Medical Cannabis for IBD: Is the Web Reliable?

The quality of information on the web about medical marijuana for inflammatory bowel disease (IBD) was only “average,” a researcher reported here.

On the validated DISCERN questionnaire used to assess quality of information, the average score was 42.6, which was classified as average, according to Marie Borum, MD, and colleagues from George Washington University in Washington.

IBD is one of the conditions for which medical marijuana has been approved as a treatment. “Based on observational and animal studies, it is thought that modulation of endocannabinoid receptors may improve inflammation and therefore the symptoms of IBD,” Borum’s group explained in a poster at the Advances in Inflammatory Bowel Diseases annual meeting.

Patients increasingly use the internet to find information about alternative treatments, and no studies have evaluated online resources about medical marijuana for IBD. This study aimed to evaluate claims, warnings, and evidence on the available internet resources for IBD.

On the DISCERN quality questionnaire, scores of 66 to 75 were considered excellent, 56 to 65 were very good, 46 to 55 were good, 36 to 45 were average, and <35 were poor.

A total of 89 web sites were included, of which 75 (84%) were intended for use by consumers and 14 (16%) were aimed at medical professionals.

The average Flesch-Kincaid grade of readability was 13.3, with no significant difference between sites intended for consumers (13.2) and for medical professionals (14, P=0.41). This test estimates the grade level for readability, and reflects the average sentence length and the average number of syllables per word. For example, a Flesch-Kincaid grade of 10.6 represents an 11th grade reading level, while a grade of 14 represents the second year of college.

On the discernment quality score, there was no difference between the consumer and medical professional web sites (40 vs 48, P=0.08).

Consumer web sites did, however, offer significantly more claims of improvement in disease pathology than did sites for professionals (45% vs 15%, P=0.04) and significantly less often provided evidence-based references (40% vs 85%, P=0.04).

Only 21.3% of the sites included precautionary information regarding marijuana use in IBD, with no significant difference seen between sites aimed at consumers and those intended for medical professionals.

The study demonstrated that a multitude of online resources exist with information of medical marijuana as an alternative treatment for IBD patients.

The majority of sites were intended for consumers, but their readability grade level exceeded the NIH recommendation of a sixth grade reading level for medical information, the researchers pointed out.

There also was variability in the available evidence-based references, and inconsistency in the inclusion of precautionary information and therapeutic claims.

“It is critical that readily available online information about cannabis treatment in IBD be readable, evidence-based, and comprehensive in order to allow patients to make informed medical decisions,” they concluded.

Sperm Motility, Testosterone Levels Lower in Active IBD

Severe active inflammatory bowel disease (IBD) is associated with impaired sperm motility and reduced testosterone levels, according to results from a tertiary IBD center in Denmark.

“Quite surprisingly, only progressive sperm motility and testosterone levels were affected by severe disease flare in patients with inflammatory bowel disease,” Dr. Ann Grosen from Aarhus University Hospital told Reuters Health by email. “We did not see an effect on sperm DNA integrity, sperm concentration, or the morphological appearance of sperm cells during severe disease. Fortunately, both sperm motility and testosterone levels (were) restored after remission in disease was obtained.”

Previous studies have found that men with recent IBD activity are more likely to experience difficulty conceiving than are men in sustained remission. But few studies have investigated the effects of IBD and its treatment on semen quality and sperm DNA integrity.

Dr. Grosen’s team investigated the effects of severe active IBD on semen quality, sperm DNA integrity and the hypothalamic-pituitary-gonadal axis, as well as the effects of infliximab and adalimumab, in 20 men with severe disease, 11 of whom achieved remission on high-dose steroids and nine of whom required additional infliximab therapy to achieve remission.

The team also included 19 outpatients who initiated anti-TNF-alpha therapy and 17 who discontinued anti-TNF-alpha treatment due to sustained remission, for an overall total of 38 men who received infliximab and seven who received adalimumab.

At the time of follow-up, all 20 men with severe disease and all 28 patients who initiated anti-TNF-alpha therapy were in remission and had been for at least three months. They had been treated for a median 5.4 months at the time of follow-up semen sampling.

