Mourad, Fadi H.

Patients with inflammatory bowel disease (IBD) frequently modify their diet and use complementary medicine, but inconsistent evidence and persistent myths complicate clinical guidance. Our aim was to critically evaluate the evidence for dietary and complementary strategies in IBD and to clarify common misconceptions, supporting evidence-based, patient-centred management. A narrative synthesis of randomised trials, systematic reviews and international guidelines was conducted. Interventions that were evaluated included dietary strategies encompassing the Mediterranean diet, low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet, exclusive enteral nutrition, Crohn’s disease exclusion diet and the specific carbohydrate diet. Other interventions included complementary modalities such as probiotics, curcumin, herbal medicine, mind-body interventions and physical activity. The Mediterranean diet shows moderate evidence for improving quality of life and inflammatory biomarkers. A low-FODMAP diet can relieve functional symptoms but does not reduce inflammation. Exclusive enteral nutrition remains first-line induction therapy in paediatric Crohn’s disease. The Crohn’s disease exclusion diet/partial enteral nutrition shows promise in adults. Among complementary therapies, specific probiotics and curcumin demonstrate benefits in certain cases of ulcerative colitis, but evidence for their use in Crohn’s disease remains limited. Personalised, multidisciplinary supervised dietary and complementary approaches may support symptom control and quality of life in IBD patients. However, they should complement rather than replace evidence-based pharmacologic therapy, and high-quality trial and clinical studies are needed to define optimal, evidence-based nutritional strategies.

Patients with inflammatory bowel diseases (IBDs) may require solid organ transplants (SOTs) for multiple reasons, making its prevalence slightly higher than the general population. Although immunosuppression used in SOT may help control IBD-related inflammation, many patients still require additional immunosuppressive medications. We aim to assess the effectiveness and safety of the combination of SOT-related immunosuppression and IBD medications in patients with liver, kidney, or heart transplantation. We conducted a clinical review using PubMed, Scopus, MEDLINE, Embase, and Google Scholar databases for our search. We included data from systematic reviews, meta-analyses, case series, and case reports to assess the safety, effectiveness, and side effect profile of immunomodulators, biologic therapies, and small molecules in patients with SOT. Our review encompassed 25 liver, 6 kidney, and 1 heart transplant studies involving patients with IBD. Common liver transplant immunosuppressants included tacrolimus, mycophenolate mofetil, cyclosporine, and steroids. Anti-TNF agents, widely used in all SOT types, showed no significant safety issues, though infections and malignancies were noted. Patients with liver transplant on tacrolimus responded well to anti-integrins and ustekinumab without major complications. For kidney transplants, cyclosporine and tacrolimus were prevalent, and their combination with anti-TNF or ustekinumab was generally safe, with rare reports of malignancy or infection. Hence, the use of anti-TNF, anti-integrin agents, and ustekinumab appears to be safe in patients with SOT, regardless of their transplant related immunosuppression. More studies are needed in patients with kidney and heart transplants and in patients treated with small molecules for their IBD.

Introduction: Diet is thought to play an important role in the clinical course and quality of life (QOL) of patients with inflammatory bowel disease (IBD). However, dietary habits of patients with IBD are still unknown. This case–control study aims to compare the dietary habits of patients with IBD to healthy controls and evaluate differences in disease severity and QOL. Materials and methods: Food frequency, severity scores using the Harvey–Bradshaw and Ulcerative colitis activity index, and QOL were assessed using online questionnaires. Dietary habits were compared for patients with active disease and remission and for those with low QOL (LQOL) and high QOL (HQOL). Results: We recruited 61 patients with IBD and 101 controls. Significance was set at p = 0.05. Controls consumed significantly more daily calories (2546 vs. 1641, p = 0.001). However, patients with IBD consumed a higher percentage of carbohydrates (50% vs. 45%, p = 0.001), more red meat (p = 0.024), and less fiber, sucrose, and lactose (p = 0.001, 0.001, and 0.036). Patients with active disease had higher lipid intake, lower protein intake, and lower QOL (47 vs. 58, p = 0.001). Dietary differences between LQOL and HQOL mirrored those between active disease and remission. Conclusion: This study is the first to provide valuable insights into the nutritional profile of Lebanese patients with IBD.

Abstract Background Approximately 15%–20% of patients with ulcerative colitis (UC) will require surgery during their lifetime. Ileal pouch–anal anastomosis (IPAA) is the preferred surgical option, which typically requires access to a specialist experienced in surgery for inflammatory bowel diseases (IBD). Methods The aims of this study are the assessment of the comparative use of IPAA for UC among different racial/ethnic groups and observe trends over the past decade in the United States as well as the comparative assessment of their respective postoperative outcomes. This was an observational retrospective study using the National Inpatient Sample (NIS) 2009–2018 dataset. All patients with ICD-9/10CM codes for UC were included. The primary outcome was comparative trends in IPAA construction across races/ethnicities in the past decade, which was compared to White patients as reference. Multivariate regression analyses were used to adjust for age, gender, Charlson comorbidity index, income in patient zip code, insurance status, hospital region, location, size, and teaching status. Results The number of patients discharged from US hospitals with an associated diagnosis of UC increased between 2009 and 2018, but the number of patients undergoing an IPAA decreased during that time period. Of 1 153 363 admissions related to UC, 60 688 required surgery for UC, of whom 16 601 underwent IPAA in the study period. Of all the patients undergoing surgery for UC, 2862 (4.7%) were Black, while 44 351 were White. This analysis indicated that Black patients were less likely to undergo IPAA both in 2009 and in 2018 compared to Whites. Hispanic patients were significantly less likely to receive IPAA in 2009 but were no longer less likely to receive IPAA in 2018 when compared to Whites. Conclusions The use of IPAA among Black patients requiring surgery for UC remains less common than amongst their White counterparts. Further research is needed to determine if racial disparity is a factor in decreased access to specialized care.

Abstract Background Despite the growing therapeutic armamentarium, at least half of the patients with Crohn’s disease will require surgery during their lifetime. Current evidence for the prevention and treatment of postoperative Crohn’s disease supports the use of anti-tumor necrosis factor agents with limited data about the use of the newer biologics, vedolizumab and ustekinumab. Methods We performed a systematic review of available data to determine the efficacy of the newer biologics in the management of postoperative Crohn’s disease. We included noncomparative and comparative studies. The main outcomes of interest were clinical and endoscopic postoperative recurrence rates. Results The search strategy identified 1231 citations, with 32 eligible for review. Several studies showed that the postoperative Crohn’s disease recurrence rates with the use of the newer biologics were comparable to previously published results with the use of anti-tumor necrosis factor agents, while other studies failed to show their efficacy. It is important to note that the studies were heterogeneous and included a relatively small sample size, making it difficult to draw a definite conclusion about the efficacy of the newer biologics in the management of postoperative Crohn’s disease. Conclusion The newer biologics do play a role in the management of postoperative Crohn’s disease. After our review, we proposed an updated algorithm on the role of newer biologics in the approach to patients with postoperative Crohn’s disease. Yet, until we have better-designed studies, their definite positioning remains to be determined.