Faculty Bibliography

BACKGROUND AND AIMS/OBJECTIVE:In patients with inflammatory bowel disease (IBD) and a history of cancer, retrospective studies suggest that exposure to immunosuppressive agents does not increase the risk of incident (recurrent or new) cancer compared to unexposed patients. SAPPHIRE is a prospective registry aimed at addressing this issue. METHODS:Since 2016, patients with IBD and confirmed index cancer prior to enrollment were followed annually. Patients receiving chemotherapy or radiation at enrollment, or recurrent cancer within five years were excluded. Primary outcome was development of incident cancer related to exposure to immunosuppressive medications. RESULTS:Among 305 patients (47% male, 88% white), median age at IBD diagnosis and cancer were 32 and 52 years, respectively. Index cancers were solid organ (46%), dermatologic (32%), gastrointestinal (13%), and hematologic (9%). During median follow-up of 4.8 years, 210 (69%) were exposed to immunosuppressive therapy and 46 (15%) developed incident cancers (25 new, 21 recurrent). In unadjusted analysis, the crude rate of incident cancer in unexposed patients was 2.58/100 person-years versus 4.78/100 PY (relative risk 1.85, 95% CI 0.92-3.73) for immunosuppression exposed patients. In a proportional hazards model adjusting for sex, smoking history, age and stage at index malignancy, and non-melanoma skin cancer, no significant association was found between receipt of immunosuppression and incident cancer (adjusted hazard ratio, aHR, 1.41, 95% CI: 0.69-2.90), or with any major drug class. CONCLUSION/CONCLUSIONS:In this interim analysis of patients with IBD and a history of cancer, despite numerically elevated aHRs, we did not find a statistically significant association between subsequent exposure to immunosuppressive therapies and development of incident cancers.

INTRODUCTION/BACKGROUND:Gastroenterologists at all levels of practice benefit from formal mentoring. Much of the current literature on mentoring in gastroenterology is based on expert opinion rather than data. In this study, we aimed to identify gender-related barriers to successful mentoring relationships from the mentor and mentee perspectives. METHODS:A voluntary, web-based survey was distributed to physicians at 20 academic institutions across the United States. Overall, 796 gastroenterology fellows and faculty received the survey link, with 334 physicians responding to the survey (42% response rate), of whom 299 (90%; 129 women and 170 men) completed mentorship questions and were included in analysis. RESULTS:Responses of women and men were compared. Compared with men, more women preferred a mentor of the same gender (38.6% women vs 4.2% men, P < 0.0001) but less often had one (45.5% vs 70.2%, P < 0.0001). Women also reported having more difficulty finding a mentor (44.4% vs 16.0%, P < 0.0001) and more often cited inability to identify a mentor of the same gender as a contributing factor (12.8% vs 0.9%, P = 0.0004). More women mentors felt comfortable advising women mentees about work-life balance (88.3% vs 63.8%, P = 0.0005). Nonetheless, fewer women considered themselves effective mentors (33.3% vs 52.6%, P = 0.03). More women reported feeling pressured to mentor because of their gender (39.5% vs 0.9% of men, P < 0.0001). Despite no gender differences, one-third of respondents reported negative impact of the COVID-19 pandemic on their ability to mentor and be mentored. DISCUSSION/CONCLUSIONS:Inequities exist in the experiences of women mentees and mentors in gastroenterology, which may affect career advancement and job satisfaction.

