Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

Ramakrishna, B. S.; Makharia, Govind; Ahuja, Vineet; Ghoshal, Uday C; Venkataraman, Jayanthi; Perakath, Benjamin; Abraham, Philip; Bhasin, Deepak K.; Bhatia, Shobna; Choudhuri, Gourdas; Dadhich, Sunil; Desai, Devendra; Goswami, Bhabhadev; Issar, Sanjeev Kumar; Jain, Ajay; Kochhar, Rakesh; Loganathan, Goundappa; Misra, Sri Prakash; Pai, C. Ganesh; Pal, Sujoy; Mathew, Philip; Pulimood, Anna; Puri, Amarender Singh; Ray, Gautam; Singh, Shivaram Prasad; Sood, Ajit; Subramanian, V

doi:10.1007/s12664-015-0539-6

Cited by 23 publications

(25 citation statements)

References 137 publications

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“…The cohort comprised of 234 CD patients, 249 UC patients and 393 healthy controls (HC). The diagnosis of CD and UC was based on a composite of clinical, radiological, endoscopic, and histopathological findings according to the consensus criteria of the Indian Society of Gastroenterology [22,23]. Patients with proven intestinal or extra-intestinal tuberculosis were excluded.…”

Section: Methodsmentioning

confidence: 99%

Association of ATG16L1 gene haplotype with inflammatory bowel disease in Indians

et al. 2017

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Inflammatory bowel disease (IBD) is characterized by multigenic inheritance. Defects in autophagy related genes are considered to show genetic heterogeneity between populations. We evaluated the association of several single nucleotide polymorphisms (SNPs) in the autophagy related 16 like 1 (ATG16L1) gene with IBD in Indians. The ATG16L1 gene was genotyped for ten different SNPs using DNA extracted from peripheral blood of 234 patients with Crohn’s disease (CD), 249 patients with ulcerative colitis (UC) and 393 healthy controls The SNPs rs2241880, rs4663396, rs3792106, rs10210302, rs3792109, rs2241877, rs6737398, rs11682898, rs4663402 and rs4663421 were genotyped using the Sequenom MassArray platform. PLINK was used for the association analysis and pairwise linkage disequilibrium (LD) values. Haplotype analysis was done using Haploview. All SNPs were in Hardy Weinberg equilibrium in cases and controls. The G allele at rs6737398 exhibited a protective association with both CD and UC. The T allele at rs4663402 and C allele at rs4663421 were positively associated with CD and UC. The T allele at rs2241877 exhibited protective association with UC only. The AA genotype at rs4663402 and the GG genotype at rs4663421 were protectively associated with both CD and UC. Haplotype analysis revealed that all the SNPs in tight LD (D’ = 0.76–1.0) and organized in a single haplotype block. Haplotype D was positively associated with IBD (P = 5.8 x 10−6 for CD and 0.002 for UC). SNPs in ATG16L1 were associated with IBD in Indian patients. The relevance to management of individual patients requires further study.

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Section: Methodsmentioning

confidence: 99%

Association of ATG16L1 gene haplotype with inflammatory bowel disease in Indians

et al. 2017

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“…It is, therefore, appropriate to re-endoscope the patients who were treated empirically for ITB and to establish complete mucosal healing at the end of 6 months. [20,21] In summary, while many of endoscopic features overlap in patients with ITB and CD, certain endoscopic features have been identified by most of the investigators as suggestive of CD. These features include involvement of left side of the colon, involvement of multiple segments of the intestine, and presence of longitudinal ulcers and cobblestoning of the mucosa.…”

Section: Approach In a Patient Where A Differentiation Between Intestmentioning

confidence: 94%

“…Both the Asian Pacific Associations of Gastroenterology and the Indian Society of Gastroenterology guidelines on CD suggest exclusion of infective causes, especially TB before making a diagnosis of CD. [20,21]…”

Section: Diagnostic Criteria For Crohn's Diseasementioning

confidence: 99%

“…Under these circumstances, both the Asia Pacific Association of Gastroenterology and the Indian Society of Gastroenterology consensus on CD suggest a trial of anti-TB treatment. [20,21] This is based on the rationale that the treatment of TB is finite, whereas treatment for CD continues indefinitely. [20,21] Furthermore, there is a risk in treating patients with corticosteroids if the diagnosis actually is TB.…”

Section: Approach In a Patient Where A Differentiation Between Intestmentioning

confidence: 99%

“…[20,21] This is based on the rationale that the treatment of TB is finite, whereas treatment for CD continues indefinitely. [20,21] Furthermore, there is a risk in treating patients with corticosteroids if the diagnosis actually is TB. Obviously the decision to treat for one disease or the other would take into account other clinical considerations including the nature of presentation of the patient, whether acutely ill and requiring immediate definitive therapy or not.…”

Section: Approach In a Patient Where A Differentiation Between Intestmentioning

confidence: 99%

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2017

Journal of Digestive Endoscopy

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Long‐term safety and effectiveness of azathioprine in the management of inflammatory bowel disease: A real‐world experience

Yewale¹,

Ramakrishna²,

Doraisamy³

et al. 2023

JGH Open

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Background and AimAzathioprine (AZA) forms the cornerstone for maintenance of sustained remission in inflammatory bowel disease (IBD). There is apprehension regarding the long‐term effectiveness and safety of AZA in IBD. We present our experience with AZA use and outcomes in a cohort of IBD patients followed up over a long period of time.MethodsRecords of 507 IBD patients under treatment at a single, tertiary care center in south India between 2013 and 2022 were evaluated retrospectively. Long‐term compliance, tolerance, clinical outcome at the point of last follow‐up, type and duration to the onset of adverse events, and subsequent amendment to treatment with regard to AZA were analyzed.ResultsOf 507 patients with IBD, 320 patients (207 Crohn's disease [CD], 113 ulcerative colitis [UC]) who received AZA were included. The median follow‐up was 41 months (interquartile range 15.5–77.5). Total duration of exposure was 1359 patient‐years with median usage of 33 months. Of the patients, 26.9% received AZA for >5 years. Mean initiation and maximum doses of AZA were 0.97 and 1.72 mg/kg/day. Among the participants, 20.6% experienced side effects, including myelotoxicity (7.2%) and gastrointestinal intolerance (5.6%). Six patients developed malignancy. Among the side effects, 39.4% of side effects were dose‐dependent. Among the patients, 38.1% had relapses requiring pulse corticosteroid therapy, and 16.2% had more than one relapse after commencement of AZA. AZA was continued till the last follow‐up in 76.5%. Among the patients, 49.7% (UC 51.3, CD 48.8) attained durable remission without biologics, and 5.3% continued to have active disease.ConclusionAZA is safe and effective in the long‐term in IBD. Effectiveness, tolerance, and compliance with AZA are well sustained beyond 5 years of usage and comparable between UC and CD.

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Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

Cited by 23 publications

References 137 publications

Association of ATG16L1 gene haplotype with inflammatory bowel disease in Indians

Association of ATG16L1 gene haplotype with inflammatory bowel disease in Indians

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Long‐term safety and effectiveness of azathioprine in the management of inflammatory bowel disease: A real‐world experience

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