REVIEW : Epidemiology of Ulcerative Colitis in South Asia

( Amarender Singh Puri ) 대한장연구학회 2013 Intestinal Research Vol.11 No.4

The South Asian region comprising of India, Pakistan, Bangladesh, Nepal, and Sri Lanka is multi-ethnic with vast cultural differences. Yet they have in common, a strong predisposition for inflammatory bowel disease especially ulcerative colitis (UC). The vast majority of the population is rural with limited access to health care facilities. Community based studies on epidemiology of UC are sparse making it difficult to extrapolate data for the whole region. India has the highest incidence and prevalence of UC in Asia which is higher than the published figures for Korea and Japan, the two leading industrialized countries in Asia. Asian diaspora studies have revealed an unmasking of the disease when natives of this region migrate to countries with a higher prevalence of the disease. Data mainly from the UK suggests a higher incidence of the disease in Asian migrants compared to the indigenous population. Incidence data from within the sub-continent suggests a higher incidence of the disease in India as compared to its southern neighbour Sri Lanka suggesting a north-south gradient. Time trend studies from India do not suggest an increasing incidence of disease as has been observed in other parts of Asia. Some data point to phenotypically different disease in south Asian patients as compared to Caucasians. Familial clustering and cumulative colectomy rates are higher in Western patients as compared to their Asian counterparts. Asian patients with UC have a significantly lower risk of development of colorectal carcinoma vis a vis the Caucasian population. There is a pressing need for more studies on the epidemiology, long-term outcome and natural history of the disease in this region. (Intest Res 2013;11:250-255)

Rectal tuberculosis after infliximab therapy despite negative screening for latent tuberculosis in a patient with ulcerative colitis

( Jatinderpal Singh ),( Amarender S Puri ),( Sanjeev Sachdeva ),( Puja Sakhuja ),( Kulandaivelu Arivarasan ) 대한장연구학회 2016 Intestinal Research Vol.14 No.2

Tumor necrosis factor-α inhibitors are now considered as standard therapy for patients with severe inflammatory bowel disease who do not respond to corticosteroids, but they carry a definite risk of reactivation of tuberculosis. We present a case in which a patient with inflammatory bowel disease developed a de novo tuberculosis infection after the start of anti-tumor necrosis factor-α treatment despite showing negative results in tuberculosis screening. Although there are many case reports of pleural, lymph nodal and disseminated tuberculosis following infliximab therapy, we present the first case report of rectal tuberculosis following infliximab therapy. (Intest Res 2016;14:183-186)

Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study

Anurag Mishra,Amarender Singh Puri,Sanjeev Sachdeva,Ashok Dalal 대한장연구학회 2022 Intestinal Research Vol.20 No.4

Background/Aims: Response to vaccine in patients with inflammatory bowel disease is lower than in the general population. We aimed to evaluate the efficacy of hepatitis B virus (HBV) vaccination in patients with ulcerative colitis (UC) versus controls.Methods: We prospectively compared antibody response to HBV vaccination in 100 patients with UC versus controls. HBV vaccination was given to all the cases and controls at 0, 1 and 6 months. Anti-hepatitis B surface (anti-HBs) titers were then measured 4 weeks after the first and the third dose. Adequate immune response (AIR) was considered if the anti-HBs titer was >10 IU/L and effective immune response (EIR) if the anti-HBs titer was >100 IU/L.Results: Median anti-HBs titer was lower in patients with UC than controls (67 IU/L vs. 105 IU/L, P<0.01). AIR and EIR were significantly lower in patients than in controls (82% vs. 96%, P=0.001; 41% vs. 66%, P<0.001, respectively). Univariate analysis showed that age <30 years, mild to moderate severity of disease, disease duration <5 years, male sex, post first dose anti-HBs titer >2 IU/L and non-exposure to corticosteroids, azathioprine and biologicals were predictors of AIR in patients with UC (P<0.05). Multivariate analysis revealed that only non-exposure to corticosteroids, azathioprine and biologicals, male sex, and disease duration <5 years were independent predictors of AIR.Conclusions: Response rate to the HBV vaccination in patients with UC was significantly lower as compared to the controls. Male sex, shorter disease duration, and non-exposure to immunomodulators were independent predictors of AIR.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis

( Amol Sonyabapu Dahale ),( Amarender Singh Puri ),( Sanjeev Sachdeva ),( Anil K Agarwal ),( Ajay Kumar ),( Ashok Dalal ),( Pritul D Saxena ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.3

Background/Aims: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions: The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value. (Korean J Gastroenterol 2021;78:168-176)

Biologics for the treatment of pyoderma gangrenosum in ulcerative colitis

K Arivarasan,Vaishali Bhardwaj,Sukrit Sud,Sanjeev Sachdeva,Amarender Singh Puri 대한장연구학회 2016 Intestinal Research Vol.14 No.4

Pyoderma gangrenosum (PG) is an uncommon extra-intestinal manifestation of inflammatory bowel disease (IBD). Despitelimited published literature, biologics have caused a paradigm shift in the management of this difficult-to-treat skin condition. The clinical data and outcomes of three patients with active ulcerative colitis and concurrent PG treated with biologics (infliximabtwo and adalimumab one) are reviewed in this report. Biologics were added because of the sub-optimal response of thecolonic symptoms and skin lesions to parenteral hydrocortisone therapy. All three patients showed a dramatic response to theaddition of the biologics. In view of the rapid healing of the skin lesions, superior response rate, and the additional benefit of improvementin the underlying colonic disease following treatment, anti-tumor necrosis factor blockers should be considered asa first line therapy in the management of PG with underlying IBD.

Colitis and Crohn’s Foundation (India): a first nationwide inflammatory bowel disease registry

( Ajit Sood ),( Kirandeep Kaur ),( Ramit Mahajan ),( Vandana Midha ),( Arshdeep Singh ),( Sarit Sharma ),( Amarender Singh Puri ),( Bhabhadev Goswami ),( Devendra Desai ),( C. Ganesh Pai ),( Kiran Ped 대한장연구학회 2021 Intestinal Research Vol.19 No.2

Background/Aims: The national registry for inflammatory bowel disease (IBD) was designed to study epidemiology and prescribing pattern of treatment of IBD in India. Methods: A multicenter, cross-sectional, prospective registry was established across four geographical zones of India. Adult patients with ulcerative colitis (UC) or Crohn’s disease (CD) were enrolled between January 2014 and December 2015. Information related to demographics; disease features; complications; and treatment history were collected and analyzed. Results: A total of 3,863 patients (mean age, 36.7±13.6 years; 3,232 UC [83.7%] and 631 CD [16.3%]) were enrolled. The majority of patients with UC (n=1,870, 57.9%) were from north, CD was more common in south (n=348, 55.5%). The UC:CD ratio was 5.1:1. There was a male predominance (male:female=1.6:1). The commonest presentation of UC was moderately severe (n=1,939, 60%) and E2 disease (n=1,895, 58.6%). Patients with CD most commonly presented with ileocolonic (n=229, 36.3%) inflammatory (n=504, 79.9%) disease. Extraintestinal manifestations were recorded among 13% and 20% of patients in UC and CD respectively. Less than 1% patients from both cohorts developed colon cancer (n=26, 0.7%). The commonly used drugs were 5-aminosalicylates (99%) in both UC and CD followed by azathioprine (34.4%). Biologics were used in only 1.5% of patients; more commonly for UC in north and CD in south. Conclusions: The national IBD registry brings out diversities in the 4 geographical zones of India. This will help in aiding research on IBD and improving quality of patient care. (Intest Res 2021;19:206-216)