Faculty Bibliography

INTRODUCTION/BACKGROUND:Inflammatory bowel disease (IBD) is prevalent during reproductive years. There are limited and conflicting data on whether IBD is associated with elevated risk of hypertensive disorders of pregnancy. METHODS:We performed a single-center cohort study using electronic health records of singleton pregnancies delivered 1998-2016. The primary outcome was any hypertensive disorder of pregnancy, including either gestational hypertension or pre-eclampsia. Secondary outcomes included gestational hypertension, pre-eclampsia, preterm delivery, gestational diabetes, severe perineal laceration, and small or large for gestational age birth weight. We used generalized estimating equations, adjusted for age, 1st trimester body mass index and blood pressure, insurance, race, and parity to estimate associations between IBD and outcomes. RESULTS:We included 364 pregnancies (266 individuals) with IBD and 45,048 pregnancies (32,189 individuals) without IBD. IBD was not associated with hypertensive disorders of pregnancy overall (adjusted odds ratio [aOR] 1.21 95% confidence interval [CI 0.81-1.82], P = 0.35). IBD was associated with an increased odds of pre-eclampsia (aOR 1.65 [95% CI 1.02-2.68]) but not gestational hypertension (aOR 0.82 [95% CI 0.42-1.57]). IBD was associated with preterm delivery (aOR 1.87 [95% CI 1.31-2.68]), small for gestational age (aOR 1.72 [95% CI 1.18-2.51]), and cesarean delivery (aOR 1.72 [95% CI 1.35-2.20]) but not with other secondary outcomes. DISCUSSION/CONCLUSIONS:Although the risk of hypertensive disorders of pregnancy overall was not increased in pregnancies affected by IBD, there was an increased risk of pre-eclampsia. This may reflect underlying immune-mediated placental dysfunction.

We present a case of a female with complex pediatric-onset stricturing small bowel and colonic Crohn's disease. She was refractory to multiple advanced therapies, requiring dual therapy with risankizumab and upadacitinib to induce healing. Using intestinal ultrasound to monitor her response to therapy, we ultimately de-escalated to risankizumab monotherapy due to a reduction of inflammatory burden. We present this case to highlight the use and importance of intestinal ultrasound to guide changes in therapy, discussing its use in practice for patients with inflammatory bowel disease.

BACKGROUND:Prior studies showed worse outcomes in obese inflammatory bowel disease (IBD) patients, especially those related to hospitalizations, surgery and steroid-free remission. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated significant metabolic benefits for patients with type 2 diabetes mellitus (T2DM) and obesity. Hence, GLP1-RAs may improve clinical outcomes in patients with IBD, especially those with obesity. The objective was to systematically evaluate the impact of GLP1-RAs on clinical outcomes in patients with IBD. METHODS:A comprehensive literature search was performed using the databases PubMed, Embase, Web of Science, and Cochrane Library from inception to 15-03-2025. Studies reporting outcomes related to GLP1-RAs in patients with IBD were included. Primary outcomes included weight loss and various IBD-related co-endpoints such as hospitalizations, surgery, corticosteroid use, and advanced therapy initiation. FINDINGS/RESULTS:In total, 11 studies with 16,242 patients with IBD treated with GLP1-RAs were included. Weight loss was achieved using semaglutide (-9.6 kg, CI-95% -12.0; -7.2), liraglutide (-9.4 kg, CI-95% -13.0; -5.8) and tirzepatide (-11.8 kg, CI-95% -18.3; -5.4) after 3 months of follow-up. In meta-analyses, GLP1-RAs were associated with lower risk of surgery for effect sizes (logHR: 0.61 [95%-CI 0.44-0.84], I2 = 0%) and event frequencies (OR: 0.46 [95%-CI 0.32-0.67], I2 = 42%). Sensitivity analysis for BMI showed lower risk of hospitalizations and surgery in patients with obesity (BMI≥30). INTERPRETATION/CONCLUSIONS:Patients with IBD and obesity using GLP1-RAs were able to achieve significant weight loss and had lower risks of surgery and hospitalizations. Our findings require confirmation in prospective trials of GLP1-RAs in IBD.

Combining two advanced therapies may improve outcomes in Crohn's disease (CD) refractory to monotherapy. We conducted a descriptive case series of 27 patients with CD who initiated combination therapy with upadacitinib and infliximab (n = 1), risankizumab (n = 17), ustekinumab (n = 3) or vedolizumab (n = 6). At 12 weeks, 24 achieved clinical response and 9 achieved steroid-free remission. At 52 weeks, these rates were 15/20 and 11/20, respectively. Endoscopic response and extraintestinal manifestation improvement were frequently observed. Adverse events occurred in 13 patients, leading to treatment discontinuation in three. Combining upadacitinib with a biologic appeared effective and safe, warranting further investigation in prospective studies.

PURPOSE/OBJECTIVE:Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have transformed obesity management, but their safety and efficacy in patients with inflammatory bowel disease (IBD) warrants further evaluation. METHODS:test for dichotomous outcomes. Logistic regression was performed for multivariable analysis of the primary efficacy outcome. RESULTS:Of 272 patients included, 175 completed at least 12 months of GLP-1 RA. Among these individuals, 61% achieved ≥ 5% TWL and 42% achieved ≥ 10% TWL. AEs occurred in 40%, and were primarily gastrointestinal (93%). GLP-1 RA were stopped in 24% of patients (48% for AE/tolerability and 18% for access/cost issues). There was no difference in the proportion of patients with IBD flares within 12 months pre vs. post GLP-1 RA (17% vs. 13%, P = 0.40). Anti-TNF exposure did not affect the likelihood of achieving ≥ 5% TWL in comparison with other IBD therapies (66% vs. 58%, P = 0.33). CONCLUSIONS:This study supports the safety, tolerability, and effectiveness of GLP-1 RA for treatment of obesity in patients with IBD.

BACKGROUND:Clostridioides difficile is the most common cause of healthcare-associated infection, and severe cases can result in significant complications. While anti-microbial therapy is central to infection management, adjunctive therapies may be utilised as preventative strategies. AIM:This article aims to review updates in the epidemiology, diagnosis, and management, including treatment and prevention, of C. difficile infections. METHODS:A narrative review was performed to evaluate the current literature between 1986 and 2023. RESULTS:The incidence of C. difficile infection remains significantly high in both hospital and community settings, though with an overall decline in recent years and similar surveillance estimates globally. Vancomycin and fidaxomicin remain the first line antibiotics for treatment of non-severe C. difficile infection, though due to lower recurrence rates, infectious disease society guidelines now favour use of fidaxomicin. Faecal microbiota transplantation should still be considered to prevent recurrent C. difficile infection. However, in the past year the field has had a significant advancement with the approval of the first two live biotherapeutic products-faecal microbiota spores-live brpk, an oral capsule preparation, and faecal microbiota live-jslm-both indicated for the prevention of recurrent C. difficile infection, with additional therapies on the horizon. CONCLUSION:Although the prevalence of C. difficile infection remains high, there have been significant advances in the development of novel therapeutics and preventative measures following changes in recent practice guidelines, and will continue to evolve in the future.