Inflammatory Bowel Disease

Rectal mucus protein collection using the OricolTM sampling device: Comparison of calprotectin levels in stool and rectal mucus in patients with suspected or confirmed inflammatory bowel disease (Oricol-EGI- 01 Study) (2022)

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Type of publication:
Conference abstract

Author(s):
*Jones, G.

Citation:
Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Edinburgh United Kingdom. 24(Supplement 2) (pp 58), 2022. Date of Publication: September 2022.

Abstract:
Background: Faecal calprotectin testing is recommended by the National Institute for Health and Care Excellence (NICE) to distinguish between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) after cancer exclusion. Many patients do not produce faecal samples as requested and therefore a direct collection technique may have a role in IBD diagnosis or monitoring. We compared the performance of faecal and rectal mucus calprotectin collected with the OriColTM sampling device Methods: Sixty-six patients with confirmed or suspected IBD were recruited in the Oricol-EGI- 01 Study. OriColTM and matched stool samples were collected and processed following standard operating procedures. Calprotectin concentrations were measured using IDK Calprotectin and fCAL assays Results: Calprotectin was detectable in the OriColTM samples with good discrimination across the calprotectin assays and discernible correlation to corresponding faecal calprotectin concentrations Using thresholds determined for rectal mucus calprotectin (calculated by linear regression), the percentage agreement between calprotectin concentrations in stool and rectal mucus for patients with faecal calprotectin >=50 mug/g was between 68% and 91% with a percentage agreement at <50 mug/g between 40% and 71% with IDK Calprotectin and fCAL assays respectively. Good agreement was observed for IBD patients with the results being above the threshold for both faecal and rectal mucus calprotectin with 93% and 86% for IDK Calprotectin and fCAL assays respectively Conclusion(s): The OriColTM Calprotectin Kit was successfully used to collect rectal mucus and measure calprotectin concentrations with positive correlation to corresponding faecal calprotectin and is potentially a new and acceptable modality in IBD patients.

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Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab (2022)

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Type of publication:Journal article

