Faculty Bibliography

Introduction: Patients with inflammatory bowel disease (IBD) have a high degree of sexual dysfunction (SD). Few studies have tracked SD longitudinally or with IBD-specific scales. We aimed to correlate SD with clinical and psychosocial IBD indices and track SD longitudinally using the IBDFemale and Male Sexual Dysfunction Scales (IBD-FSDS and MSDS).
Method(s): We surveyed patients with Crohn's disease (CD) and ulcerative colitis (UC) starting a new biologic or small molecule therapy (anti-TNF, anti-integrin, anti-IL12/23, JAK inhibitor) at start of induction and 2- and 6-months. Surveys also included the PROMIS Brief Sexual Function and Satisfaction Profile, disease activity indices [Harvey-Bradshaw index (HBI), partial Mayo score], and psychosocial scales [Patient Health Questionnaire-9 (PHQ-9), Short IBD Questionnaire (SIBDQ), and IBD-Disability Index (IBDDI)]. Clinical data included endoscopic scores, inflammatory biomarkers (ESR, CRP, calprotectin), and IBD history. Therapy response was defined as a reduction in HBI, pMayo, SCCAI >=3 or total HBI <= 4, pMayo<2, SCCAI <=2 at survey 3.
Result(s): 123 patients (68 males and 53 females) completed survey 1, 89 completed survey 2, and 74 completed survey 3. The median age was 31 years. 58% had CD, 42% had UC, and 31% were nonwhite. At induction, the median MSDS score was 6 out of 40 (IQR 2.5-13.5) and FSDS was 12 out of 60 (3-27.5); (Table 1). SD scores strongly correlated with PROMIS scores (r5-0.75, p<0.001), Mayo endoscopic score (r=0.71, p<0.001), and moderately correlated with HBI (r=0.49, p=0.002) and pMayo scores (0.44, p=0.03), but not with inflammatory biomarkers. SD also correlated with SIBDQ (r=0.55, p<0.001), PHQ-9 (r=0.42, p<0.001), and IBD-DI (r=0.47, p<0.001). MSDS scores significantly improved from survey 1 to survey 3 (p= 0.039). FSDS scores numerically improved but did not reach significance. Over 50% of patients had a significant response to therapy. When stratified by treatment response, MSDS and FSDS scores improved significantly among therapy responders (p=0.006 and p= 0.041, respectively) as did Male-PROMIS scores. This improvement was not observed in non-responders (p=0.27). HBI, SCCAI, pMayo, SIBDQ and IBD-DI also improved among responders.
Conclusion(s): In this longitudinal cohort, there was a strong correlation between SD, disease activity, and psychosocial indices. Among therapy responders, there was a significant improvement in SD. These findings further clarify the relationship between SD and therapeutic response in IBD

Intussusception is defined as telescoping of the proximal bowel (intussusceptum) into the lumen of the distal bowel, otherwise called the intussuscipiens. While it is one of the most common causes of intestinal obstruction in children between the ages of 3 months and 6 years, intussusception accounts for about 1% of such cases in adults. Intussusception is idiopathic in 8-20% of patients and most commonly occurs in the small intestines in adults. We describe the unique case of a colo-colonic intussusception in a 54-year-old female patient 1 week after a colonoscopy for suspected inflammatory bowel disease. The discussion focuses on the presentation and management options of intussusception.

It is often difficult to assess disease activity in inflammatory bowel disease (IBD). Noninvasive biomarkers are a means of quantifying often nebulous symptoms without subjecting patients to endoscopy or radiation. This paper highlights markers present in feces, serum, or urine that have all been compared with the gold standard, histologic analysis of endoscopically collected specimens. Two categories of markers are featured: well-researched markers of mucosal inflammation with high sensitivity and specificity (calprotectin, lactoferrin, and S100A12) and novel promising markers, some of which are already clinically employed for reasons unrelated to IBD (interleukin [IL]-17, IL-33/ST2, adenosine deaminase, polymorphonuclear elastase, matrix metalloproteinase-9, neopterin, serum M30, and fecal immunohistochemistry). The data pertaining to the more-established markers are intended to highlight recent clinical applications for these markers (ie, assessing disease outside of the colon or in the pediatric population as well as being a cost-saving alternative to colonoscopy to screen for IBD). As there is no evidence to date that a specific marker will accurately be able to represent the entire IBD patient population, it is likely that a combination of the existing markers will be most clinically relevant to the practicing gastroenterologist attempting to evaluate disease severity in a specific patient. Familiarity with the most promising emerging markers will allow a better understanding of new studies and their impact on patient care.

A 60-year-old woman with mitral valve prolapse, chronic low back pain, and a 30-pack year smoking history presented for a second admission of poorly controlled mid-back pain 10 days after her first admission. She had concomitant epigastric pain, sharp/burning in quality, radiating to the right side and to the mid-back, not associated with food nor improving with pain medications. She denied nausea, vomiting, diarrhea, constipation, dark stools, or blood per rectum. Our purpose was to determine the cause of the patient's epigastric pain. Physical examination revealed epigastric and mid-back tenderness on palpation. Labs were normal except for a hemoglobin drop from 14 to 12.1 g/dL over 2 days. Abdominal ultrasound and subsequent esophagogastroduodenoscopy were normal. Contrast-enhanced abdominal computed tomographic (CT) scan revealed the development of a spontaneous celiac artery dissection as the cause of the epigastric pain. The patient was observed without stenting and subsequent CT angiography 4 days later did not reveal worsening of the dissection. She was discharged on aspirin and clopidogrel with outpatient follow-up. Thus far, less than 100 cases of isolated spontaneous celiac artery dissections have been reported. The advent of CT scans and magnetic resonance imaging has increasingly enabled its detection. Risk factors may include hypertension, arteriosclerosis, smoking, and cystic medial necrosis. There is a 5:1 male to female ratio with an average presenting age of 55. Management of dissections may include surgical repair, endovascular stenting, and selective embolization. Limited dissections can be managed conservatively with anti-platelet and/or anticoagulation agents and strict blood pressure control, as done in our patient.