Among men with severe active disease and those who started anti-TNF-alpha therapy, progressive motility values were abnormally low (mean, 28.4%), based on World Health Organization reference limits, and increased to normal levels (mean, 37.4%) after the patients achieved remission.

All other semen parameters were within the normal range and did not differ significantly between baseline and follow-up samples for any of the three subgroups.

DNA fragmentation index (DFI) decreased from a median 12.8 before initiation of anti-TNF-alpha therapy to a median 10.0 after the start of the anti-TNF-alpha therapy, the researchers reported in the Journal of Crohn’s and Colitis, online November 30.

Sperm DNA integrity did not differ between baseline and follow-up samples for any of the three subgroups, between men with ulcerative colitis and men with Crohn’s disease, or between infliximab- and adalimumab-treated patients.

Plasma testosterone levels were decreased in men with severe disease and in those who started anti-TNF-alpha therapy, but levels normalized after achieving remission.

Infliximab and adalimumab were detected in serum and seminal plasma collected while men were on maintenance treatment but were undetectable in the off-drug semen samples.

“The levels in semen corresponded to 1-2% of serum levels,” Dr. Grosen said. “Consequently, a potential female exposure through the ejaculate is negligible, and barrier methods are not necessary to use for men who are treated with anti-TNF-alpha drugs. This is especially relevant in case the female partner is pregnant.”

“Physicians should inform men with inflammatory bowel disease that we have seen no alarming effects on sperm quality, and pregnancy can be pursued without drug cessation,” she concluded. “Further, patients should not fear adverse effects on fertility despite disease flares.”

Increased Risk of Sexual Dysfunction With Inflammatory Bowel Disease

Men and women with inflammatory bowel disease (IBD) have a significantly increased risk of sexual dysfunction, according to a new meta-analysis.

“As people get older, the prevalence of sexual dysfunction increases due to disturbance of hormones,” said Dr. Zhigang Zhao from The First Affiliated Hospital of Guangzhou Medical University, in Guangzhou, China.

“Inversely, however, our study, which combined the relative risk from 8 relevant studies, indicated both male and female inflammatory bowel diseases patients with a younger age exhibited significantly increased odds of sexual dysfunction when compared to the healthy subjects, but such association was not found in a relatively older age in both sexes,” he told Reuters Health by email.

Previous studies have reported sexual dysfunction rates ranging from 44% to 53.9% in patients with IBD, with higher rates in women (66%) than in men (40%), but controversy remains regarding the association between IBD and sexual dysfunction.

To investigate, Dr. Zhao’s team conducted a meta-analysis of eight studies including more than 351,000 men and 1,309 women ranging in mean age from 33.6 years to 52.4 years.

Among men, 11.7% of those with IBD had sexual dysfunction, compared with 9.7% of those without IBD, a difference of 40 more men per 1,000, the researchers report in Inflammatory Bowel Diseases, online November 23.

Similarly, 44.9% of women with IBD had sexual dysfunction, compared with 24.0% of women without IBD, a difference of 182 more women per 1,000.

IBD was associated with a 41% increased risk of sexual dysfunction in men and a 76% increased risk in women.

IBD was associated with significantly greater odds of sexual dysfunction among men younger than 50 years and women younger than 40 years, but there was no association between IBD and sexual dysfunction for men 50 and older or women 40 and older.

“The etiologies of sexual dysfunction in inflammatory bowel diseases patients may be multifactorial, including but not limited to the nature of disease (activity, severity, and duration), pelvic floor disorders, psychosocial factors, body image perceptions and changes, medications usage, hypogonadism, and surgical interventions,” Dr. Zhao said.

“Accordingly, those patients with inflammatory bowel diseases who complained about sexual dysfunction may benefit from controlling the disease itself, treating pelvic floor disorders and psychosocial conditions, envisaging reality of the disease and being more confident, treating hypogonadism, and selecting the proper surgery,” he said.

Dr. Zhao added, “Additional high-quality stringent cohort studies with large sample size are still warranted to elucidate the relationship between inflammatory bowel diseases and the risk of sexual dysfunction in both sexes.”

