Ozdemir Kanar

Immunomodulator and Biologic Agent Effects on Sleep Quality in Patients With Inflammatory Bowel Disease

Background Inflammatory bowel disease (IBD) can disrupt normal sleep physiology and amplify a negative perception about quality of life. Evidence suggests increased circulation of inflammatory cytokines, such as tumor necrosis factor-alpha and interleukin-1, may play a role. Methods A total of 56 patients completed the Pittsburgh Sleep Quality Index (PSQI) to measure 7 sleep domains: sleep quality, sleep latency, sleep duration, sleep efficacy, sleep disturbance, sleep medications, and daytime dysfunction. Domain scores were summed to determine the presence or absence of sleep impairment. We compared patients taking immunomodulators or biologic agents to patients not on immunomodulator or biologic agent therapy. Demographics and IBD-related clinical information were collected to adjust for potential confounders that may secondarily affect sleep, such as body mass index, depression/anxiety, and sleep-affecting medications. Results The majority of patients with IBD (46 [82%]) reported poor sleep quality; 22 (79%) of the patients taking immunomodulators or biologic agents and 24 (86%) of the patients not on these therapies had a global PSQI score ≥5, suggestive of poor sleep quality. However, we found no significant difference between the 2 groups. When we analyzed the 7 PSQI sleep domains individually, we found improved sleep duration in the group taking immunomodulators or biologic agents compared to the group not on therapy, although the difference was not statistically significant. Conclusion The majority of patients with IBD experience some degree of sleep impairment, and treatment with immunomodulators and biologic agents does not appear to improve sleep quality. A multicenter study with a larger sample size is warranted to better assess the diverse population of patients with IBD and the factors that impact their sleep. Routine assessment of sleep quality during IBD clinical encounters is recommended.

Giardiasis: a malignant mimicker?

SIMI 2015 A 27-year-old man, with no pertinent past medical history, presented with a 3-week history of severe nausea, vomiting, diarrhea, and abdominal pain. The pain was nonspecific and described as bloating. Associated symptoms included subjective fever and flatulence. The patient worked as a truck driver, traveling often, who had recently transported a shipment of river mulch. His mother was recently diagnosed with colon cancer and grandmother with lymphoma. The patient was afebrile, normotensive, and mildly tachycardiac on arrival. No cough, chest pain, alcohol use, weight change, sick contacts, or bleeding was reported. Physical examination revealed diffuse abdominal tenderness without peritoneal signs. Complete blood count showed a leukocytosis at 17.4 9 10 3 /lL. Folate, B12, and

Primary Histoplasma capsulatum Enterocolitis Mimicking Peptic and Inflammatory Bowel Disease

In immunocompromised patients, histoplasmosis may present as disseminated disease. We present a 52-year-old Caucasian male with symptoms of dyspepsia, postprandial epigastric pain, nausea, and nonbloody diarrhea. Upper and lower gastrointestinal endoscopies were suspicious for inflammatory bowel disease (IBD); however, biopsies were consistent with histoplasmosis, specifically in the duodenum.