Publications by authors named "Sudheer K Vuyyuru"

Background And Aims: Assessing endoscopic activity is integral in the management of postoperative Crohn's disease (CD). We aimed to comprehensively characterize the reliability and responsiveness of different endoscopic instruments when used to assess postoperative CD activity.

Methods: Ileocolonoscopy videos (n=70) from the PREVENT trial were reviewed by three blinded central readers.

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Background And Aims: Outcomes of patients admitted with acute severe ulcerative colitis(ASUC) in the post biologic era are under explored, as well as ability of scoring indices to predict early steroid non-response.

Methods: This Retrospective cohort study included adults hospitalized with ASUC(2010-2022) at London Health Sciences Centre, Canada. Steroid response, need for rescue therapy, colectomy during index hospitalization and colectomy and hospitalization at 3- and 12-months following discharge was assessed.

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In response to recent advancements in inflammatory bowel disease (IBD) management, the British Society of Gastroenterology (BSG) Clinical Services and Standards Committee (CSSC) has commissioned the BSG IBD section to update its guidelines, last revised in 2019. These updated guidelines aim to complement the IBD standards and promote the use of the national primary care diagnostic pathway for lower gastrointestinal symptoms to enhance diagnostic accuracy and timeliness. Formulated through a systematic and transparent process, this document reflects a consensus of best practices based on current evidence.

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Background: The differentiation between gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) is challenging. Detection of urinary lipoarabinomannan (LAM), a glycolipid component of the Mycobacterium tuberculosis cell wall, has shown potential as a non-invasive diagnostic marker for tuberculosis.

Objective: We evaluated the diagnostic accuracy of urinary LAM in distinguishing GITB from CD.

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Background & Aims: Approval of new therapies for inflammatory bowel disease (IBD) requires rigorously designed and well-executed randomized controlled trials (RCTs). Corticosteroids remain a cornerstone of IBD induction therapy, and many patients in trials are enrolled while taking corticosteroids. Despite this, approaches to corticosteroid management in RCTs have been highly heterogeneous, often differing from clinical practice.

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Background & Aims: Acute severe ulcerative colitis (ASUC) is a medical emergency associated with high morbidity and mortality. We aimed to assess the efficacy and safety of medical treatments for ASUC.

Methods: MEDLINE, EMBASE, and CENTRAL were searched to November 14, 2024 for randomized controlled trials (placebo or active comparator), and comparative cohort studies that evaluated medical therapies for hospitalized adults with ASUC.

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Interleukin-23 (IL-23), a member of the IL-12 family of cytokines, plays a critical role in intestinal homeostasis and inflammation and is strongly implicated in the pathogenesis of inflammatory bowel disease (IBD). Therapies targeting the p19 subunit of IL-23 have recently expanded the therapeutic options for IBD demonstrating efficacy and safety for the treatment of moderate to severe Crohn's disease (CD). Thus, in this review, we provide an overview of agents targeting the IL-23 pathway in CD, highlighting similarities and differences of specific IL-23 inhibitors.

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Introduction: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing interleukin (IL)-23p19 antagonists with ustekinumab, stratified by prior biologic exposure, in patients with moderate-to-severe Crohn's disease (CD).

Methods: Through a systematic review through August 17, 2024, we identified phase 2 and 3 RCTs comparing IL-23p19 antagonists vs ustekinumab in adults with moderate-to-severe CD. The primary outcome was achieving clinical remission at ∼1 year, and secondary outcomes were achieving endoscopic remission and serious adverse events.

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Background And Aims: Over 10% of patients with Crohn's disease require permanent ileostomy. We aimed to summarize the existing data on diagnosis, definitions of recurrence, and management of Crohn's disease patients with permanent ileostomy.

Methods: MEDLINE, Embase, and CENTRAL databases were searched from inception to February 6, 2024.

