Chedid, Victor G

ABSTRACT Glucagon-like peptide-1 receptor agonists (GLP-1RA) are generally avoided in patients with a history of pancreatitis due to concerns about potential associated risk of acute pancreatitis (AP). However, their role in managing severe hypertriglyceridemia (HTG) remains underexplored. We present a case of a 42-year-old woman with recurrent HTG-induced AP who was initiated on GLP-1RA and achieved 15% weight loss, sustained triglyceride reduction, and remained AP-free while on that therapy. This case highlights a potential new role for the use of GLP-1RAs for HTG-AP.

Abstract Background Sexual dysfunction is common among patients with inflammatory bowel disease (IBD). For lesbian, gay, bisexual, transgender, or queer (LGBTQ+) patients, these challenges may be compounded by health disparities related to sexual health, stigma, and fear of discrimination in the clinical setting. There has been little research related to sexual health and IBD among this patient demographic. Methods Patients with IBD who receive care at Massachusetts General Hospital and the Brigham and Women’s Hospital were invited to participate in a 4-part survey on sexual health via an electronic patient portal messaging system and outpatient clinic flyers. Patients from the broader IBD community were invited to participate via social media outlets. Demographic data, IBD disease characteristics, and information related to health care experiences and interactions with IBD providers were collected. Sexual history information was obtained using an adapted version of the IBD-Specific Sexual Dysfunction Scale. Results In total, 340 patients completed the survey, of which 20.3% (n = 69) identified as LGBTQ+. The majority of patients (75%, n = 255) reported distress in their sexual life due to IBD; however, only 5% (n = 17) of respondents had previously discussed the topic of sexual health with their IBD provider. One in 4 LGBTQ+ patients listed fear of discrimination as a source of discomfort in these discussions, and a similar proportion expressed uncertainty regarding whether their sexual and/or gender identity negatively impacted their IBD care. Conclusions Further research and enhanced provider awareness of sexual health challenges related to IBD among LGBTQ+ patients may serve as an important step toward advancing inclusive and culturally sensitive care for this patient population.

INTRODUCTION: Little is known about the impact of gender-affirming hormone therapy (GAHT) on transgender and gender diverse adults with inflammatory bowel disease (IBD). The primary aim was to evaluate the incidence of IBD flare in the year before and after GAHT initiation. METHODS: A retrospective study across 5 IBD centers. Flare was defined as need for steroids, IBD-associated emergency department visit, or need for IBD medication change. Factors associated with IBD flare were assessed with univariate analysis and multivariable logistic regression controlling for age and IBD type. RESULTS: A total of 85 transgender and gender diverse adults with IBD who initiated GAHT were included in this study. Forty-six (54.1%) received estrogen and 39 (45.9%) received testosterone. In the year before GAHT, 42 (49%) flared compared with 32 (38%) in the year after, P = 0.06. There was no statistically significant difference in incidence of flare by age, IBD type, or IBD therapy type. Individuals with active IBD at GAHT initiation were more likely to flare in univariate (58% vs 24%, P = 0.003) and multivariable analyses (adjusted odds ratio 5.1, 95% confidence interval 1.7–15.2). In both univariate and multivariable analyses, individuals who received testosterone were more likely to flare in the year after starting GAHT, testosterone: 51% vs estrogen: 26%, P = 0.02 with an adjusted odds ratio 3.1 (95% confidence interval 1.2–8.1). DISCUSSION: Although there was no overall increased risk of flare in the year after GAHT start, those with active IBD before hormone start and those who received testosterone were more likely to experience an IBD flare.

Abstract Objectives Oral extraintestinal manifestations (OEIMs) of inflammatory bowel disease (IBD) may impact IBD treatment. The aims of this study were to: (1) determine which OEIMs are most prevalent among patients with IBD, (2) investigate the presence of a temporal association between GI luminal disease activity and OEIMs, and (3) determine how often changes in therapeutic management of IBD are needed in the presence of OEIMs. Study Design A retrospective cohort study was performed for adult patients with IBD evaluated between January 2017 and November 2021 with at least 1 oral complaint. Demographic data were collected from the charts of these patients. Kruskal-Wallis test for continuous measures and Fisher’s Exact test for categorical measures were used. Results A total of 116 patients with IBD who had presented with at least 1 oral finding during the study time period were identified. Aphthous ulcers were the most common oral presentation in both Crohn’s disease (CD) (85.1%) and ulcerative colitis (UC) (75.0%). OEIMs were associated with CD activity in the small intestine (P = .004) and colon (P < .001). UC pancolitis was associated with OEIMs (P = .002). In 32.7% of patients, OEIMs led to either an increase in dose or frequency of IBD therapy. In an additional 16.4% of patients, new systemic agents were started because of the OEIMs. Conclusions This study provides evidence that patients with IBD may develop OEIMs synchronous with IBD flares and may require escalation of IBD therapy when OEIMs occur.

