Publications by authors named "Achuthan Aruljothy"
Article Synopsis
- - Crohn's disease (CD) can be tricky to diagnose because it causes inflammation that can skip areas of the intestines, particularly in the terminal ileum (TI), leading to potential mismanagement of the condition.
- - A study of 202 patients showed that 22.3% had inflammation in areas not seen during standard ileo-colonoscopy, with 24.5% having skip lesions mainly in the ileum, and strictures being missed in about 36.2% of cases without additional imaging.
- - The research highlights the importance of using cross-sectional imaging techniques, as they help identify more cases of active CD and stricturing disease that may go undetected with just ileo-colonoscopy.
Prevalence of stricturing, penetrating complications and extraintestinal manifestations in inflammatory bowel disease detected on cross-sectional imaging in a tertiary care setting.
United European Gastroenterol J
September 2024
Article Synopsis
- Inflammatory bowel disease (IBD) commonly leads to complications like strictures and extraintestinal manifestations (EIMs), but there is limited research on their prevalence.
- A study at two hospitals in London, Ontario, included 557 IBD patients who underwent imaging tests between 2010 and 2018, primarily using MR enterography (MRE).
- Results showed that about 40% of patients with Crohn's disease (CD) had strictures or fistulas, and 7% had detectable EIMs, with cholelithiasis being the most common EIM, indicating a significant burden of disease that requires targeted treatment options.
Systematic review with meta-analysis: Medical therapies for treatment of ulcerative proctitis.
Aliment Pharmacol Ther
October 2023
Article Synopsis
- Ulcerative proctitis (UP) is a challenging form of ulcerative colitis with significant symptoms, and the aim of this study was to evaluate the effectiveness of various medical treatments for it.
- The research analyzed 53 randomized controlled trials, focusing mainly on induction and maintenance of clinical remission, with findings indicating that topical 5-aminosalicylic acid (5-ASA) and corticosteroids significantly outperform placebo in treating UP.
- The study concludes that treatments like topical 5-ASA and corticosteroids are effective for active UP, while therapies like tacrolimus and Etrasimod show promise for both induction and maintenance of remission, highlighting the need for more trials specifically targeting UP.
Background: This analysis evaluates the association between baseline patient-reported symptom (PRS) severity in Crohn's disease (CD), including abdominal pain, stool frequency, general well-being, and achievement of clinical and endoscopic outcomes. We compared baseline PRS to baseline endoscopic scores for the prediction of endoscopic remission (ER).
Methods: This post hoc analysis of 2 clinical trials of infliximab in CD included 601 patients and evaluated baseline PRS variables (abdominal pain, stool frequency, and general well-being) as measured by the Crohn's disease activity index and their association with 6-month clinical remission (CR) (Crohn's Disease Activity Index<150), corticosteroid-free CR, and week 26/54 ER (absence of mucosal ulceration).
Article Synopsis
- This study examined the relationship between ulcer size after treatment and the likelihood of achieving remission in Crohn's disease patients one year later.
- Data from 283 patients indicated that those with larger ulcers (≥5 mm) post-treatment were significantly less likely to reach endoscopic remission compared to those with smaller or no ulcers.
- The findings suggest prioritizing objective measures like ulcer size over patient-reported symptoms when assessing treatment effectiveness in clinical settings and trials.
The impact of ustekinumab on extraintestinal manifestations of Crohn's disease: A post hoc analysis of the UNITI studies.
United European Gastroenterol J
June 2021
Unlabelled: This post hoc analysis of the UNITI studies found ustekinumab (UST) did not significantly improve overall extraintestinal manifestations (EIMs) of Crohn's disease compared to placebo-treated patients at weeks 6 and 52.
Background And Aims: The UNITI trials demonstrated that UST was effective in inducing and maintaining clinical remission in Crohn's disease (CD). However, limited data exists regarding its effectiveness for treatment of EIMs.
Histologic remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission.
Aliment Pharmacol Ther
December 2020
Background: Histologic remission in ulcerative colitis (UC) patients may be associated with positive outcomes. It is unclear whether UC patients in endoscopic remission obtain additional benefit from achieving histologic remission.
Aim: To evaluate the relationship between time to relapse and histological activity among UC patients in endoscopic remission.
Introduction: It is unclear how baseline endoscopic characteristics in Crohn's disease (CD) affect the ability to achieve endoscopic remission (ER). We aimed to determine the endoscopic prognostic factors that influence achieving ER in CD.
Design: This post hoc analysis of SONIC (NCT00094458; YODA #2019-3980) evaluated baseline and week 26 endoscopy indices in 172 patients using the CD Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for CD.
Endoscopic surveillance strategies for dysplasia in ulcerative colitis.
Frontline Gastroenterol
March 2020
Ulcerative colitis (UC) is a chronic inflammatory bowel disorder with an increased risk of colorectal cancer (CRC). This has led to the implementation of surveillance programmes to minimise this risk. Overall, these proactive programmes in association with better medical therapies have reduced the incidence of CRC in this population.
View Article and Find Full Text PDFBackground And Objective: Optimization strategies with infliximab (IFX) are increasingly used as rescue therapy for steroid refractory acute severe ulcerative colitis (ASUC). We aim to determine if intensified IFX induction improves colectomy rate and identifies outcome predictors.
Methods: Hospitalized adult patients who received IFX for ASUC between 2010 and 2016 were identified.
Background: Inflammatory bowel disease (IBD) patients may be at risk for nonalcoholic fatty liver disease (NAFLD) due to chronic inflammation, hepatotoxic drugs, and alteration of the gut microbiota. Prospective data using accurate diagnostic methods are lacking.
Methods: We prospectively investigated prevalence and predictors of NAFLD and liver fibrosis by transient elastography (TE) with associated controlled attenuation parameter (CAP) in IBD patients as part of a routine screening program.
Symptomatic intestinal strictures develop in more than one third of patients with Crohn's disease (CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures.
View Article and Find Full Text PDFBackground: Managing loss of response (LOR) in Crohn's disase (CD) patients remains challenging. Compelling evidence supports therapeutic drug monitoring (TDM) to guide management in patients on infliximab, but data for other biologics are less robust. We aimed to asses if empiric dose escalation led to improved clinical outcome in addition to TDM-guided optimization in CD patients with LOR to adalimumab (ADA).
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