warranted

Avoidance of Fiber Is Associated With Greater Risk of Crohn’s Disease Flare in a 6-Month Period

Chronic inflammatory bowel diseases (IBDs) have been associated with an abnormal mucosal response to the gastrointestinal microbiota. Although dietary fiber affects the gastrointestinal microbiota, there is limited information on the role of fiber on IBD activity. We investigated factors associated with fiber consumption and whether it was associated with flares in patients with IBD

Nonmelanoma skin cancer in inflammatory bowel disease: A review

At least 1 million new cases of non-melanoma skin cancer (NMSC) are diagnosed in the United States each year, and the incidence is increasing. A higher incidence of non-melanoma skin cancer (NMSC) in organ transplant recipients on immunosuppression has been documented for some time, and recent studies indicate that patients with inflammatory bowel disease (IBD), particularly those treated with immunosuppressive medications, might also be at higher risk for this condition. In this review, we summarize recent data evaluating the associations between immunomodulators, anti-tumor necrosis factor-α (anti-TNF) biologic agents and NMSC in patients with IBD and other autoimmune conditions such as rheumatoid arthritis (RA). We also offer recommendations for prevention of NMSC in these populations

Quality of Health Care in the United States: Implications for Pediatric Inflammatory Bowel Disease

The Institute of Medicine’s publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in U.S. health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease

Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease

To determine the role of NSAIDs in activation of IBD

Topiramate Use Does Not Reduce Flares of Inflammatory Bowel Disease

Additional medications are needed for inflammatory bowel disease (IBD), as existing therapies are incompletely effective and can be costly and toxic. Preclinical studies suggest that topiramate (an anticonvulsant) may have disease-modifying properties in IBD, but its efficacy in humans is unknown

A causal association between Accutane and IBD has yet to be established

A number of case reports have been published describing a possible association between isotretinoin (Accutane) and inflammatory bowel disease (IBD). We critically appraised the published literature on this association to assess whether the current literature supports a causal relationship between isotretinoin and IBD

Increased Risk of Pneumonia Among Patients With Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD) may be at increased risk for infectious complications. We aimed to determine the risk of pneumonia in IBD and how biologic and immunosuppressive medications affect this risk