IBD Journal Scan

Key articles from high impact journals in last month

Editorial Recommendations
JUNE - 2024

IBD's Hidden Burden: Unveiling the Widespread Extra-Intestinal Impact

Inflammatory bowel disease (IBD) extends beyond the gut, affecting various body systems including the musculoskeletal, ocular, skin, hepatobiliary, pulmonary, cardiac, and haematological systems, significantly influencing patient morbidity and mortality. A comprehensive meta-analysis, analysing data from 352,454 patients across 52 studies, found that 24% of IBD patients experience at least one joint, ocular, or skin extra intestinal manifestation. Notably, 27% of ulcerative colitis (UC) and 35% of Crohn's disease (CD) patients exhibit these symptoms. Pyoderma gangrenosum and axial joint issues are equally prevalent in UC and CD, while ocular and peripheral joint manifestations, as well as erythema nodosum, are more common in CD. This ground-breaking study provides robust data that can enhance patient counselling and inform future research. Anti-TNF agents are commonly used to treat inflammatory bowel disease (IBD), yet their long-term success in paediatric cases remains uncertain. In a study tracking 1,344 patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before age 17, researchers found that about 60% of CD and 70% of UC patients experienced anti-TNF therapy failure within 5 years, with loss of response (LOR) being the primary cause. The failure risk was highest during the first year of treatment. Factors like female gender and early initiation of anti-TNF were linked to increased failure rates. In contrast, no deaths or serious complications such as cancer or tuberculosis occurred during treatment. These findings highlight the need for improved long-term management strategies for paediatric-onset IBD.

Unseen Risks: Unveiling the Kidney Complications in IBD Patients

While extra-intestinal manifestations (EIMs) are common in inflammatory bowel disease (IBD) and significantly impact patient morbidity and mortality, renal complications remain under-recognized. Up to 15% of adult IBD patients develop chronic kidney disease, a condition arising from complex and poorly understood pathophysiology. Various renal disorders can affect the glomeruli or tubular structures, compounded by the nephrotoxic potential of IBD medications and metabolic complications from the disease itself. This systematic review aims to shed light on the rare but significant renal manifestations in IBD, highlighting the urgent need for vigilant monitoring and appropriate treatment strategies to mitigate these risks.

Gut to Pancreas: Unravelling the Hidden Links Between IBD and Pancreatic Disorders

Inflammatory bowel disease (IBD), a chronic immune-mediated gut disorder, frequently leads to extra-intestinal complications, including various pancreatic conditions like acute pancreatitis (AP), chronic pancreatitis (CP), autoimmune pancreatitis (AIP), and pancreatic exocrine insufficiency (PEI). Despite the significance of these associations, data remains limited and varied. A comprehensive review of 124 studies reveals that AP is the most common pancreatic issue in IBD, often caused by gallstones and medications, though idiopathic cases are rising. AIP, particularly type 2, shows a strong link to IBD, especially ulcerative colitis, suggesting an immune-mediated pathway. Although CP and PEI associations are suggested, current data is conflicting. This systematic review highlights the importance of recognizing and addressing pancreatic involvement in IBD to improve patient outcomes.

Beyond the Gut: Unveiling the Liver Complications in IBD

Inflammatory bowel disease (IBD) encompasses chronic, immune-mediated gastrointestinal disorders that often lead to extraintestinal manifestations, including significant hepatobiliary complications. This meta-analysis evaluated the prevalence of hepatic issues among IBD patients by reviewing 118 cohort studies from PubMed, Scopus, Web of Science, and Embase. Analyzing data from 1,729,128 patients, the study found that 3.49% experienced hepatic manifestations. Non-alcoholic fatty liver disease was present in 26.1% of 228,216 patients, while 1.67% of 9,642 patients had primary sclerosing cholangitis. Biliary stones appeared in 4.1%, and rarer conditions like autoimmune hepatitis and portal vein thrombosis were identified in 0.51% and 0.21% of cases, respectively. These findings highlight the critical need for vigilant monitoring and management of liver complications in IBD patients, enhancing overall patient care and outcomes.

Hidden Dangers: Elevated Cardiovascular Risks in IBD Patients, Especially Women

The connection between inflammatory bowel disease (IBD) and cardiovascular disease (CVD) risks remains ambiguous. This meta-analysis examined studies from PubMed and Web of Knowledge up to December 2017 to clarify this link. Analyzing 27 articles, including 11 on CVD incidence and 16 on CVD mortality, revealed significant findings. IBD patients faced increased risks for cerebrovascular disease (25% higher), coronary heart disease (17% higher), and myocardial infarction (12% higher), with women particularly vulnerable. Despite these elevated incidence rates, there was no significant increase in CVD mortality for Crohn's disease or ulcerative colitis patients. These findings underscore the importance of cardiovascular monitoring in IBD patients, with heightened vigilance for female patients.

Vedolizumab: A Mixed Bag for IBD Patients with Extraintestinal Issues

Extraintestinal manifestations (EIMs) significantly impact inflammatory bowel disease (IBD) patients, and while vedolizumab (VDZ) targets the gut, its effects on EIMs are unclear. This meta-analysis reviewed 21 studies from databases like PubMed and Cochrane CENTRAL to evaluate VDZ's impact on EIMs. Among 386 VDZ-treated IBD patients, 39% saw resolution of pre-existing EIMs, with notable improvements in articular-related EIMs (40%) and erythema nodosum (50%). However, 28% of 376 patients experienced exacerbations, particularly in arthritis/arthralgia (28%) and erythema nodosum/pyoderma gangrenosum (18%). New EIMs developed in 15% of 2541 patients, primarily articular-related (11%). Thus, while VDZ is effective for certain skin and joint EIMs, some patients may experience exacerbations, highlighting the need for careful monitoring.