Dr. Sonia Friedman from Harvard Medical School and Brigham and Women’s Hospital, in Boston, who wrote an accompanying editorial, told Reuters Health by email, “Sexual dysfunction in IBD patients is quite common, but few physicians ask their patients about it. Most patients feel comfortable with and would like to discuss this with their physicians (regardless of patient gender or physician gender).”

“Ask IBD patients about sexual function; if yes, figure out cause and treat or refer for treatment,” she said. “Evaluate for depression, IBD activity, hypogonadism, pelvic floor dysfunction in women, and medications – specifically steroids, anti-depressants, and narcotics. For men, check testosterone and have them see a urologist.”

Splenda (Artificial Sweetner) intensifies symptoms in Bowel Disease

Steroid Use Tied to Thromboembolism Risk in IBD

Steroid therapy is associated with an increased risk of venous thromboembolic events in patients with inflammatory bowel disease (IBD), but biological therapy is not, researchers from Hungary report.

The risk of venous thromboembolism (VTE) is 1.5- to 3-fold higher in IBD patients, compared with non-IBD controls, with most events occurring during acute flareups of the disease. It remains unclear whether therapy with steroids and anti-TNFalpha agents contributes to this increased risk.

To investigate, Dr. Patricia Sarlos from the University of Pecs in Hungary and colleagues reviewed eight retrospective studies of 40,083 steroid-treated IBD patients and 18,435 anti-TNFalpha-treated IBD patients.

Steroid-treated IBD patients were more likely to develop VTE complications than patients not receiving such drugs (odds ratio, 2.2; P<0.001), the team reports in the Journal of Crohn’s and Colitis, online December 6.

In contrast, the odds of having VTE complications was significantly lower in anti-TNFalpha-treated IBD patients (by 73.3%) than in steroid-treated IBD patients (P=0.005).

The researchers were unable to ascertain how many IBD patients received pharmacological thromboprophylaxis in these studies.

“These associations highlight the importance of steroid-sparing therapy in IBD, especially in patients with additional risk factors for VTE,” the researchers conclude. “The choice between glucocorticoids and anti-TNFalpha therapy in the management of severe flares, should take this into consideration, especially in patients with previous VTE or a family history of thrombotic events.”

“Patients with IBD should be stratified according to their general and IBD-specific risk factors for VTE into high-risk and intermediate/low-risk patients,” they add. “Beside detailed patient history focused on well-known general and disease-specific VTE risk factors, clot lysis parameters should be included in the risk assessment. We recognize the importance of our findings in the promotion of the appropriate thromboprophylaxis during steroid treatment. Further research is needed to establish the exact weight of these factors and large prospective cohort studies are awaited.”

Dr. Akbar Waljee from the University of Michigan, in Ann Arbor, who recently reviewed corticosteroid use and its complications in IBD patients, told Reuters Health by email, “There is an association between steroids and a variety of complications, including fractures, infections, and VTE as shown in our prior paper. The authors highlight the association (2-fold increased risk) between steroids and VTE specifically in an IBD population. However, this association between steroids and VTE should be interpreted with caution, as IBD by itself is associated with increased risk of VTE.”

“There are recommendations that suggest that patients having an IBD flare admitted to the hospital should receive thromboprophylaxis in the absence of any contraindication,” he said. “In the outpatient setting, further research is needed to identify who is sufficiently high risk to warrant prophylaxis and for how long prophylaxis is needed.”

“While corticosteroids may be appropriate in some situations, like many drugs they have side effects,” Dr. Waljee said. “It is important to minimize their use if alternatives exist.”

Recurrent C. difficile Infection More Common in IBD

People with inflammatory bowel disease (IBD) are at increased risk of experiencing recurrent Clostridium difficile infection (CDI), according to a new study.

“In addition to finding that IBD patients had higher rates of recurrent C. difficile infection than non-IBD patients, we also found that these recurrent infections often occurred well beyond 6 months,” Dr. Geoffrey C. Nguyen from the University of Toronto, Ontario, Canada, told Reuters Health by email.

