No abstract

Inflammatory bowel disease (IBD) was previously thought to be rare in Asia, but emerging data indicate rising incidence and prevalence of IBD in the region. The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology with the goal of developing best management practices, coordinating research, and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis, and management of Crohn's disease. The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses, and treatment availability. It does not intend to be all comprehensive and future revisions are likely to be required in this ever-changing field.

Crohn Disease (CD) is a complex genetic disorder for which more than 140 genes have been identified using genome wide association studies (GWAS). However, the genetic architecture of the trait remains largely unknown. The recent development of machine learning (ML) approaches incited us to apply them to classify healthy and diseased people according to their genomic information. The Immunochip dataset containing 18,227 CD patients and 34,050 healthy controls enrolled and genotyped by the international Inflammatory Bowel Disease genetic consortium (IIBDGC) has been re-analyzed using a set of ML methods: penalized logistic regression (LR), gradient boosted trees (GBT) and artificial neural networks (NN). The main score used to compare the methods was the Area Under the ROC Curve (AUC) statistics. The impact of quality control (QC), imputing and coding methods on LR results showed that QC methods and imputation of missing genotypes may artificially increase the scores. At the opposite, neither the patient/control ratio nor marker preselection or coding strategies significantly affected the results. LR methods, including Lasso, Ridge and ElasticNet provided similar results with a maximum AUC of 0.80. GBT methods like XGBoost, LightGBM and CatBoost, together with dense NN with one or more hidden layers, provided similar AUC values, suggesting limited epistatic effects in the genetic architecture of the trait. ML methods detected near all the genetic variants previously identified by GWAS among the best predictors plus additional predictors with lower effects. The robustness and complementarity of the different methods are also studied. Compared to LR, non-linear models such as GBT or NN may provide robust complementary approaches to identify and classify genetic markers.

Bowel Disease (SECURE-IBD) database, an international, collaborative database created to monitor COVID-19 outcomes in patients with inflammatory bowel disease (IBD), has previously reported that corticosteroids and mesalamine or sulfasalazine are associated with an increased risk of severe COVID-19 and tumor necrosis factor (TNF) antagonists do not impact risk. 1 A follow-up report observed that patients on combination therapy with TNF antagonists and thiopurines appeared to be at higher risk of severe COVID-19. 2 However, at that time, the number of reported cases was too low to fully evaluate the risk of other IBD therapies. As the cases reported to SECURE-IBD have increased substantially, more granular analyses evaluating other IBD medication classes (including combination therapies) and adjusting for more covariates are possible. In this study, we compared associations between multiple medication classes and adverse COVID-19 outcomes in the SECURE-IBD database.We analyzed reports to SECURE-IBD from inception (March 13, 2020) through May 21, 2021. Details regarding data and analysis are provided in the Supplementary Material.Demographic and clinical characteristics of 6144 included reports stratified by medication type are provided in Supplementary Table 1. Figure 1 summarizes the independent associations of medication classes on adverse COVID-19 outcomes among all cases reported to SECURE-IBD. Systemic corticosteroids were associated and methotrexate was marginally associated with an increased odds of hospitalization or death or both. Medications associated with a decreased odds of COVID-19-related hospitalization or death or both included TNF, interleukin-12/23, and integrin antagonists. Systemic corticosteroids were significantly associated with increased odds of severe COVID-19, and TNF and interleukin-12/23 antagonists were associated with a decreased odds of severe COVID-19. Systemic corticosteroids were associated with increased odds of death due to COVID-19, and biologics were not. Notably, there were no statistically significant associations between mesalamine or sulfasalazine and any adverse COVID-19 outcome. We also observed that TNF antagonist and thiopurine combination therapy was associated with a significantly increased risk of hospitalization or death (adjusted odds ratio [aOR], 1.82; 95% confidence interval [CI], 1.26-2.62), but not severe 1.63; 95% CI,. In contrast, a combination of TNF antagonist and methotrexate was not significantly associated with risk of either adverse COVID-19 outcome (aOR, 0.82; 95% CI, 0.42-1.60 and OR, 2.44; 95% CI, 0.55-10.74).

Background and Aim: Enteral nutrition (EN) is not commonly used for the treatment of adults with active Crohn’s disease (CD), despite patient interest in nutrition-based alternatives to corticosteroids and evidence of efficacy in paediatric CD. The aim of this study was to assess the impact of 2 different EN regimens on disease symptoms, nutrition and inflammatory markers in young adults with active CD. Methods: A prospective non-randomized pilot study of adults aged 16–40 years with active CD on endoscopy or imaging was undertaken. Patients were sequentially recruited to use 2 weeks of exclusive EN (EEN) followed by either 6 weeks of EEN or partial EN (PEN) with usual diet. Assessments of disease symptoms, nutrition and inflammatory markers were undertaken at baseline and throughout the treatment. Results: Thirty-eight patients with active disease were recruited. Thirty-two (84%) patients completed 2 weeks of EEN and had significant improvements in disease symptoms (p = 0.003), serum c-reactive protein (CRP; p = 0.005), insulin-like growth factor-1 (p = 0.006) and faecal calprotectin (FC; p = 0.028). During the following 6 weeks, 21 patients continued EEN (14 [67%] completed treatment) and 11 patients used PEN (9 [82%] completed treatment). Initial improvements in symptoms, CRP and nutrition markers were sustained over the next 6 weeks on both treatments. FC non-significantly increased in 5 out of 9 patients who used PEN and at week 8 FC was greater than 500 µg/g in 9 out of 14 and 7 out of 9 patients who used exclusive or PEN respectively. There was no significant difference in clinical outcomes between the 2 groups at week 8. Conclusion: Two weeks of EEN significantly improved disease symptoms, nutrition and inflammatory markers. Further treatment with exclusive or PEN maintained initial improvements.