New research was virtually presented at DDW 2020, the annual Digestive Disease Week, starting on May 2. The features below highlight some of the studies that emerged from the conference.
Fecal Transplant Highly Effective in Real World
Despite limited prospective safety data and poorly described real-world practice and effectiveness, evidence suggests that fecal microbiota transplant (FMT) is widely practiced for the treatment of Clostridium difficile infection (CDI). To assess FMT methods, safety, and effectiveness outcomes from North American FMT providers, researchers assessed de-identified data on 30-day and 6-month outcomes from patients who had undergone FMT. At 30 days, 89% of patients experienced cure of CDI and only 1% had endoscopy-related complications. Severe symptoms at 30 days included diarrhea (2%), abdominal pain (2%), and hospitalization considered to be related or possibly related to FMT (2%). Among those with 30-day cure who were followed to 6 months, 5% had CDI recurrence. Adverse events reported between 1 and 6 months post-FMT included non-CDI infections (5%). New diagnoses of irritable bowel syndrome and ulcerative colitis were made in 3% and 1% of these patients, respectively.
Patient Vs Physician Perspectives on Steroids for IBD
Although research indicates they are less effective than maintenance therapy and prolonged use is suggested to be associated with significant morbidities, corticosteroids are often used in the treatment of inflammatory bowel disease (IBD). To assess the real-world management of IBD related to steroid use, researchers surveyed nearly 2,400 patients with Crohn’s disease (CD) or ulcerative colitis (UC) and more than 650 gastroenterologists. Among the 50% of patients with CD and 32% with UC who were currently on biologic therapy, 69% with CD and 58% with UC reported a loss of response to prior treatments. Most physicians reported that their patients experienced a loss of response to biologic therapy fairly/very frequently (66% CD, 56% UC). Roughly three-quarters of all patients reported ever using steroids for their IBD, with 35% and 18% of patients with CD, and 39% and 19% of patients with UC, reporting 4 or more months or 6 or more months of use in the past year, respectively. Corresponding numbers reported by physicians were 40% and 14% for their patients with IBD. Among patients currently on steroid therapy, 48% with CD and 42% with UC reported concerns about any steroid use, and two-thirds reported wanting to stop use as soon as their disease was under control. Conversely, only 27% of physicians reported concern with any steroid use, with about 50% reporting concern with 4 or more months of steroid use per year.
Disparities in Liver Transplant for NASH-Induced Cirrhosis
Research indicates that non-alcoholic steatohepatitis (NASH) is quickly becoming a leading etiology of end-stage liver disease in liver transplant recipients. To better understand the care of this emerging patient population, study investigators examined admissions data for disparities in adults with NASH and cirrhosis in centers with at least one documented liver transplant. Among 17,337 weighted admissions, there were 2,007 weighted transplantations. Compared with Caucasians, African-American patients had an adjusted odds ratio of 0.587 for transplantation, whereas Hispanic, Asian or Pacific-Islander, and Native-American patients had odds ratios or 0.890, 0.811, and 1.092, respectively. Compared with males, females had an odds ratio of 0.796 for transplantation. Odds ratios for transplantation were 0.877 for those aged 36-50, 0.864 for those aged 51-64, and 0.484 for those aged 65 and older, compared with those aged 18-35. Hepatocellular carcinoma and hepatorenal syndrome were correlated with higher transplant odds, as were private insurance and greater zip code median income.
The Etiological Distribution & Esophageal Motility of Esophageal Chest Pain
To assess the etiological distribution and esophageal motility characteristics of patients with esophageal chest pain, researchers examined nearly 100 such patients using high-resolution esophageal manometry and 24-hour pH monitoring. Among participants, 86.73% had abnormal esophageal motility, of whom 52.04% had nonspecific esophageal dyskinesia, 16.33% had GERD, 12.24% were cases of esophagogastric junction outflow obstruction, 3.06% were cases of disuse spasm of the esophagus, and 3.06% were cases of achalasia. No differences were observed between those with normal and abnormal esophageal motility in age, height, or weight. The most common lower and upper esophageal sphincter dysfunctions among all participants were due to low pressure, while the most common contraction mode issue was weak peristaltic contraction. The most common esophageal dyskinesia of GERD was invalid esophageal motility.
Added Dietary Sugar Tied to Worse Mental Health Status in Patients With IBD
Prior research indicates an association of sugar with clinical depression and anxiety through altering of biochemical signals along the gut-brain axis. Other studies suggest that inflammatory bowel disease causes significant disruption of the microbiome and possibly the gut-brain access. However, studies are lacking on the interaction of specific dietary components, including sugar, and mental health in patients with IBD. With the hypothesis that patients with IBD who consume large amounts of added sugars would be at increased risk for psychiatric comorbidities, study investigators collected prospective diet data and assessed risk for depression and anxiety among patients with IBD. More than 1,400 patients (70% with Crohn’s disease, 30% with ulcerative colitis, 43% male) were grouped by daily sugar consumption (<100 g = low, >100 g = high). Those in the high sugar group were significantly more likely to have feelings of fatigue, trouble with social engagement, difficulty with leisure activity, feelings of depression, and trouble relaxing compared with those in the low sugar group.