INTRODUCTION: Utilizing recently-developed inflammatory bowel disease (IBD)-specific scales, we aimed to correlate sexual dysfunction (SD) with clinical and psychosocial IBD metrics, and track SD longitudinally, specifically in patients initiating biologic therapies.
METHOD(S): We surveyed Crohn's disease (CD) and ulcerative colitis (UC) patients starting a biologic agent (anti-TNF, anti-integrin, or anti-IL12/23) at induction of therapy and 60 days after. Surveys included the IBD- Female and Male Sexual Dysfunction Scales (IBD-FSDS and MSDS), the PROMIS Brief Sexual Function and Satisfaction Profile, as well as disease activity indices [Harvey-Bradshaw index (HBI), partial Mayo score], and scales for depression [Patient Health Questionnaire-9 (PHQ-9)], quality of life (QoL) [Short IBD Questionnaire (SIBDQ)], functional disability [IBD-Disability Index (IBDDI)], and illness perception [Brief Illness Perception Questionnaire (BIPQ)]. We reviewed baseline colonoscopies [simple endoscopic score (SES) and Mayo endoscopic subscore (MES)], biomarkers of inflammation (ESR, CRP, calprotectin), comorbidities, and IBD history.
RESULT(S): 61 patients (35 males and 26 females) completed survey 1 and 35 completed survey 2. The mean age was 34 years, 59% had CD, 41% had UC, and 38% were non-white. At induction, there was a high degree of SD as measured by the MSDS and FSDS (mean MSDS 9, FSDS 15). Initial SD scores were strongly correlated with PROMIS scores (r = 0.82, P < 0.001) and MES (r = 0.74, P < 0.001), and moderately correlated with the HBI (r = 0.48, P = 0.003) and Mayo score (0.46, P = 0.03). SD also correlated with the SIBDQ (r = 0.54, P < 0.001), PHQ-9 (r = 0.41, P < 0.001), IBDDI (r = 0.46, P < 0.001), and with domains of the BIPQ assessing illness effect on emotions and wellbeing (r = 0.58, P < 0.001; r = 0.50, P < 0.001). SD did not correlate with baseline biomarkers of inflammation (Table 2). FSDS scores improved from survey 1 to 2 (mean 18.2 to 11.3, P = 0.01). MSDS scores also numerically improved (10.1 to 8.5), but did not reach significance (Table 3). HBI, SCCAI and pMayo scores improved with a clinically significant response seen in 22% of patients.
CONCLUSION(S): In this prospective observational cohort, SD scores correlated with depression, QoL metrics, and disease activity, but did not correlate with biomarkers of inflammation. There was a moderate improvement in disease activity and SD scores after induction therapy with biologics, but a degree of SD persisted. Further studies must track this effect during maintenance therapy

INTRODUCTION: Inflammatory bowel disease (IBD) can have a detrimental effect on patients' functional capacity. Recently, a self-report version of the IBD Disability Index (IBD-DI) was developed to assess how disease burden affects patients' ability to work and maintain relationships. There have been few studies tracking IBD-DI over time or with treatment of disease.
METHOD(S): We prospectively identified patients with Crohn's disease (CD) and ulcerative colitis (UC) starting a new biologic agent (anti-TNF, anti-integrin, or anti IL12/23). Patients were surveyed at induction of therapy and 60 days after, approximating the start of maintenance. Surveys included clinical disease activity indices [Harvey Bradshaw Index (HBI), Simple Clinical Colitis Activity Index (SCCAI), partial Mayo Score] and scales that assessed depression (PHQ-9), quality of life [Short IBD Questionnaire (SIBDQ)]), illness perception [Brief Illness Perception Questionnaire (BIPQ)], and IBD-DI (with higher sores indicating more disability). We reviewed baseline colonoscopies (simple endoscopic and Mayo endoscopic subscore), biomarkers of inflammation (ESR, CRP, calprotectin), comorbidities, and IBD history.
RESULT(S): 61 patients (35 males and 26 females) completed the induction survey and 35 completed survey 2. The mean age was 34 years, 59% had CD, 41% had UC, and 38% were non-white (Table 1). There was a strong correlation between the IBD-DI and the HBI, SIBDQ, and PHQ-9 (r = 0.62, 0.81, 0.82, P < 0.001; Table 2). There was a moderate correlation with SCCAI (r = 0.53, P < 0.01), Mayo and pMayo (r = 0.44, r = 0.39, P < 0.001), and with the domains of the BIPQ assessing illness effect on wellbeing, symptoms and emotions (P < 0.001). The IBD-DI did not correlate with baseline biomarkers of inflammation or endoscopic scores. There were no statistically significant differences in IBD-DI scores between males and females or between patients with CD or UC (Table 3). There was a statistically significant improvement in IBD-DI scores from survey 1 to survey 2 (mean 33.9 out of 100 to 27.1, P < 0.001).
CONCLUSION(S): In this prospective cohort, there was a strong correlation between IBD-DI and indices of disease activity, depression, and quality of life. There was an improvement in IBD-DI scores after induction with biologics. This is the first study to assess this metric longitudinally and with treatment of disease using the self-report IBD-DI. Future studies must track the IBD-DI during maintenance therapy and assess how it relates to therapeutic response