“This is in contrast to non-IBD patients who experienced recurrent CDI within the first 6 months. I think this is an indication that IBD patients have ongoing risk factors related to their disease or its treatment,” he said.

CDI is twice as common among hospitalized IBD patients and is associated with more than triple hospital mortality rates compared with non-IBD patients. Recurrent CDI remains a significant challenge for IBD patients, Dr. Nguyen and colleagues note in The American Journal of Gastroenterology, online May 24.

The team investigated the incidence of recurrent CDI among 503 patients with CDI, 110 (22%) of whom were IBD patients.

During more than 13,000 person-months of follow-up, nearly a third of IBD patients (31.8%) experienced recurrent CDI, compared to 23.9% of non-IBD patients (p<0.01).

The incidence of recurrent CDI was 2.04 episodes per 100 person-months for IBD patients, compared with 1.25 episodes per 100 person-months for non-IBD patients (p<0.001).

The mean time to first recurrence of CDI was significantly shorter in the non-IBD group (76 days) than among patients with IBD (157 days).

IBD patients were more likely than non-IBD patients to require colectomy after CDI (6.4% vs. 0.3%, p<0.001). There were no CDI-attributable deaths among IBD patients, but 12.2% of non-IBD patients died because of CDI.
Compared with IBD patients who had only a single episode of CDI, IBD patients with recurrent CDI were significantly more likely to report recent antibiotic therapy, 5-aminosalicylic acid (5-ASA) use, steroid use, and biologic therapy.

Significant independent predictors of recurrent CDI in IBD patients included non-ileal Crohn’s disease and the use of 5-ASA.

Compared with non-IBD patients, IBD patients were 48% less likely to have a recurrence within six months, but 4.88-fold more likely to experience one after six months.

“The predisposing factors for CDI and recurrent CDI are likely different for those with IBD than those without,” Dr. Nguyen said. “We need to further understand these risk factors in order to reduce the burden of CDI in the IBD population.”

“I think physicians need to remain vigilant for recurrent CDI in IBD patients even years after the initial infection,” Dr. Nguyen concluded. “So we need to continue to test for C. difficile during diarrhea-predominant IBD flares.”

Dr. David G. Binion, director of translational IBD research at the University of Pittsburgh School of Medicine, told Reuters Health by email that “Much of the morbidity and mortality related to C. difficile stems from recurrent infection.”

“The paper is very interesting and important and sheds new light on the challenge of C. difficile infection in patients with IBD,” said Dr. Binion, who was not involved in the study.

Inflammatory Bowel Disease

A new review article covers the wide range of cancers associated with inflammatory bowel disease and the drugs used to manage them. Surveillance recommendations are presented.

Cancers complicating inflammatory bowel disease can be attributed to chronic intestinal inflammation or to the carcinogenic effects of the immunosuppressive drugs used to treat inflammatory bowel disease.

Clinical Pearls

What is the epidemiology of colorectal cancer in patients with inflammatory bowel disease?

Patients with inflammatory bowel disease without colonic inflammation and patients with ulcerative colitis limited to the rectum are not at excess risk for colorectal cancer. In contrast, patients with primary sclerosing cholangitis associated with inflammatory bowel disease are at high risk for colorectal cancer, beginning at the time of the diagnosis. In other patients with inflammatory bowel disease, the excess risk of colorectal cancer, as compared with the risk among persons of the same age and sex without inflammatory bowel disease, is driven by the extent, duration, and severity of colonic inflammation.

How do the precursor colitis-associated dysplastic lesions compare with the dysplastic lesions seen in sporadic colorectal cancer?

As in sporadic colorectal cancer, in which the precursor dysplastic lesion is usually a visible polyp, in colitis, most dysplasia is also visible in the colon. However, colitis-associated dysplastic lesions are often flatter and have less distinct borders, and they can even be invisible when standard endoscopic techniques are used. This has prompted the recommendation to perform extensive biopsies throughout the colorectum, taking care to target any raised or suspicious lesions. Newer endoscopic techniques, especially high-definition white-light colonoscopy and chromoendoscopy with mucosal dye-spraying, enhance the detection of dysplasia, as compared with standard-light colonoscopy. This is why most international authorities now favor chromoendoscopy with targeted biopsies over random biopsies, although the latter approach, alone or in combination with targeted biopsies, has not yet been fully abandoned.

