Najwa El-Nachef

Anti-tumor necrosis factor therapy for inflammatory bowel disease in the setting of immunosuppression for solid organ transplantation.

Anti-Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease in the Setting of Immunosuppression for Solid Organ Transplantation

Changing perceptions and practices regarding aspirin, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs among US primary care providers

Background  Our understanding of the benefits and risks of aspirin non steroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 (COX‐2) selective NSAIDs and gastro‐protective agents (GPAs) continues to expand.

Successful Treatment of Common Variable Immunodeficiency Disorder-Associated Diarrhea With Budesonide: A Case Report

PURPOSE:Common variable immunodeficiency disorder (CVID) is an immunological disease that can present with gastrointestinal (GI) symptoms including chronic diarrhea and abdominal pain. We report a patient with CVID and chronic diarrhea who significantly improved with budesonide.METHODS:A 47-yr-old woman with CVID-associated diarrhea, steatorrhea, abdominal pain, and bloating for several years had an exhaustive evaluation for secondary causes of her symptoms, which was unrevealing. At the advice of her immunologist, she attempted a course with budesonide that significantly improved her GI symptoms. Given the absence of literature on this treatment in CVID, we attempted to systematically evaluate the clinical benefits after withdrawal of and retreatment with budesonide.RESULTS:Diarrhea, steatorrhea, abdominal pain, and bloating recurred within 2 days of discontinuing budesonide. All parameters assessed improved upon reinitiating budesonide. Further, serum immunoglobulin G (IgG) levels significantly increased with treatment. No significant side effects were observed with budesonide.CONCLUSION:This is the first report of a patient with CVID-related chronic diarrhea to be successfully treated with oral budesonide. This observation provides clinicians with an effective and safe treatment option in this difficult group of patients.

The Current Landscape and Lessons from Fecal Microbiota Transplantation for Inflammatory Bowel Disease: Past, Present, and Future.

Abstract: Fecal microbiota transplantation (FMT) has changed the standard of care for Clostridium difficile infection. However, there is limited data focusing on efficacy and safety profile of FMT in patients with C. difficile infection with underlying inflammatory bowel disease (IBD), including the risk of IBD flare. Recently, there is also emerging evidence supporting the role of FMT to treat IBD including promising randomized trials in ulcerative colitis. However, with heterogeneity across these studies, the clinical application of this emerging therapy has yet to be fully elucidated. Here, we aim to review the current landscape of this rapidly developing field, mapping the efficacy and safety of FMT (1) to treat C. difficile infection in patients with IBD, (2) to treat underlying IBD, and (3) outline ongoing clinical trials and the future of the microbiome space.

Fecal Microbial Therapy – Promises and Pitfalls

A rapidly expanding range of diverse human diseases is now associated with perturbations to the gastrointestinal microbiome. Fecal microbial transplant (FMT) has been used with high rates of efficacy to treat gastrointestinal microbiome perturbation associated with recurrent Clostridium difficile infection, and is now being considered for other indications. Here we discuss the gut microbiome, review published and ongoing studies using FMT as a treatment modality for human disease, consider the regulatory aspects of FMT, and outline some factors that should be considered in patients in whom this therapeutic strategy is being contemplated.

Effect of I-scan Electronic Chromoendoscopy on Detection of Adenomas During Colonoscopy

Background & Aims: I‐scan is an electronic chromoendoscopy technology that improves resolution of epithelial and mucosal surfaces and vessels. We performed a randomized controlled trial to compare detection of adenomas by i‐scan vs standard high‐definition white‐light (HDWL) colonoscopy. Methods: From February 1 through December 31, 2017, 740 outpatients (50–75 years old) undergoing screening and surveillance for colorectal neoplasia were randomly assigned to groups that received colonoscopies with i‐scan 1 (surface and contrast enhancement) or HDWL. When lesions and polyps were detected, endoscopists could switch between i‐scan 1 and HDWL imaging to confirm their finding; polyps were collected and analyzed by histology. The primary outcome was adenoma detection rate (ADR, proportion of subjects with at least 1 adenoma of any size); secondary outcomes included detection of sessile serrated polyps and neoplasias, along with location, size, and morphology of polyps. We performed intent to treat and per‐protocol analyses (on 357 patients evaluated by i‐scan and 358 evaluated by HDWL colonoscopy) to assess the primary and secondary outcomes. Results: There were no differences in baseline characteristics between the groups. In the intent to treat analysis, the ADR was significantly higher in the i‐scan 1 group (47.2%) than in the HDWL colonoscopy group (37.7%) (P = .01). In the per‐protocol analysis, the ADR in the i‐scan 1 group (47.6%) was also significantly higher than in the HDWL group (37.2%) (P = .005), but this effect was not consistent among all endoscopists. There was no difference between groups in detection of sessile serrated polyps. However, the rate of neoplasia detection was significantly higher in the i‐scan 1 group (56.4%) than in the than the HDWL group (46.1%) (P = .005). In secondary analyses, the increase in ADR was associated with improved detection of diminutive flat adenomas in the right colon. Conclusion: In a prospective randomized trial, higher proportions of patients with adenomas were identified in a group that underwent colonoscopy with i‐scan 1 than in a group evaluated by HDWL colonoscopy. This effect was mainly due to improved detection of diminutive, flat right sided adenomas. I‐scan 1 technology may benefit some endoscopists. ClinicalTrials.gov no: NCT02811419.

Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: A multicenter experience.

Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti‐CDI antibiotics, respectively. Ninety‐four SOT patients underwent FMT, 78% for recurrent CDI and 22% for severe or fulminant CDI. FMT‐related adverse events (AE) occurred in 22.3% of cases, mainly comprising self‐limiting conditions including nausea, abdominal pain, and FMT‐related diarrhea. Severe AEs occurred in 3.2% of cases, with no FMT‐related bacteremia. After FMT, 25% of patients with underlying inflammatory bowel disease had worsening disease activity, while 14% of cytomegalovirus‐seropositive patients had reactivation. At 3 months, primary cure was 58.7%, while overall cure was 91.3%. Predictors of failing a single FMT included inpatient status, severe and fulminant CDI, presence of pseudomembranous colitis, and use of non‐CDI antibiotics at the time of FMT. These data suggest FMT is safe in SOT patients. However, repeated FMT(s) or additional antibiotics may be needed to optimize rates of cure with FMT.