Author(s):Lin S.; Kennedy N.A.; Saifuddin A.; Sandoval D.M.; Reynolds C.J.; Seoane R.C.; Kottoor S.H.; Pieper F.P.; Lin K.-M.; Butler D.K.; Chanchlani N.; Nice R.; Chee D.; Bewshea C.; Janjua M.; McDonald T.J.; Sebastian S.; Alexander J.L.; Constable L.; Lee J.C.; Murray C.D.; Hart A.L.; Irving P.M.; Jones G.-R.; Lees C.W.; Altmann D.M.; Boyton R.J.; Goodhand J.R.; Powell N.; Kok K.B.; Bokth F.; Cipriano B.; Francia C.; Khalid N.; Khatun H.; Kingston A.; Lee I.; Lehmann A.; Naik K.; Pabriaga E.; Plaatjies N.; Samuels K.; Saich R.; Cousins H.; Thomas R.; Brown M.; White B.; Tilley B.; Muhammed R.; Bi R.; Cotter C.; Grove J.; Hong K.; Howman R.; Clayton S.; Sultan S.; Rooney M.; Cottrill C.; Singh S.; Dawe C.; Hull R.; Silva N.; Manning J.; Finlayson L.; Roebuck A.; Dawson J.; Sonwalkar S.; Chambers N.; Robinson M.; Haigh A.; Matapure L.; Raine T.; Kapizioni C.; Strongili K.; Thompson T.; Ahmed M.; Kontos C.; Bourges C.; Barbutti I.; Gozzard M.E.; Hendy P.; Bull R.; Costa P.; Davey L.; Hannington H.; Nundlall K.; Martins C.; Avanzi L.; Carungcong J.; Barr S.; Appleby R.; Johnson E.; Phillis K.; Gascoyne R.; Crowder A.; Whileman A.; London I.; Grounds J.; Martin E.; Price J.; Cawley K.; Dhar A.; Brown E.; Cowton A.; Warner B.; Stuart C.; Lacey L.; de Silva S.; Allcock C.; Harvey P.; Jones L.; Cooke E.; Brooks J.; Baker P.; Beadle H.; Cruz C.; Potter D.; Collum J.; Masters F.; Kumar A.; Coetzee S.; Peiu M.; Icke B.; Raj M.; Gaynor E.; Chadokufa S.; Huggett B.; Meghari H.; El-Khouly S.; Kiparissi F.; Girshab W.; Claridge A.; Fowler E.; McCafferty L.; Christodoulides K.; Clifford A.; Dawson P.; Honap S.; Lim S.; Luber R.; Mahiouz K.; Meade S.; Reynolds R.; Stanton A.; Tripoli S.; Hare N.; Balachandran S.; North E.; North J.; Browne B.; Jameson E.; Siaw Y.H.; Manzano L.; Segal J.; Al-Bakir I.; Khakoo I.; Thoua N.; Davidson K.; Miah J.; Canclini L.; Hall A.; Hayes M.; Myers S.; Talbot A.; Turnbull J.; Whitehead E.; Stamp K.; Pattinson A.; Mathew V.; Sherris L.; Harvey A.; Hicks L.; Byrne T.-M.; Cabreros L.; Downing-Wood H.; Hunter S.; Prabhudev H.; Balarajah S.; Ibraheim H.; Torkizadeh M.; Lo J.W.; Liu Z.; Sutherland H.; Wilhelmsen E.; Mackintosh K.; Verma A.M.; Sebastian J.; Peerally M.F.; Raymode P.; Guerdette A.-M.; Kent A.; Choong L.M.; Pantaloni B.; Ravdas P.; Vadamalayan B.; Foley S.; Arnold B.; Heeley C.; Lovegrove W.; Sowton D.; Allsop L.; Gregory H.; Smith P.J.; Bretland G.; King S.; Lofthouse M.; Rigby L.; Subramanian S.; Tyrer D.; Martin K.; Probert C.; Kamperidis N.; Adedoyin T.; Baden M.; Chacko F.; Cicchetti M.; Saifuddin M.A.; Yesupatham P.; Gowda R.; Williams M.; Kemp K.; Akhand R.; Gray G.; John A.; John M.; Mohammed T.; Sathe D.; Jones N.; Soren J.; Sprakes M.; Burton J.; Kane P.; Lupton S.; Bartholomew J.; MacFaul G.; Scaletta D.; Siamia L.; Williams F.; Green C.; Ver Z.; Lamb C.A.; Doona M.; Hogg A.; Jeffrey L.; King A.; Speight R.A.; Doyle J.; Owen R.; Mowat C.; Rice D.; MacFarlane S.; MacLeod A.; Mohammed S.; Murray S.; Elliott A.; Morris M.A.; Coke L.; Hindle G.; Kolokouri E.; Wright C.; Lee C.; Ward N.; Dann A.; Lockett M.; Cranfield C.; Jennings L.; Srivastava A.; Ward L.; Jeynes N.; Ranga P.; Rajasekhar P.; Gallagher L.; Patterson L.; Ward J.; Basnett R.; Murphy J.; Parking L.; Lawson E.; Short