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Integrating artificial intelligence (AI) into clinical trials for inflammatory bowel disease (IBD) has potential to be transformative to the field. This article explores how AI-driven technologies, including machine learning (ML), natural language processing, and predictive analytics, have the potential to enhance important aspects of IBD trials-from patient recruitment and trial design to data analysis and personalized treatment strategies. As AI advances, it has potential to improve long-standing challenges in trial efficiency, accuracy, and personalization with the goal of accelerating the discovery of novel therapies and improve outcomes for people living with IBD.

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Background/aims: Crohn's disease (CD) and intestinal tuberculosis (ITB) are gastrointestinal (GI) inflammatory disorders with overlapping clinical presentations but diverging etiologies. The study aims to decipher CD and ITB-associated gut dysbiosis signatures and identify disease-associated co-occurring modules to evaluate whether this dysbiosis signature is a disease-specific trait or is a shared feature across diseases of diverging etiologies.

Methods: Disease-associated gut microbial modules were identified using statistical machine learning and co-abundance network analysis in controls, CD and ITB patients recruited as part of this study.

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Background: The evidence for the management of patients with Crohn's disease (CD) and permanent ileostomy (PI) is limited. We aimed to summarize the interventional studies related to the provision of adjunctive ostomy care in this population.

Methods: MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to January 5, 2024.

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Background & Aims: Incidence of obesity and Crohn's disease (CD) is increasing globally. Therefore, understanding any associations between adiposity and disease phenotype is crucial. We aimed explore the relationship between nutritional status measured by body mass index (BMI) and phenotypes of CD using a large national recallable data set.

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Article Synopsis
  • Crohn's disease (CD) is linked to an increased risk of cancer, partly due to disease characteristics and immunosuppressive treatment; this study focuses on data from a northern Indian cohort to shed light on CD-related malignancies in Asia.
  • A total of 952 participants, with a mean age of 36.9 years and a follow-up period of 34 months, were analyzed, revealing a malignancy occurrence rate of 1.05%, which is 10.45 times higher than the general population.
  • By 30 years of diagnosis, the cumulative cancer risk for Indian individuals with CD was found to be 13.4%, covering various types of malignancies including bowel and extraintestinal cancers, but no cases of
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Background: Standardized clinical care processes for patients with Crohn's disease (CD) and a permanent ileostomy (PI) are lacking. The EndOTrial consortium aims to address this gap by developing pathways for care.

Methods: In this umbrella review, we searched major databases for relevant systematic reviews (SRs) or scoping reviews (ScR) published until January 5, 2024.

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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.
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Acute Severe Ulcerative Colitis (ASUC) is a severe form of ulcerative colitis relapse which requires hospitalization and intensive medical intervention to avoid colectomy. The timely recognition of patients at risk of corticosteroid failure and the early initiation of medical rescue therapy are paramount in the management of ASUC. The choice of medical rescue therapy is influenced by multiple factors, especially patient's prior treatment history.

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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.
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  • A study was conducted to evaluate the effectiveness of intravenous albumin infusions in patients with acute severe ulcerative colitis (ASUC) who were not responding to standard steroids.
  • The trial involved 61 patients, who were divided into two groups: one receiving albumin with standard care and exclusive enteral nutrition, and the other receiving only standard care and nutrition.
  • Results showed no significant difference in steroid response, need for colectomy, or adverse events between the two groups, indicating that albumin infusion did not provide additional benefits for ASUC patients.
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Background: Perianal fistulas (PF) affect one-third patients with Crohn's disease (CD) with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells (BMSCs) in this population.

Methods: An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn's disease refractory to standard therapies.

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Article Synopsis
  • The study investigates how the extent of disease in Ulcerative Colitis (UC) affects the effectiveness of advanced medical therapies in clinical trials involving 5450 patients.
  • It found that the effectiveness of certain treatments like tofacitinib and infliximab might vary based on whether patients have left-sided or extensive colitis, particularly in inducing clinical response and remission.
  • However, there was no consistent evidence that disease extent influenced endoscopic improvements or other clinical outcomes across the various therapies studied.
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