Publications

BACKGROUND: The diagnosis of inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohn's disease (CD), relies on clinical and pathological criteria. Non-invasive precision medicine tools to diagnose IBD and discriminate between UC and CD are needed to personalise management. Serum proteomics identified protein biomarkers capable of diagnosing IBD and differentiating CD from UC subtypes.

METHODS: We obtained serum samples from a retrospective study of 47 patients with IBD and non-IBD patients seen in a tertiary care paediatric gastroenterology clinic and applied SomaScan proteomics to measure 1305 proteins to discriminate between IBD and non-IBD and UC and CD. Four proteins were further validated by immunoassays in two retrospective cohorts of 295 and 105 individuals and multi-protein predictors were developed using Support Vector Machines (SVM).

FINDINGS: The SomaScan discovery phase identified 95 serum protein biomarkers (BH p < 0.01) that differentiated IBD from non-IBD and 70 proteins (p < 0.01) that distinguished UC from CD. Pathway analysis linked specific inflammatory processes and vascular functions to IBD and UC versus CD. An 8-protein classifier achieved an AUC of 0.95 for identifying IBD. Significant elevation of four key predictor proteins (MMP1, MMP3, Resistin, Haptoglobin) in IBD was validated by ELISA in the expanded cohort (N = 295). The 4-protein SVM predictor achieved an AUC of 0.86 and 0.90 for IBD discrimination in two independent cohorts. A separate 4-protein SVM predictor for differentiating UC from CD achieved an AUC of 0.93 in independent validation.

INTERPRETATION: Patients with paediatric-onset IBD have a unique serum protein signature associated with pro-inflammatory and vascular pathways. Additional studies are needed to determine whether these dysregulated proteins can be used in conjunction with traditional risk factors to support non-invasive biomarkers that identify IBD and discriminate between its subtypes.

FUNDING: Martin Schlaff, The Diane and Dorothy Brooks Foundation, The Manessis Family, Thomas and Lynn Kuzma, and The Hasso Serrano Foundation.

BACKGROUND: Postpartum pain management is an important part of maternal healthcare. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are typically offered as first-line pharmacologic therapies for postpartum pain. There is a belief that NSAIDs may play a role in exacerbating inflammatory bowel disease (IBD); as a result, some obstetricians avoid NSAIDs for postpartum pain management in patients with IBD. However, data concerning the relationship between short-term NSAID use and IBD flares are inconsistent. The aim of this study was to assess whether hospital postpartum NSAID use is associated with postpartum IBD flare within 9 months from delivery.

METHODS: This single-center retrospective cohort study included patients with IBD, aged 18 years or older, who had singleton live births between January 1, 2016, and November 30, 2023. Chart review data for each eligible patient were collected for a 9-month postpartum period.

RESULTS: Among the 187 patients included in the study, there was no difference between NSAID-exposed and non-exposed patients in postpartum IBD flare: 10/114 (9%) vs. 10/73 (14%), respectively, P=0.335. Based on multivariate regression analysis, NSAID exposure was not associated with postpartum IBD flare, adjusted for active disease at conception and IBD flare during pregnancy: adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.2-1.7; P=0.327. The same was true for mode of delivery and inpatient opioid exposure: aOR 0.6, 95%CI 0.1-1.5; P=0.291.

CONCLUSIONS: Postpartum NSAID use for pain control is not associated with IBD flare 9 months after delivery. Large prospective studies are needed to confirm this finding.

Microscopic colitis (MC) is a histologically confirmed cause of chronic diarrhea with normal endoscopy, and limited data complicate diagnosis and management during pregnancy. We report a 31-year-old woman with lymphocytic colitis, initially misdiagnosed as irritable bowel syndrome, who experienced an MC flare at 15 weeks' gestation after starting sertraline. Symptoms resolved with sertraline discontinuation and budesonide, with remission maintained postpartum. This case underscores the importance of medication review, early recognition, and multidisciplinary care in pregnant patients with persistent diarrhea, particularly when coordinating gastrointestinal and psychiatric management.

INTRODUCTION: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction that affects over 6% of Americans. Increased physical activity improves IBS symptoms and may be associated with lower odds of IBS; however, prior studies are small or limited by self-reported measurements. This study aimed to investigate associations between Fitbit-recorded physical activity data and the prevalence of IBS.

METHODS: A retrospective, cross-sectional analysis was conducted using the All of Us Research Program. Adults over 18, who shared Fitbit and electronic healthcare record data, were included. Participants were placed into quartiles based upon their mean daily activity metrics: steps, active minutes, sedentary minutes, and maximum heart rate. Covariates included demographics, lifestyle factors (alcohol and smoking), BMI, education, income, and comorbidities. Multivariable logistic regression was used to analyze associations between activity metrics and IBS.

RESULTS: Of 43,967 participants, 1551 (3.5%) had an IBS diagnosis. The IBS group was 83% female, 79% White, with a median age of 53 years. Compared to the lowest quartile, participants in the highest quartile of average daily steps (OR: 0.82; p=0.028), very active minutes (OR: 0.72; p<0.001), and maximum heart rate (OR: 0.65; p<0.001) had significantly lower odds of IBS. Conversely, those in the highest quartile of sedentary minutes had higher odds of IBS (OR: 1.24; p=0.007).