Morning Report Questions

Q: What is the relative risk of cancer in patients with inflammatory bowel disease treated with thiopurines as compared to TNF-alpha antagonists?

A: After adjustment for confounders, current use of thiopurines for inflammatory bowel disease has been shown to be associated with an overall relative risk of cancer of 1.3 to 1.7 in adequately powered cohort studies. This excess risk is reversible after thiopurine withdrawal. There is no overall excess risk of cancer in patients treated with TNF-alpha antagonists for inflammatory bowel disease, but a long-term excess risk due to accumulated doses cannot yet be ruled out because of the relatively recent use of biologics.

Q: What is the most common type of lymphoma induced by thiopurines in this population?

A: Thiopurines were shown in the 1970s to increase the incidence of non-Hodgkin’s lymphoma after kidney transplantation. This phenomenon was established in the early 2000s in patients with inflammatory bowel disease. Most of the lymphomas induced by thiopurines are posttransplant-like EBV-associated B-cell lymphomas. These lymphomas may occur in patients seropositive for EBV (i.e., almost all adults >30 years of age); in these patients, non-Hodgkin’s lymphoma is attributed to the cytotoxic effects of thiopurines on EBV-specific immune cells that prevent the proliferation of EBV-infected B lymphocytes.


Ankylosing Spondylitis: More Than Just the Spine

The eyes, skin, and bowel all can be affected.

Extra-articular disease manifestations that can have substantial impact on quality of life are common among patients with ankylosing spondylitis, a meta-analysis found.

Across published studies, the pooled prevalence of acute anterior uveitis among patients with this inflammatory spine disease was 25.8% (95% CI 24.1-27.6), according to Carmen Stolwijk, MD, of Maastricht University Medical Center in the Netherlands, and colleagues.

In addition, the pooled prevalence of psoriasis was 9.3% (95% CI 8.1-10.6), while the prevalence of inflammatory bowel disease was 6.8% (95% CI 6.1-7.7), the researchers reported in the January issue ofAnnals of the Rheumatic Diseases.

In the general population, the estimated prevalence of acute anterior uveitis is 0.2% to 1%, while the prevalence of psoriasis is 0.3% to 2.5% and that of inflammatory bowel disease is 0.01% to 0.5%, they noted.

In recent years there has been increasing interest in the extra-articular manifestations of ankylosing spondylitis and the related spondyloarthropathies, but accurate information on the prevalence and related factors has been lacking.

Therefore, Stolwijk and colleagues conducted a systematic literature review for studies published between 1984 and 2012, identifying 156 that met their inclusion criteria on symptoms beyond the spine.

“We hypothesized that the prevalences of all [extra-articular manifestations] would be associated with disease duration and with geographical area, the latter being associated with differences in distribution of HLA-B27 positivity,” they noted.

HLA-B27 is a surface antigen in the major histocompatibility complex located on chromosome 6 that is strongly associated with the spondyloarthropathies.

A total of 143 studies that included 44,372 patients reported on the prevalence of acute anterior uveitis. In these studies, considerable heterogeneity was found (I2=94%). The prevalence was significantly associated with duration of disease, rising to 38.5% (95% CI 33.3-43.9) after 20 years from 17.4% (95% CI 14.3-21.3) at 10 years.

Significant differences in uveitis also were seen according to geographic area, with rates of 35.2% in North American patients with ankylosing spondylitis compared with 21.4% in Asia and 20.1% in Latin America.

In 56 studies that included 27,626 patients, the prevalence of psoriasis was reported and, once again, heterogeneity was substantial (I2=91%).

Geographic location was associated with prevalence, with rates of 10.9% in Europe, 4.2% in the Middle East, and 3.1% in Asia.

