Risk factors for diagnostic delay in Crohn's disease and their impact on long‐term complications: how do they differ in a tuberculosis endemic region?

Banerjee, Rupa; Pal, Partha; Girish, B Ganesh; Reddy, D. Nageshwar

doi:10.1111/apt.14617

Cited by 55 publications

(47 citation statements)

References 39 publications

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“…We have earlier reported that empirical use of ATT was the single largest contributor for diagnostic delay in an adult CD cohort of more than 700 patients which resulted in higher long term stenotic complications and need for surgery. 43 India is endemic for TB and there is limited awareness about CD. Hence at the community level, patients are initiated on ATT and CD is diagnosed only if there is no response leading to inordinate delays in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

et al. 2021

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cluding a severe and aggressive course of disease, predominant colonic involvement and a higher incidence of familial IBD compared to PIBD other than VEOIBD (6-17 years). 1 The incidence of PIBD is on the rise globally. 2 A complex interplay of genetic and changing environmental factors has been implicated for the rising incidence although specific factors are yet to be completely understood. 2-6 Most of the epidemiological data however are from the West including North America, Canada, and Europe. 3 A few recent studies from Asia also suggest a rising trend of PIBD. Interestingly the phenotype appears to be distinct from that of the West including a milder ulcerative colitis (UC) and a higher perianal

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Section: Discussionmentioning

confidence: 99%

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

et al. 2021

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“…Inflammatory bowel disease (IBD) is a series of inflammatory responses that occur in the colon and small intestine [19]. IBD may cause diarrhea, abdominal pain, and even gastrointestinal bleeding; when patients suffer from it, this will be a difficult situation to solve [20]. In this study, a model of mouse intestinal inflammation induced by 5% DSS was used to investigate the alleviating effects of IQW and IRW.…”

Section: Discussionmentioning

confidence: 99%

IRW and IQW Reduce Colitis-Associated Cancer Risk by Alleviating DSS-Induced Colonic Inflammation

Jiang

Fang

et al. 2019

BioMed Research International

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Background and Objective Bioactive peptides exert great influence in animals and human health by targeting gastrointestinal tracts. The colitis model of mice was induced by dextran sulfate sodium (DSS). Thirty-two 8-week-old mice weighing 23 g on average were randomly assigned to four groups of 8 each: mice fed basal diet (CON), mice fed basal diet with 5% DSS (DSS), mice fed 0.03% IRW with 5% DSS (IRW-DSS), and mice fed 0.03% IRW with 5% DSS (IQW-DSS). After an adaptation period of 3 days, on day 8, all mice were slaughtered. Serum samples were collected to determine the level of amino acids; colonic tissue was quick-frozen for the determination of gene expression. Methods The aim of this study was to assess the ability of two kinds of peptides (IRW and IQW) to repair intestinal inflammatory in the DSS-induced model in accordance with serum amino acids and intestinal inflammatory factors. Results The results demonstrated that the addition of IRW and IQW had a mitigating effect on DSS-induced intestinal inflammation. The level of Asp decreased in the serum of mice supplemented with IRW-DSS (P < 0.05), and IQW enhanced the level of Leu, but lowered the level of Ser (P < 0.05). IQW and IRW addition reduced the level of TNF-α and IL-17 (P < 0.05). No other significant effects were observed. Conclusions The present study demonstrated that intracolic administration of IRW and IQW might be a novel option for preventing inflammatory bowel disease via regulating the level of serum amino acid and enhancing the intestinal immune defense.

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“…Indeed, empirical ATT has been identified as the single largest factor contributing to diagnostic delay in CD in TB-endemic countries. 26 The reverse misdiagnosis is potentially more dangerous-if TB is misdiagnosed as CD, then treatment with steroids or even biologics alone (for CD) can result in an even further immunosuppressed status and disseminated TB, which can potentially be disastrous for the patient.…”

Section: Diagnosis Of Ibdmentioning

confidence: 99%

Biologics for the Management of Inflammatory Bowel Disease: A Review in Tuberculosis-Endemic Countries

et al. 2020

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The advent of biologics and biologic therapy has transformed the management of inflammatory bowel disease (IBD) with enhanced early and adequate responses to treatment, fewer hospitalizations, a reduced need for surgery, and unprecedented outcomes including complete mucosal and histologic healing. However, an important issue with the use of anti-tumor necrosis factor (anti-TNF) agents in IBD is the increased risk of tuberculosis (TB). This is compounded by the diagnostic dilemma when differentiating between Crohn’s disease and gastrointestinal TB, and the potentially serious consequences of initiating an incorrect treatment in the case of misdiagnosis. The interplay between IBD and TB is most relevant in Asia, where more than 60% of the 10.4 million new TB cases in 2016 were reported. A number of studies have reported an increased risk of TB with anti-TNF agents, including in patients who had tested negative for TB prior to treatment initiation. The limited evidence currently available regarding adhesion molecule antagonists such as vedolizumab suggests a comparatively lower risk of TB, thus making them a promising option for IBD management in TB-endemic regions. This comprehensive review examines the available literature on the risk of TB with the use of biologics in the TB-endemic regions of Asia, focusing on the diagnostic dilemma, the risk of reactivation, and the optimized management algorithms for latent and active disease.

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Risk factors for diagnostic delay in Crohn's disease and their impact on long‐term complications: how do they differ in a tuberculosis endemic region?

Cited by 55 publications

References 39 publications

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

IRW and IQW Reduce Colitis-Associated Cancer Risk by Alleviating DSS-Induced Colonic Inflammation

Biologics for the Management of Inflammatory Bowel Disease: A Review in Tuberculosis-Endemic Countries

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