Gi Insights

Guest: Anish Patel, DO, FACG Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy Chao Chen, PhD, Abraham G Hartzema, PhD, Hong Xiao, PhD, Yu-Jung Wei, PhD, Naueen Chaudhry, MD, Ofor Ewelukwa, MD, Sarah C Glover, DO, Ellen M Zimmermann, MD BACKGROUND AND AIMS:Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD). METHODS:Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent propor

Guest: Robin Dalal, MD Improving the Quality of Inpatient Ulcerative Colitis Management: Promoting Evidence-Based Practice and Reducing Care Variation With an Inpatient Protocol Sara M Lewin, MD, Ryan A McConnell, MD, Roshan Patel, MD, Suzanne R Sharpton, MD, MAS, Fernando Velayos, MD, MPH, Uma Mahadevan, MD BACKGROUND:Hospitalization for ulcerative colitis is a high-risk period associated with increased risk of Clostridium difficile infection, thromboembolism, and opiate use. The study aim was to develop and implement a quality-improvement intervention for inpatient ulcerative colitis management that standardizes gastroenterology consultant recommendations and improves delivery of evidence-based care. METHODS:All adult patients hospitalized for ulcerative colitis between July 1, 2014, and December 31, 2017, who received intravenous corticosteroids were included. On July 1, 2016, the UCSF Inpatient Ulcerative Colitis Protocol was implemented, featuring standardized core recommendations and a daily checkl

Host: Thomas Ullman, MD Guest: Juli Tomaino, MD Guest: Sarah Yim, MD Biosimilar medications have now entered the clinical landscape of treatment protocols for several disciplines—including gastroenterology. Joining Dr. Thomas Ullman to discuss the biosimilars that are available for Crohn’s disease and ulcerative colitis and how other parts of the world are using them are Dr. Sarah Yim, Acting Director of the Office of Therapeutic Biologics & Biosimilars, and Dr. Juli Tomaino, a pediatric gastroenterologist and Lead Medical Officer at the FDA.

Host: Jennifer Caudle, DO Guest: Mark Murphy, DO Millions of patients go to the hospital each year with symptoms like diarrhea caused by bacterial, parasitic, and viral pathogens, and these gastrointestinal infections can be particularly harmful in children. Joining Dr. Jennifer Caudle to examine how new guidelines can help direct our approach and, by extension, improve care decisions going forward is Dr. Mark Murphy.

Multicenter Clinical Validation of the Molecular-Based BD MAX™ Enteric Viral Panel for the Detection of Enteric Pathogens. William Stokes, MD, Patricia J. Simner, MSc, PhD, Joel Mortensen, PhD, Margret Oethinger, MD, PhD, Kathleen Stellrecht, PhD, Elizabeth Lockamy, PhD, Tricia Lay, MS, Peggy Bouchy, PhD, Dylan Pillai, MD, PhD Background: Conventional methodology for gastrointestinal pathogens remains time-consuming, expensive, and of limited sensitivity. Objective: Performance evaluation of the BD MAX™ Enteric Viral Panel (MAX EVP) assay for identification of viral pathogens in stool specimens from individuals with symptoms of acute gastroenteritis, enteritis, or colitis. Study Design: Prospective and archival stool specimens were collected in Cary-Blair medium or unpreserved containers from adult and pediatric patients with diarrhea. Specimens tested via the MAX EVP (on the BD MAX™ System) were compared to reference method (alternate PCR assays, followed by bi-directional sequencing). Positive percent agree

Host: Jennifer Caudle, DO To gain more insights into how inflammatory bowel disease (IBD) affects our young patients, Dr. Jennifer Caudle connects with Caroline, a 12-year-old patient who was diagnosed with IBD at the age of 4, and her parents, Preston and Rachelle, about the challenges they face and the strategies and solutions available that can help children and teens like Caroline manage this condition.