For inflammatory bowel disease, there were 69 studies with 32,341 patients, and considerable heterogeneity was present (I2=84.2%). Geographic location again was associated with different rates, being 9.6% in Latin America and 2.9% in Asia.

The researchers then conducted meta-regression analyses for each of the three extra-articular disease manifestations “to explore the methodological and clinical heterogeneity among the studies. Disease duration and geographical area were the most striking contributors to heterogeneity found,” they explained.

This analysis confirmed persistent significant associations for acute anterior uveitis with disease duration (beta=0.05, 95% CI 0.03-0.06) and for geographic location (Middle East versus Europe, beta=-0.64, 95% CI minus 1-minus 0.28).

For psoriasis, geographic area was significant, with lower estimates being seen for Asia (beta=-1.33, 95% CI minus 2.09-minus 0.57) and the Middle East (beta=-1.03, 95% CI minus 1.73-minus 0.32) versus Europe.

For inflammatory bowel disease, geographic location also was significant in this analysis, being lower in Asia (beta=-0.80, 95% CI minus 1.29-minus 0.32) than in Europe. The percentage of women included in the studies also was significant for inflammatory bowel disease (beta=0.02, 95% CI 0-0.03).

As to the finding that geographical location was a significant factor in the prevalence of extra-articular manifestations, the authors cautioned that not all of the variation was likely to relate to differences in rates of HLA-B27 positivity. The significant association remained after adjusting for HLA-B27, “suggesting that other (epi)genetic factors are likely to play a role.”

Limitations of the study included the possibility of bias from confounding and missing information on factors such as disease duration in some studies.

The authors concluded, “The prevalence of [extra-articular manifestations] among patients with [ankylosing spondylitis] is clearly increased compared with the general population … Awareness of [extra-articular manifestations] among clinicians is important in view of their role in the diagnostic process, for treatment choices, and for health-related quality of life.”

Pediatric Arthritis, Look to the Gut

Alterations in the intestinal microbiota have been identified in children with enthesitis-related arthritis (ERA), suggesting the possibility that the microbiome may play a triggering role in the disease, researchers reported.

Among children with ERA, which is a subtype of juvenile idiopathic arthritis considered to be the pediatric equivalent to axial spondyloarthritis in adults, there were lower levels of organisms of theFaecalibacterium genus compared with controls (5.2% versus 11%, P=0.005), according to Matthew L. Stoll, MD, and colleagues from the University of Alabama at Birmingham.

Specifically, F. prausnitzii constituted 10% of the microbiota of healthy controls compared with only 3.8% in children with ERA (P=0.008).

This decrease has previously been reported among patients with inflammatory bowel disease, and may be relevant because of the potential for this organism to exert anti-inflammatory effects through production of butyrate, the researchers explained online inArthritis Research & Therapy.

“The human intestine is colonized with an estimated 100 trillion bacteria, a process that begins shortly after birth. It is becoming increasingly clear that these bacteria play important roles in immune function as well as in a variety of autoimmune and inflammatory disorders,” they wrote.

Next-generation sequencing has permitted the full assessment of intestinal microbiota, with distinct alterations identified in a number of inflammatory diseases such as rheumatoid arthritis and celiac disease. This has sparked interest in the microbiome as an environmental trigger for the diseases.

Furthermore, “intestinal bacteria need not be present in abnormal quantities to trigger arthritis; it is also possible that a pathologic immune response to normal resident microbes may result in disease,” Stoll and colleagues wrote.

For instance, many patients with Crohn’s disease develop antibodies against intestinal microbial flagellins, and the presence of those antibodies is associated with stricturing disease.

To explore the possibility of abnormalities in commensal quantities and immune responses in children with ERA, the researchers recruited 25 patients and 13 controls.

They performed sequencing of 16S ribosomal DNA on fecal samples of all participants, and ELISAs to measure bacterial IgG and IgA in order to evaluate antigenic reactivity.

Participants’ mean age was 13, and median disease duration was 2.4 years. Among the 25 ERA patients, 11 were female and two had concomitant inflammatory bowel disease. Immunosuppressive therapies were being used by 21.

