Background Mucosal healing is an important therapeutic endpoint in the management of Crohn’s disease (CD) and ulcerative colitis (UC). Limited data exists regarding the comparative efficacy of various therapies in achieving this outcome. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCT) examining mucosal healing as an endpoint of immunosuppressives, anti-tumor necrosis factor α (anti-TNF) or anti-integrin monoclonal antibody therapy for moderate-to-severe CD or UC. Pooled effect sizes for induction and maintenance of mucosal healing were calculated and pair-wise treatment comparisons evaluated using a Bayesian network meta-analysis. Results A total of 12 RCTs were included in the meta-analysis (CD – 2 induction, 4 maintenance; UC – 8 induction, 5 maintenance). Duration of follow-up was 6–12 weeks for induction and 32–54 weeks for maintenance trials. In CD, anti-TNFs were more effective than placebo for maintaining mucosal healing (28% vs. 1%, Odds ratio (OR) 19.71, 95% confidence interval (CI) 3.51 – 110.84). In UC, anti-TNFs and anti-integrins were more effective than placebo for inducing (45% vs. 30%) and maintaining mucosal healing (33% vs. 18%). In network analysis, adalimumab therapy was inferior to infliximab (OR 0.45, 95% credible interval (CrI) 0.25 – 0.82) and combination infliximab-azathioprine (OR 0.32, 95% CrI 0.12 – 0.84) for inducing mucosal healing in UC. There was no statistically significant pairwise difference between vedolizumab and anti-TNF agents in UC. Conclusion Anti-TNF and anti-integrin biologic agents are effective in inducing mucosal healing in UC with adalimumab being inferior to infliximab or combination therapy. Infliximab and adalimumab were similar in CD.

This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.

Background According to the hygiene hypothesis, individuals raised in a sanitary environment have a higher risk of developing inflammatory bowel diseases (IBD). However, results have been inconsistent. We conducted this systematic review of factors related to environmental hygiene and risk of IBD, Crohn's disease (CD) and ulcerative colitis (UC). Methods A systematic search was performed on MEDLINE between 1980-2015 to identify studies of the association between IBD and contact with pets and farm animals, number of siblings, bedroom sharing in childhood, access to personal toilet and hot water. Random or fixed effect meta-analyses were performed, and analysis further stratified based on ethnicity of the included cohort. Results A total of 29 relevant studies were included. Having a pet (Odds Ratio (OR) 0.76, 95% confidence interval (CI) 0.63 – 0.88) and contact with farm animals was inversely associated with risk of IBD (OR 0.45, 95% CI 0.31 – 0.60). However, the strength of association with farm animals was statistically stronger in non-white cohorts (OR 0.27, 95% CI 0.02 – 0.53) than white cohorts (OR 0.55, 95% CI 0.45 – 0.65) (p=0.028). Access to toilet (OR 0.71, 95% CI 0.56 – 0.85) and hot water (OR 0.67, 95% CI 0.44 – 0.89) was inversely associated with UC in non-white populations but not Caucasians. Having more than 2 siblings was inversely associated with risk of CD. Conclusions Several factors pertaining to reduced environmental hygiene are inversely associated with risk of IBD. However, underlying ethnicity influences susceptibility to the effect of these factors.

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