S.; Devadason D.; Moran G.; Khan N.; Tarr L.; Olivia C.; Limdi J.; Goulden K.; Javed A.; McKenzie L.; Bhandari P.; Baker-Moffatt M.; Dash J.; Le Poidevin A.; Downe H.; Bombeo L.; Blackman H.; Wiles A.; Bloxham H.; Dias J.; Nadar E.; Curgenven H.; Macdonald J.; Finan S.; McMeeken F.; Mahmood M.; Shields S.; Seenan J.P.; DeSilva D.; Malkakorpi S.; Carson R.; Whiteoak S.; Edger-Earley K.; Vamplew L.; Ingram S.; Botfield S.; Hammonds F.; James C.; Ahmad T.; Aspinall G.; Hawkins S.; Marriott S.; Redstone C.; Windak H.; Adam A.-M.; Mabb H.; Murray C.; Diaba C.; Joseph F.; Pakou G.; Gleeson Y.; Berrill J.; Stroud N.; Pothecary C.; Roche L.; Turner K.; Deering L.; Israel L.; Baker E.; Cutler S.; Evans R.M.; Nash M.; Mallison G.; Roynon A.; Gordon J.; Levell E.; Zagalo S.; Fraser W.; Hoad I.; Kirkineziadis N.; Russell R.; Henderson P.; Millar M.; Fagbemi A.; Jennings F.; Mayor I.; Wilson J.; Alexakis C.; Michalak N.; Saunders J.; Burton H.; Cambridge V.; Clark T.; Ekblad C.; Hierons S.; Katebe J.; Saunsbury E.; Perry R.; Brookes M.; Davies K.; Green M.; Plumbe A.; Ormerod C.; Christensen H.; Keen A.; Ogor J.; Anthony A.; Newitt E.; Trim F.; Casey R.; Seymour K.; Fogden E.; Russell K.; Phillips A.; Abdulla M.; *Butterworth J.; *Adams C.; *Buckingham E.; *Childs D.; *Magness A.; *Stickley J.; *Motherwell N.; *Tonks L.; *Gibson H.; *Pajak S.; Thomas C.; Brinkworth E.; Connor L.; Cook A.; Rees T.; Harford R.; Wesley E.; Moss A.; Lucas J.; Lorimer C.; Oleary M.; Dixon M.; Ramadas A.; Tregonning J.; Okeke O.; Jackson W.; Koumoutsos I.; George V.; Kunhunny S.; Laverick S.; Anderson I.; Smith S.; Patel K.; Ali M.; Mhandu H.; Rana A.; Spears K.; Teixeira J.; Pollok R.; Mencias M.; Seaward A.; Sousa J.; Said N.; Soomaroo M.; Raspa V.; Tacouri A.; Reps N.; Martin R.; Selinger C.; Carbonell J.; Onovira F.; Quartey D.; L'Anson A.; Ashworth A.; Bailey J.; Dunn A.; Mahmood Z.; Campbell R.; Marsh L.; Rahman M.; Davies S.; Habibi R.; Jessup-Dunton E.; Joefield T.; Layug R.; Patel V.; Vere J.; Turner V.; Kilroy S.; Walker G.; Atkins S.; Growdon J.; McNeill C.; Cooney R.; Bennett L.; Bowlas L.; Shariff S.; Fraser A.; Punnette D.; Bishop-Hurman C.; Undrell E.; Belfield K.; Din S.; Addleton C.; Appleby M.; Brown J.; Holding K.; Hooper P.; deCaestecker J.; Watchorn O.; Hayward C.; Inniss S.; Pritchard L.; Rudge K.; Carney A.; Andreyev J.; Hayhurst C.; Lockwood C.; Osborne L.; Roper A.; Warner K.; Hindle J.; Watt C.; Szymiczek K.; Mehta S.; Bell J.; Blad W.; Whitley L.; Dhamaraj D.; Baker M.; Sivamurugan E.J.; Evans M.; Cummings F.; Harris C.; Jones A.; Krauze L.; Rahmany S.; Earl M.; Vowles J.; Torokwa A.; Petrova M.; Procter A.; Stanley J.; Silvamoniz C.; Bettey M.; Wahid A.; Morrison Z.; Thomas-Turner R.; Yendle L.; Muller J.; Mitchell M.; Kirkwood J.; Barnes A.; Chaudhary R.; Claridge M.; Ellis C.; Kemp C.; Tobi O.; Milton J.; Johnston E.; Oblak M.; Godden J.; Lees C.; Alexander D.; Covil K.; Derikx L.; Siakavellas S.; Baxter H.; Robertson S.; Smith L.; Poulose B.; Colemam A.; Balint M.; Rhys-Jones G.; Johns K.; Hughes R.; Phipps J.; Taylor A.; MacPhee C.; Brooks S.; Smith K.; Howard L.; Wood D.; Muddu A.; Barman L.; Mallinson J.; Neale T.; Ionita D.; Elliot K.; Turnball A.; Thomas I.; Andrews K.; Sutton J.; Jones C.M.; Roberts J.; Bishop J.