Host: Louis J Cohen, MD Impact of Obesity on Short- and Intermediate-Term Outcomes in Inflammatory Bowel Disease: Pooled Analysis of Placebo Arms of Infliximab Clinical Trials. Siddharth Singh, MD, MS James Proudfoot, MS Ronghui Xu, PhDWilliam J Sandborn, MD Background: To assess whether obesity may affect natural history of inflammatory bowel diseases (IBD), we conducted an individual participant data (IPD) pooled analysis of placebo arms, using data from clinical trials of infliximab in IBD and using the Yale Open Data Access (YODA) Project. Methods: We obtained IPD from 4 placebo-controlled trials of infliximab in adults with IBD (ACCENT-I and ACCENT-II; ACT-1 and ACT-2). Patients were categorized into quartiles based on body mass index (BMI) or weight at time of trial entry. Primary outcome was clinical remission (Crohn’s disease activity index [CDAI]<150, Mayo Clinic Score <3); secondary outcomes were clinical response and mucosal healing. Using multivariable logistic regression analysis, we c

Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area

Host: Gary R. Lichtenstein, MD Guest: Marla Dubinsky, MD Not every IBD patient fits into IBD care guidelines, which is why Dr. Gary Lichtenstein and Dr. Marla Dubinsky discuss the best ways to use these guidelines in your practice at the second annual Crohn’s & Colitis Congress in Las Vegas.

Guest: Shail Govani, MD, MSc Incidence and Predictors of Success of Adalimumab Dose Escalation and De-escalation in Ulcerative Colitis: a Real-World Belgian Cohort Study. Saartje Van de Vondel, MD, Filip Baert, MD, PhD, Christine Reenaers, MD, PhD, Stijn Vanden Branden, MD, Leila Amininejad, MD, Pieter Dewint, MD, PhD, Wouter Van Moerkercke, MD, Jean-François Rahier, MD, PhD, Pieter Hindryckx, MD, PhD, Peter Bossuyt, MD, Marc Ferrante, MD, PhD, and Belgian IBD Research and Development (BIRD) BACKGROUND: Adalimumab (ADM) has been shown efficacious in ulcerative colitis (UC). In randomized controlled trials, dose escalation from 40 mg ADM every other week to 40 mg every week was required in 20%–25% of patients within 1 year. Real-life data suggest higher escalation rates. Attempts for dose de-escalation have not been studied yet. We assessed the need for, outcome of, and predictors of dose escalation and de-escalation in a large retrospective cohort of UC patients treated with ADM. METHODS: We included 231

Guest: Yash Mittal, MD Reliability of Measuring Ileo-Colonic Disease Activity in Crohn's Disease by Magnetic Resonance Enterography. Vipul Jairath, MD, PhD, Ingrid Ordas, MD, PhD, Guangyong Zou, PhD, Julian Panes, MD, Jaap Stoker, MD, PhD, Stuart A Taylor, MD, Cynthia Santillan, MD, Karin Horsthuis, MD, Mark A Samaan, MD, Lisa M Shackelton, PhD, Larry W Stitt, MSc, Pieter Hindryckx, MD, PhD, Reena Khanna, MD, William J Sandborn, MD ,Geert D'Haens, MD, PhD, Brian G Feagan, MD, Barrett G Levesque, MD, and Jordi Rimola, MD, PhD BACKGROUND: Magnetic resonance enterography is increasingly utilized for assessment of luminal Crohn's disease activity. The Magnetic Resonance Index of Activity and the London Index are the most commonly used outcome measures in clinical trials. We assessed the reliability of these indices and several additional items. METHODS: A consensus process clarified scoring conventions and identified additional items based on face validity. Four experienced radiologists evaluated 50 images i

Host: Barnett Mennen, MD Physician Quality Reporting Systems, or PQRS, are here to stay in clinical medicine. Within the field of gastroenterology, understanding the metrics of PQRS can make a substantial difference in the success of a practice. Joining host Dr. Barry Mennen to detail the ins and outs of PQRS in gastroenterology is Dr. Ziad Gellad, Assistant Professor of Medicine, Director of Quality in the Division of Gastroenterology, and Director of Clinical Improvement in the Department of Medicine at Duke University Medical Center.