INTRODUCTION: Evidence-based recommendations for sexual practices regarding anoreceptive intercourse (ARI) do not exist in patients with inflammatory bowel diseases undergoing restorative proctocolectomy with ileal pouch anal anastomosis (IPAA). This study surveys providers on perspectives and attitudes related to sexual practices after IPAA. METHODS: We developed a 23-item survey and distributed it to providers caring for patients with inflammatory bowel diseases. RESULTS: 95% of providers believe that it is important to discuss sexual orientation or practices before IPAA, but only 27% routinely discuss this. 50% did not feel comfortable and 74% did not feel confident discussing ARI recommendations with patients who underwent or will undergo IPAA. DISCUSSION: Future interventions should aim to standardize recommendations regarding feasibility and time line to safe ARI after IPAA.

Abstract Background and Aims Inflammatory bowel disease (IBD) is associated with altered mucus and increased intestinal permeability (IP). Prior reports on permeability in IBD typically used lactulose-to-mannitol ratio (LMR). Food contamination with 12C-mannitol is a significant potential confounder in IP assessment. We aimed to compare small intestinal (SI) and colonic (COL) permeability in IBD, both active (ACT) and in remission (REM), to normal healthy volunteers (NHV). Methods Inflammatory bowel disease activity was based on Simple Endoscopic Score for Crohn’s Disease (SES-CD) and Mayo endoscopy score for ulcerative colitis (UC). We performed 24-hour IP test using 100 mg 13C-mannitol and 1000 mg lactulose with urine collected during 0-2, 2-8, and 8-24 hours. The primary endpoint was mg excretion of 13C-mannitol and lactulose during 2-24 hours reflecting SI and COL permeability. Results Among 17 CD patients, 7 were ACT (SES-CD >6), and 10 REM (SES-CD 0-2). Among 20 UC patients, 10 had ACT (Mayo score 2-3), and 10 REM (Mayo score 0-1). Urinary excretions over 2-24 hours were higher for IBD than NHV: 13C-mannitol (13.8 [IQR 8.8, 18.7] NHV; 18.4 [15.6, 29.9] REM; 19.7 [13.8, 23.6] ACT, P = .003) and lactulose (1.8 [1.3, 3.1] NHV; 3.6 [2.0, 5.0] REM; 3.5 [2.0, 6.6] ACT, P = .006). There was no difference between ACT and REM for any timed urine collection. LMR at 2-24 hours (or 2-8 and 8-24 hours) were not statistically significant between the 3 groups (0.014 [0.010, 0.021] NHV; 0.016 [0.010, 0.023] REM; 0.016 [0.012, 0.038] ACT, P = .237). Conclusions Intestinal permeability is increased in IBD using validated in vivo assay relative to NHV; increased IP in IBD persists during remission.

ABSTRACT Orofacial granulomatosis (OFG) is a rare syndrome that can occur in association with Crohn's disease (CD). The electronic medical record was searched for “OFG” and “CD.” A total of 297 patients were identified, and relevant data were abstracted. Five patients met inclusion criteria. Most (80%) had ileocolonic CD with nonstricturing/nonpenetrating phenotype. The most common treatments included intralesional corticosteroids (4 patients), oral corticosteroids (3 patients), and anti-TNF agents, specifically infliximab (3 patients). Intralesional corticosteroid administration was followed by partial response in 3 patients, but recurrences were common following initial injection. One patient had no response to topical or oral corticosteroids, antihistamines, or oral antibiotics, but partial response to intralesional corticosteroids and infliximab. None of the patients had complete response to any therapies directed at this condition. OFG may be characterized by partial response, often requiring long-term therapy. Additional investigations into novel treatments may improve future clinical outcomes.

Lay Summary Upadacitinib, a selective JAK-1 inhibitor, was used as rescue therapy for ulcerative colitis in the setting of pregnancy following use of mesalamine, vedolizumab, infliximab, and corticosteroids. This resulted in an uncomplicated live full birth without need for surgical intervention.