DISCUSSION: This large, real-world study, using objective physical activity data, demonstrates that higher levels of physical activity is associated with lower odds of IBS. Prospective studies are warranted to determine whether physical activity has a causal protective effect against IBS.

This review offers information and practical guidance for professionals who care for patients with disorders of gut-brain interaction (DGBI). It summarizes evidence-based psychosocial approaches for adult and pediatric populations, organized into 4 sections: background, assessment, management, and training. The review begins by establishing a biopsychosocial framework, highlighting the bidirectional influences of biological and psychosocial factors on gut physiology and brain mechanisms. It then outlines key assessment strategies, including targeted patient interview questions and guidance on interpreting responses followed by empirically supported psychosocial treatments suitable for integrated and standalone care settings. The final section presents curriculum recommendations for providers in DGBI-specific psychosocial care. Emphasizing the brain-gut axis and the importance of the patient-provider relationship, this review underscores the need for accurate psychosocial assessment and contextually informed intervention. It concludes with future directions for training and research to enhance clinical outcomes in this complex and multifaceted domain.

BACKGROUND AND AIMS: Real-world data are needed to better understand the burden and outcomes of patients hospitalized with severe ulcerative colitis (UC).

METHODS: This retrospective cohort study analyzed US electronic health record (EHR) data with linked insurance claims to identify adults hospitalized for UC who received intravenous corticosteroids during an inpatient admission (index hospitalization) between January 1, 2014, and December 31, 2022, with ≥180 days of prior EHR activity. Results were analyzed for the overall cohort, in three subgroups: (1) no prior UC diagnosis in the EHR, (2) prior UC diagnosis without prior advanced therapy, and (3) prior UC with prior advanced therapy, and in a nested cohort of patients discharged without colectomy. Multivariable analyses assessed factors associated with colectomy before discharge.

RESULTS: Overall, we identified 9716 patients (mean [SD] age, 46.3 [17.4] years); 83.3% had a previous diagnosis of UC and 23.8% had prior biologic use for UC. During hospitalization, 13.1% received advanced therapy; 12.2% underwent colectomy. The rate of colectomy was 12.6% in subgroup 1, 9.2% in subgroup 2, and 19.6% in subgroup 3 (P < .0001). Prior UC diagnosis with prior advanced therapy use and abnormal/missing albumin labs were associated with higher risk of colectomy. The cumulative risk of colectomy <1 year after index hospitalization was 20.4% overall and 18.5%, 16.1%, and 32.7% in subgroups 1, 2, and 3, respectively. In the nested cohort (n = 4383), one-third received advanced therapy within 90 days; 38.4% experienced a UC-related hospitalization <1 year after index hospitalization.

CONCLUSION: These data from a large contemporary cohort elucidate the burden and outcomes for patients hospitalized with severe UC.

Gastrointestinal malignancies such as signet-ring cell carcinoma can mimic inflammatory bowel disease, leading to diagnostic uncertainty. We present the case of a 39-year-old woman who presented with cramping abdominal pain, watery diarrhea, and unintentional weight loss. Imaging revealed multifocal colonic strictures and pelvic ascites, initially suspected to represent Crohn's disease. Bidirectional endoscopy showed gastric edema and colonic strictures without typical inflammatory features. Following laparoscopic-assisted subtotal colectomy for progressive obstruction, histopathology revealed diffuse infiltration of signet-ring cells consistent with metastatic gastric adenocarcinoma. This case highlights the importance of maintaining a broad differential diagnosis when atypical features are present. Clinicians should maintain a high index of suspicion for malignancy in young patients with atypical strictures, especially when accompanied by systemic features such as weight loss or ascites, even when initial endoscopic biopsies are non-diagnostic.

PURPOSE: Studies show women are underrepresented in gastroenterology (GI). Understanding representation is crucial to improving representation. This study describes the geographic distribution of women in academic GI in the United States (US).

METHODS: We conducted a cross-sectional study of 224 US GI fellowship programs in 2023 by review of program websites and direct inquiry. Gender distribution of trainees and faculty across US regions was evaluated. Program characteristics were examined in univariate analyses. Logistic regression models assessed factors associated with women in leadership, adjusting for program type and region.

RESULTS: Women comprised 39.3% of 1,801 fellows and 30.2% of 3,899 GI faculty. Percentage of women fellows was highest in the West (50%), Northeast (38%), South (33%), and Midwest (33%), (p = 0.014). Median percentage of senior women faculty was highest in the Northeast (27%) (p = 0.009). Programs with women GI division chiefs had more women GI fellowship program directors (60% vs 40%, p = 0.001) and higher median percentage of women faculty (33% vs 26%, p = 0.016). The presence of a woman GI division chief was independently associated with having a woman GI fellowship program director (p = 0.008) and increased percentage of women faculty (p < 0.001).

CONCLUSION: Gender representation varied regionally, with some institutions lacking women faculty or trainees. Women in leadership are associated with greater faculty gender diversity, potentially impacting trainee recruitment, faculty retention, and patient care. The association between women GI division chiefs and increased women faculty and program directors highlights how leadership gender diversity may support recruitment and retention of women in academic GI.