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A study published in the journal Intestinal Research examined the use of fecal microbiota transplantation (FMT) for patients with inflammatory bowel disease (IBD) and recurrent Clostridioides difficile infection (CDI). The study found that FMT was effective in preventing CDI recurrence in IBD patients, but did not have a beneficial effect on the course of IBD itself. The study suggests that earlier use of FMT for CDI and early IBD therapy escalation may be beneficial in preventing IBD flare and colectomy. Further research is needed to fully understand the potential of FMT as a treatment option for IBD. [Extracted from the article]

The worldwide prevalence of obesity has reached staggering proportions, and the inflammatory bowel disease (IBD) population has not been immune to this trend, with obesity rates estimated to be between 15% and 40%. With the concurrent rise in incidence of IBD itself, there are biologically plausible mechanisms that suggest a potential role of obesity in the pathogenesis of IBD, although epidemiologic data on this issue are conflicting. Similarly, studies exploring the impact that obesity may have on the natural history of disease have produced inconsistent results. Some studies suggest higher and others lower rates of surgery in obese Crohn's disease patients, other studies suggest a higher risk of surgery in obese ulcerative colitis patients, and yet other studies reveal no difference in outcomes regarding hospitalization or surgery for either group. Regardless of its impact on the pathogenesis or natural history of IBD, the rising prevalence of obesity in this population results in a need to better understand the effect it has on IBD management. Although pharmacologic data suggest that obesity may influence the absorption, distribution, and clearance of the available therapeutic agents, the actual clinical consequences that these differences have on disease management are less clear. Finally, it is possible that weight loss interventions for obesity could have an impact on the clinical course of IBD. [ABSTRACT FROM AUTHOR]

Hospitalisation and surgery are considered to be markers of more severe disease in Crohn's disease. These are costly events and limiting these costs has emerged as one rationale for the cost of expensive biologic therapies. The authors sought to review the most recent international literature to estimate current hospitalisation and surgery rates for Crohn's disease and place them in the historical context of where they have been, whether they have changed over time, and to compare these rates across different jurisdictions. It is in this context that the authors could set the stage for interpreting some of the early data and studies that will be forthcoming on rates of hospitalisation and surgery in an era of more aggressive biologic therapy. The most recent data from Canada, the United Kingdom and Hungary all suggest that surgical rates were falling prior to the advent of biologic therapy, and continue to fall during this treatment era. The impact of biologic therapy on surgical rates will have to be analysed in the context of evolving reductions in developed regions before biologic therapy was even introduced. Whether more aggressive medical therapy will decrease the requirement for surgery over long periods of time remains to be proven. [ABSTRACT FROM AUTHOR]

Crohn's disease is an idiopathic chronic intestinal illness that requires specialized medical care for prompt disease diagnosis and appropriate management. Clinicians must accurately interpret and integrate findings from multitude of sources in order to achieve diagnostic certainty. Ileocolonoscopy remains the most relied modality, allowing for a direct mucosal visualization and biopsies for histologic assessments. Serologic markers currently serve an adjunctive role, often utilized in attempts to further subtype patients with indeterminate colitis. Radiologic imaging, such as computed tomography enterography can evaluate the far reaches of the small intestine, while also providing information about penetrating complications and extraintestinal disease manifestations. Treatment options and strategies continue to evolve with new biologic agents and ongoing testing of aggressive "top-down" approaches. In addition, identification of increased colorectal cancer risks in individuals with Crohn's colitis has led to formal surveillance guidelines. The clinical diagnosis and management of Crohn's disease continues to be an area of rapid change and exciting developments. [ABSTRACT FROM AUTHOR]

The article presents insights on a study on the use of algorithmic approach in community gastroenterology practices for decreasing the risk of Crohn's disease-related complications. Topics covered include the division of community practices to an algorithmic approach of early combined immunosuppression (ECI) and conventional management of the disease, the key predictors of development of serious Crohn's-related complications and the limitations of the study.

Therapeutic drug monitoring (TDM) of biologics is a rapidly evolving field. We aimed to provide a consensus statement regarding the clinical utility of TDM for biologics in inflammatory bowel disease (IBD). A modified Delphi method was applied to develop consensus statements. A comprehensive literature review was performed regarding TDM of biologic therapies in IBD, and 45 statements were subsequently formulated on the potential application of TDM in IBD. The statements, along with literature, were then presented to a panel of 10 gastroenterologists with expertise in IBD and TDM who anonymously rated them on a scale of 1–10 (1 5 strongly disagree and 10 5 strongly agree). An expert consensus development meeting was held virtually to review, discuss, refine, and reformulate statements that did not meet criteria for agreement or that were ambiguous.During the meeting, additional statements were proposed. Panelists then confidentially revoted, and statements rated ≥7 by 80% or more of the participants were accepted. During the virtual meeting, 8 statements were reworded, 7 new statements were proposed, and 19 statements were rerated. Consensus was finally reached in 48/49 statements. The panel agreed that reactive TDM should be used for all biologics for both primary nonresponse and secondary loss of response. Itwas recommended that treatment discontinuation should not be considered for infliximab or adalimumab until a drug concentration of at least 10–15 mg/mL was achieved. Consensus was also achieved regarding the utility of proactive TDM for anti–tumor necrosis factor therapy. It was recommended to perform proactive TDMafter induction and at least once during maintenance. Consensus was achieved inmost cases regarding the utility of TDM of biologics in IBD, specifically for reactive and proactive TDM of anti–tumor necrosis factors. [ABSTRACT FROM AUTHOR]