Host: Barnett Mennen, MD Host Dr. Barry Mennen welcomes Dr. Ashwin Ananthakrishnan, Assistant Professor of Medicine at Harvard Medical School and medical co-director at the MGH Crohn’s and Colitis center. Dr. Ananthakrishnan is involved in several large cohort studies that are attempting to examine established and novel environmental factors, including diet, that influence the risk of development of inflammatory bowel diseases. His recent study focusing on the potential role of dietary zinc in preventing bowel inflammation becomes the focus of this discussion.

Dr. Carol Burke, Director of the Center for Colon Polyp and Cancer Prevention at the Cleveland Clinic, unveils ongoing but underrecognized gender disparities in the practice of gastroenterology, such as differences in academic vs private practice opportunities, average salaries and hours worked, rates of promotion and partnerships, and male-modeled endoscopic equipment designs. Dr. Burke then explores gender disparities in GI care for patients with colorectal cancer, including differences in efficacy of colorectal cancer screening, male vs female morbidity and mortality rates, and even the underlying biologies of cancers themselves.

Irritable bowel syndrome is becoming increasingly recognized as a complex interplay of pathologies, from changes in gut microflora to nutrient absorption abnormalities to psychosocial stressors. The ways in which these factors contribute and interact create different profiles of disease, requiring personalized therapeutic plans for IBS patiets. Joining Dr. Barry Mennen to discuss a multimodal model for approaching the root causes of IBS is Dr. Neelesh A. Tipnis, the Paul H. Parker Professor and Chair of Pediatric Gastroenterology and Director of the GI Motility and Functional Bowel Disorders Program at the University of Mississippi Medical Center.

Live from the floor of Digestive Disease Week in Washington DC, GI Insights presents two interviews focusing on screening, surveillance, and therapeutic updates for colorectal and liver cancers, hosted by Dr. Barry Mennen. Guests on this program include: Dr. Linda Rabeneck, Vice President of Prevention and Cancer Control at Cancer Care Ontario (CCO), Professor of Medicine at the University of Toronto, and Senior Scientist at the Institute for Clinical Evaluative Sciences (ICES) in Toronto. Dr. Rabeneck speaks on global initiatives to increase awareness about colorectal cancer screening and surveillance. Dr. Kris Kowdley, Director of the Liver Care Network and Research Director of the Organ Care Program at Swedish Medical Center in Seattle, WA. Dr. Kowdley summarizes key takeaways on recognition of liver cancer and other related diseases of the liver in American populations today.

Live from the floor of Digestive Disease Week in Washington DC, GI Insights presents two interviews focusing on innovative approaches to inflammatory bowel disease, hosted by Dr. Barry Mennen. Guests on this program include: Dr. Jonathan Braun, Professor and Chair of Pathology and Lab Medicine at the David Geffen School of Medicine at UCLA. His research centers on the biology of mucosal interaction of host immunity with the local microbial community, and its impact on chronic mucosal inflammatory disease and cancer. Michael Hurst, author of Poop Power: How a Man Used a Fecal Transplant at Home to Permanently Cure Himself of Ulcerative Colitis. Mr. Hurst is a known advocate and volunteer for the Fecal Transplant Foundation, whose story of self-designing an unorthodox treatment regimen for ulcerative colitis has since offered new insights on best clinical management practices for IBD.

Host Dr. Barry Mennen welcomes Dr. Ryan Stidham, Assistant Professor of Internal Medicine at the Inflammatory Bowel Diseases Center of the University of Michigan Health System, to discuss the current therapeutic landscape for IBD based on recent comparative clinical trials.

Host: Jay Goldstein, MD Guest: Douglas Drossman, MD Host Dr. Jay Goldstein discusses the latest in IBS & Functional GI Disorders (FGIDs) with guest expert Dr. Douglas Drossman of the Drossman Center for the Education and Practice of Integrated Care. Dr. Drossman is Professor Emeritus in the departments of Gastroenterology and Psychiatry at the Center for Functional GI and Motility, University of North Carolina at Chapel Hill.

Host Dr. Jay Goldstein welcomes Dr. Sunanda V. Kane, Professor of Medicine in the Department of Gastroenterology & Hepatology at Mayo Clinic, to dicuss the latest in Crohn's disease diagnosis and management. Dr. Kane is author of IBD Self-Management: The AGA Guide to Crohn's Disease and Ulcerative Colitis, now in its second edition.