Featured Publications

Systematic Review With Meta-analysis: Safety and Effectiveness of Combining Biologics and Small Molecules in Inflammatory Bowel Disease

Alayo, QA, Fenster, M, Altayar, O, Glassner, KL, Llano, E, Clark-Snustad, K, Patel, A, Kwapisz, L, Yarur, AJ, Cohen, BL, Ciorba, MA, Thomas, D, Lee, SD, Loftus, EV, Fudman, DI, Abraham, BP, Colombel, JF & Deepak, P 2022, 'Systematic Review With Meta-analysis: Safety and Effectiveness of Combining Biologics and Small Molecules in Inflammatory Bowel Disease', Crohn's and Colitis 360, vol. 4, no. 1, otac002. https://doi.org/10.1093/crocol/otac002

Combining biologics and small molecules could potentially overcome the plateau of drug efficacy in inflammatory bowel disease (IBD). To assess the safety and effectiveness of such combinations, Bincy P. Abraham, MD, Kerri L. Glassner, DO, and colleagues conducted a systematic review and meta-analysis of 13 studies involving 266 patients with IBD on dual biologic therapy (DBT) or small molecule combined with a biologic therapy (SBT). Safety was assessed as pooled rates of adverse events (AEs) and serious AEs (SAEs) for each combination; effectiveness was reported as pooled rates of clinical, endoscopic and/or radiographic response and remission. Per their analysis, DBT and SBT appear to be generally safe and may be effective in patients with IBD, but the evidence is uncertain, given the observational nature, imprecision and inconsistency of the studies.

Interactions between symptoms and psychological status in irritable bowel syndrome: An exploratory study of the impact of a probiotic combination

Groeger, D, Murphy, EF, Tan, HTT, Larsen, IS, O'Neill, I & Quigley, EMM 2022, 'Interactions between symptoms and psychological status in irritable bowel syndrome: An exploratory study of the impact of a probiotic combination', Neurogastroenterology and Motility. https://doi.org/10.1111/nmo.14477

Stress exacerbates, and anxiety and depression are comorbid with, symptoms of irritable bowel syndrome (IBS). Both stress and IBS symptoms respond to treatment with different probiotic strains. To explore the relationship between the psychological and visceral effects of a combination of these strains (COMBO) in patients with IBS, Eamonn M. M. Quigley, MD, and colleagues assessed IBS symptoms, psychometric measures, salivary cortisol awakening response (CAR), and plasma inflammatory biomarkers in 40 patients with IBS and mild to moderate anxiety and/or depression who were treated with COMBO. They found that participants with IBS had a blunted CAR compared to healthy controls, but that treatment with COMBO restored and improved IBS symptoms. COMBO treatment also improved anxiety, depression, inflammation and sleep quality from baseline. These findings highlight the pivotal role that the stress response plays in driving IBS symptoms.

Prophylactic Perioperative Antibiotics in Open Pancreaticoduodenectomy: When Less Is More and When It Is Not. A National Surgical Quality Improvement Program Propensity-Matched Analysis

Naffouje, SA, Allenson, K, Hodul, P, Malafa, M, Pimiento, JM, Anaya, DA, Dam, A, Klapman, J, Fleming, JB & Denbo, JW 2022, 'Prophylactic Perioperative Antibiotics in Open Pancreaticoduodenectomy: When Less Is More and When It Is Not. A National Surgical Quality Improvement Program Propensity-Matched Analysis', Journal of Surgical Research, vol. 279, pp. 722-732. https://doi.org/10.1016/j.jss.2022.06.028

Patients undergoing open pancreaticoduodenectomy (PD) require prophylactic perioperative antibiotics to reduce the risk of surgical-site infection (SSI), but not all patients require the broadest-spectrum antibiotics. Kelvin Allenson, MD, and colleagues retrospectively analyzed more than 6,000 cases from the National Surgical Quality Improvement Program dataset of patients who underwent elective PD from 2014-2019 to test the hypothesis that first-generation cephalosporins (G1CEP) would be adequate when no biliary stent is present but might be inferior to second-generation cephalosporins or broad-spectrum antibiotics (G2CEP/BS) when a biliary stent is present. Their analysis grouped patients by presence or absence of a stent; each group was subdivided by antibiotic type. In the stent group, they found that G2CEP/BS were significantly associated with fewer SSI-specific and infectious complications; in the no-stent group, G1CEP provided adequate antimicrobial coverage.

Alterations in brain activation patterns in women with functional defecatory disorder: A novel fMRI rectal balloon expulsion study

Neshatian, L, Karmonik, C, Khavari, R, Shi, Z, Elias, S, Boone, TB & Quigley, EMM 2022, 'Alterations in brain activation patterns in women with functional defecatory disorder: A novel fMRI rectal balloon expulsion study', Neurogastroenterology and Motility. https://doi.org/10.1111/nmo.14389

Functional defecatory disorders (FDD) are common among women and have been researched extensively, but the central–neural contribution to its pathophysiology remains poorly understood. To identify specific supra-spinal regions involved in defecation and to determine whether their activity differs in patients with FDD, Eamonn M. M. Quigley, MD, and colleagues performed functional MRI (fMRI) with concurrent rectal manometry in 18 women with FDD and 15 controls and mapped brain activation based on blood-oxygen-level-dependent (BOLD) signals. They found distinct differences in supra-spinal control of defecation between those with FDD and controls: women with FDD had fewer regions engaged in defecation, and BOLD activation was much lower in areas related to executive–cognitive function. This innovative study is one of the first to demonstrate the active role of the brain in the act of defecation and related disorders.