Sequencing analysis of fecal samples of all 38 children showed that there were notable differences in three taxa other than Faecalibacterium.

As with Faecalibacterium, the ERA patients had lower levels of Lachnospiraceae (7% versus 12%, P=0.020).

However, levels of Bifidobacterium (primarily B. adolescentis) were higher in the ERA group (1.8% versus 0%, P=0.032), as were Bacteroides (21% versus 11%).

“Thus, at the genus and species levels, our data demonstrate some statistically significant differences between patients and controls,” Stoll and colleagues wrote.

Further analysis divided the ERA patients into two clusters. The eight patients in cluster 1 had higher levels of Bacteroides than those in cluster 2 (32% versus 13%, P<0.001), but similar levels of F. prausnitzii (4.7 versus 3.2%, P=0.897).

None of the patients in cluster 1 had high levels of Akkermansia, but 41% of those in cluster 2 had levels of 2% or greater.

“A novel finding of this study is that both Bacteroides species and Akkermansia muciniphilawere found to be associated with disease states in largely non-overlapping subsets of ERA patients,” the researchers noted.

Then, to examine the possible influence of immunoreactivity, the researchers conducted ELISA tests against B. fragilis and F. prausnitzii in 31 of the participants, and found that patients in cluster 1, who had higher levels of Bacteroides, also exhibited greater IgA and IgG reactivity against B. fragilis.

Abnormal immune responses to Bacteroides also have been observed in adult patients with ankylosing spondylitis, they pointed out.

The presence of increased levels of A. muciniphila also was of interest. This is a recently identified bacterium that thrives on mucin in the intestine, “suggesting that high quantities could potentially lead to a defect in the intestinal wall barrier function,” they noted.

In addition, the IgA responses to B. fragilis may result in invasion of the intestinal wall and a subsequent systemic immune response.

The study findings represent “the first comprehensive evaluation of the microbiota in pediatric or adult [spondyloarthritis], confirming a potential role for insufficient protectiveF. prausnitzii in the pathogenesis of ERA and introducing potential novel bacteria as associative agents,” Stoll and colleagues observed.

“These findings suggest that altering the gut microbiota may be beneficial in children with ERA,” they concluded.

Limitations of the study included its small sample size and a lack of information about diet.

Lung Disease Patients Have Higher Incidence of Inflammatory Bowel Disease

A new study entitled “Increased incidence of inflammatory bowel disease in Quebec residents with airway diseases” revealing that patients with airway diseases have a higher frequency of inflammatory bowel disease was recently published in the European Respiratory Journal by Dr. Paul Brassard, a professor from the Lady Davis Institute and lead author of the study.


It has been suggested that inflammatory bowel disease (IBD) and airway diseases may be developed through common inflammatory pathways, and triggered by factors of genetic and environmental origin. Previous epidemiological studies have shown that the incidence of IBD was highly increased in patients with airway diseases when compared to the general population. Quebec is the province with the second highest frequency of Crohn’s disease in Canada, with an incidence of asthma and chronic obstructive pulmonary disease (COPD) more than the country’s average and with the highest mortality rate due to COPD nationally.

The authors evaluated if the frequency of Crohn’s disease and ulcerative colitis were higher in patients with airway diseases when compared to the general population of Quebec, Canada. This is the first population-based study ever done to assess this type of association. The authors analyzed the patients diagnosed with airway disease and with inflammatory bowel disease between 2001 and 2006, looking for patients with prescriptions for medications for both asthma and COPD. The researchers found that the frequency of Crohn’s disease was 27% and 55% higher in subjects, respectively, with asthma and COPD, and ulcerative colitis was 30% more prevalent in people with COPD, when compared with the rest of population.

“These findings have important implications for the early detection of inflammatory bowel disease in airway disease patients. Although a link has previously been suggested, this is the first study to find significantly increased rates of inflammatory bowel disease incidence in people with asthma and COPD. If we can confirm a link between the two conditions it will help diagnose and treat people sooner, reducing their symptoms and improving their quality of life,” said Dr. Paul Brassard, in a press release.