Citation:Nature Communications. 13(1) (no pagination), 2022. Article Number: 1379. Date of Publication: December 2022 [epub ahead of print]

Abstract:Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 – 27.5] vs 47.6 days [45.5 – 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 – 36.8] vs 58.0 days [55.0 – 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.

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Are we doing enough to prevent colectomy in inflammatory bowel disease (IBD) patients? A 5-year review of colectomy rates in Shropshire and Mid-Wales UK (2015-2019) (2022)

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Type of publication:Conference abstract

Author(s):*Javed A.; *Butterworth J.; *Townson G.

Citation:Journal of Crohn's and Colitis; Jan 2022; vol. 16

Abstract:Background: Colectomy for IBD significantly impacts the psycho-social aspects & quality of life.Method(s): Electronic records were retrospectively analysed for colectomy rates & parameters of interest.Result(s): 68 patients (Men 37:Women31), median age 30 years had colectomies. Annual colectomy rates remained constant;7 (2015), 20 (2016), 11 (2017) & (2018) each and 19 (2019). 28% had colectomy within 1 year of diagnosis and only 63% received a biologic agent. Over half, (54%)had emergency surgeries & 37% experienced infections, re-laparotomy and ileus (20% each).Conclusion(s): There is an opportunity to risk-stratify patients at diagnosis based on the risk factors (men, younger age, severe/extensive disease) to a top-down therapy & treat to target strategy to reduce colectomy rates. (Table Presented).

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A Complex Case of Adalimumab Induced Pleuropericarditis in a Patient with Underlying Ulcerative Colitis (2021)

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Type of publication:
Journal article

Author(s):
*Abbasi A, *Day S, Subahani M, *Townson G

Citation:
Asploro Journal of Biomedical and Clinical Case Reports, 2021 Jan; 4(1) p.16-21

Abstract:
Introduction: Adalimumab is an anti-tumour necrosis factor (anti-TNF) monoclonal antibody and an important part of the treatment regime for autoimmune conditions including inflammatory bowel disease. We present a case of adalimumab induced pleuropericarditis and discuss the diagnosis challenges we faced.
Case History: A 22-year-old male presented to the emergency department with 3 days history of headache, malaise, fever and right-sided chest pain. He was diagnosed with ulcerative colitis 8 months ago but failed to respond to mesalazine, requiring high dose steroids to induce disease remission. His mesalazine was stopped after 4 months and he was initiated on adalimumab 2 months prior to the current presentation. At presentation, he had a temperature of 38.7 °C (101.6 °F) but no other physical signs. His inflammatory markers were raised, and the chest x-ray was clear. He was started on empirical intravenous antibiotics on suspicion of the underlying infective process. On day 4 the patient developed a new pleural rub and crepitations on both lung bases. An urgent echocardiogram and computed tomography scan of the thorax abdomen and pelvis revealed pleural effusion and a 1.8 cm diameter pericardial effusion. Extensive investigation including virology screen, autoimmune screen and pleural fluid analysis were normal.
Diagnosis, Management and Outcome: This case was discussed in a multidisciplinary meeting. A diagnosis of pleuropericarditis secondary to adalimumab was made. Adalimumab and antibiotics were stopped, and he was started on a course of oral steroids. The patient responded well to the treatment and his symptoms resolved.
Conclusion: Rare drug toxicity should be part of differential diagnosis, especially in young patients with unusual presentation. An early multidisciplinary approach is crucial for a positive outcome. The patient should be actively involved in decision making to improve long term outcome.

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