June Tome

Lay Summary: This multicenter study evaluated clinical outcomes in pregnancy for women with ulcerative colitis and an ileal pouch-anal anastomosis. Close monitoring is needed with a multidisciplinary team for management of inflammatory complications of the pouch such as pouchitis in pregnancy and postpartum.

Lay Summary: In this study we evaluated the effectiveness of vedolizumab (anti-integrin) vs ustekinumab/risankizumab (anti-interleukin) therapy for isolated small-bowel Crohn’s disease using a real-world, multicenter national database. We found that anti-interleukin therapy was more effective for inducing steroid-free remission and reducing hospitalizations.

Background: The term “incomplete microscopic colitis” (MCi) has been suggested to define patients with chronic watery diarrhea not fulfilling the complete histologic criteria for MC. There are inconsistent data on the epidemiology of MCi and the optimal management of these patients. Methods: A systematic search of randomized control trials (RCTs) and observational studies of adults with biopsy-proven MCi (incomplete lymphocytic colitis and collagenous colitis) was conducted using Cochrane, Medline, Scopus, and Embase from inception to May 6, 2025. Data were extracted on (1) incidence and prevalence of MCi, (2) patient features and risk factors, (3) clinical response with treatment, and (4) relapse after treatment cessation. Data were pooled using the random-effects model to calculate weighted pooled estimates and 95% confidence intervals (CIs). Results: Of 136 potentially relevant publications identified, 49 passed abstract screening, and 17 studies (1 RCT and 16 observational) were included, with a total of 1370 patients with MCi (median age of 62 years and 69.6% women). The incidence rate of MCi ranged from 0.96 to 5.0 cases per 100 000 person-years. The pooled proportion of concurrent autoimmune disease with MCi was 18% (95% confidence interval [CI], 0.07-0.28; I2 = 95%), and 46% (95% CI, 0.28-0.64; I2 = 95%) were on medications associated with microscopic colitis (MC). The pooled clinical remission rate with any induction therapy was 78% (95% CI, 0.68-0.89; I2 = 81%) and 85% (95% CI, 0.72-0.98; I2 = 88%) with budesonide. Conclusions: Patients with MCi share similar characteristics with full MC including demographics, risk factors, and response to therapy, indicating that the histologic criteria for MC should potentially be broadened.

Patients with inflammatory bowel disease (IBD) frequently ask their providers for nutritional or dietary recommendations; however, providers are limited in both time and knowledge to adequately address their questions. In this single-center study, we sought to improve provider experiences with nutrition counseling for patients seen in a dedicated IBD clinic. To understand the current state, providers, including gastroenterology fellows, attendings, and advanced practice providers were surveyed regarding their experiences with nutritional recommendations in a dedicated IBD clinic. Following the pre-intervention survey, we worked with registered dieticians on how to address key concerns and developed an informational handout based upon current guidelines. After displaying handouts in clinical workspaces for 5 weeks, providers were surveyed again to evaluate their response. All 22 respondents (100%) in the pre-intervention survey either agreed or strongly agreed that IBD patients have unique nutritional requirements. A majority (72%) strongly agreed that the clinic would benefit from more access to dieticians. Additionally, 41% of providers either strongly disagreed or disagreed that they had enough time to address nutritional concerns. Post-intervention, 57% of respondents (8/14) reported that they found the handouts helpful. A significant number of providers reported improvement in their comfort level discussing nutrition and dietary recommendations with IBD patients, with tmean Likert score increasing from 3.5 to 4.1 (P = .01). In this quality improvement study, we identified key issues preventing providers from addressing patient desire for nutritional counseling and developed a novel awareness campaign that significantly improved provider confidence in discussing nutritional recommendations with their IBD patients.

INTRODUCTION: Bile acid sequestrants (BAS) are an option for microscopic colitis (MC) refractory or intolerant to budesonide. There are inconsistent data on the prevalence of bile acid malabsorption (BAM) and utility of bile acid testing in MC. The aim of this systematic review and meta-analysis was to evaluate these outcomes. METHODS: A systematic search of randomized control trials and observational studies of adults with MC treated with BAS was conducted using MEDLINE, Embase, Cochrane, and Scopus from inception to January 22, 2024. Data were extracted on (i) prevalence of BAM, (ii) clinical response and adverse events, and (iii) recurrence after BAS discontinuation. Data were pooled using random-effects models to determine weighted pooled estimates and 95% confidence intervals (CIs). RESULTS: We included 23 studies (1 randomized control trial, 22 observational), with 1,011 patients with MC assessed for BAM and 771 treated with BAS. The pooled prevalence of BAM was 34% (95% CI 0.26–0.42, I ² = 81%). The pooled response rate with BAS induction for all patients with MC, irrespective of BAM, was 62% (95% CI 0.55–0.70, I ² = 71%). There was a higher pooled response rate in patients with BAM compared with those without BAM (P < 0.0001). The pooled rate of BAS-related adverse effects was 9% (95% CI 0.05–0.14, I ² = 58%). DISCUSSION: One-third of patients with MC had BAM, and almost two-thirds of all patients responded to BAS with limited side effects. Patients with MC and BAM were more likely to respond to therapy, supporting the value of bile acid testing.

Microscopic colitis (MC) is a common cause of chronic diarrhea. Randomized controlled trials (RCTs) have demonstrated the efficacy of budesonide treatment for MC. However, relapse is frequent after discontinuation of budesonide, and data on maintenance therapy are limited. We performed a systematic review and meta-analysis evaluating these outcomes in clinical trials and real-world settings. A systematic search was performed on October 31, 2022, of Medline, Embase, Cochrane, and Scopus. Case series, case-control, cohort studies, and RCTs of adults with MC were included. Data were pooled using random effects models to calculate weighted pooled estimates and 95% confidence intervals. Heterogeneity was assessed using the I² statistic. We included 35 studies (11 RCTs, 24 observational studies) with 1657 MC patients treated with budesonide induction and 146 for maintenance. The overall pooled clinical remission rate with budesonide treatment was similar between RCTs and observational studies. The pooled remission rate with budesonide maintenance therapy was 84% (95% CI, 0.60-1.00; I² = 91%). After budesonide discontinuation, the pooled relapse rate was 53% (95% CI, 0.42-0.63; I² = 76%). On maintenance therapy, no differences were noted in adverse events (eg, metabolic bone disease, hypertension, hyperglycemia, cataracts/glaucoma) in those on budesonide vs placebo or other noncorticosteroid medications for MC (P = .9). Budesonide is an effective maintenance treatment for MC. There is a high risk of recurrence after budesonide discontinuation, but long-term use at the lowest effective dose appears to be relatively safe and have limited adverse effects.