|Year : 2022 | Volume
| Issue : 3 | Page : 140-141
Department of Medical Gastroenterology, SIMS Institute of Gastroenterology, Hepatobiliary Sciences and Liver Transplantation, SRM Institute for Medical Science Hospital, Chennai, Tamil Nadu, India
|Date of Submission||28-Apr-2022|
|Date of Decision||30-May-2022|
|Date of Acceptance||31-May-2022|
|Date of Web Publication||05-Jul-2022|
Department of Medical Gastroenterology, SIMS Institute of Gastroenterology, Hepatobiliary Sciences and Liver Transplantation, SRM Institute for Medical Science Hospital, Chennai - 600 026, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jayaraman K. Gastroenterology elsewhere. Gastroenterol Hepatol Endosc Pract 2022;2:140-1
| Is Intermittent Fasting as Effective as It Has Been Claimed?|| |
Liu D, Huang Y, Huang C, Yang S, Wei X, Zhang P, et al. Calorie restriction with or without time-restricted eating in weight loss. N Engl J Med 2022;386:1495-504.
Intermittent fasting is a popular diet choice for weight loss, based on the putative notion that eating in the latter part of the day leads to weight gain. Studies on the efficacy of intermittent fasting show varied results, and confusion prevails about whether calories should be restricted or not. 139 obese participants with a mean weight of 88 kg and eating 10 h a day were randomized to calorie-restricted eating at limited periods (8 h) or calorie-restricted eating alone. All patients were strictly followed for a year ensuring adherence by weekly phone calls and monthly visits. Physical activity was not restricted, but patients were not in an active weight loss program. Time- and calorie-restricted eaters lost a mean weight of 8 kg at 1 year, while calorie-restricted eaters lost 6.3 kg, which was statistically insignificant (net difference, −1.8 kg; 95% confidence interval [CI], −4.0–0.4; P = 0.11). Anthropometric measurements and metabolic parameters such as fasting blood glucose, insulin resistance, lipids, and blood pressure improved similarly in both groups. This study underscores that calorie restriction is the key to weight loss. Intermittent fasting might still be helpful for people who tend to eat heavily during a particular mealtime. Caution to be taken while prescribing to people with diabetes as hypoglycemia is a serious concern. Intermittent fasting is here to stay and works but no better than a regular calorie-restricted regimen.
| Risk of Tuberculosis with Vedolizumab and Ustekinumab – ASAN Inflammatory Bowel Disease Experience|| |
Choi MG, Ye BD, Yang SK, Shim TS, Jo KW, Park SH. The risk of tuberculosis in patients with inflammatory bowel disease treated with vedolizumab or ustekinumab in Korea. J Korean Med Sci 2022;37:e107.
Anti-integrin inhibitors and anti-IL-12/23 inhibitors are novel biologics that may not directly affect tumor necrosis factor (TNF) and supposedly reduce tuberculosis (TB) infection, as shown in various clinical trials. In this retrospective study from a single center, 238 patients with inflammatory bowel disease (IBD) who received at least one dose of vedolizumab (n = 125, ulcerative colitis – 45.6%, Crohn's disease – 54.4%) or ustekinumab (n = 113, Crohn's disease – 100%) were included. All patients underwent screening for latent TB infection. 87% of the patients were biologic experienced, and more than half were started on ustekinumab or vedolizumab within 90 days of stopping the previous biologic. Use of steroids and other immunomodulators was noted in both groups though slightly higher in ustekinumab users. None had developed active TB after a median follow-up period of 15.7 months and 21 months in vedolizumab and ustekinumab groups respectively. These results from a Korean study with an intermediate TB burden cannot be translated to a country like India with a high TB burden but is still relatable. The authors also suggest initiating these newer molecules in TB-endemic regions.
| Prophylactic Rectal Indomethacin to Prevent Postextracorporeal Shock Wave Lithotripsy Pancreatitis|| |
Qian YY, Ru N, Chen H, Zou WB, Wu H, Pan J, et al. Rectal indomethacin to prevent pancreatitis after extracorporeal shock wave lithotripsy (RIPEP): A single-centre, double-blind, randomised, placebo-controlled trial. Lancet Gastroenterol Hepatol 2022;7:238-44.
Pancreatitis after extracorporeal shock wave lithotripsy (ESWL) is a known complication though it is believed less likely to happen, as most of them have burnt-out pancreas. Some studies report 6%–12% of post-ESWL pancreatitis. 1370 patients with chronic pancreatitis undergoing ESWL were randomized into equal halves to preprocedurally receive rectal indomethacin or rectal glycerine in this double-blinded, controlled trial. Post-ESWL pancreatitis was defined by the conventional consensus and Revised Atlanta Criteria as hyperamylasemia is infrequent in chronic pancreatitis. 9% of the indomethacin group and 12% of the placebo group developed post-ESWL pancreatitis (relative risk 0.71, 95% CI 0.52–0.98; P = 0.042), of which none had severe pancreatitis. Asymptomatic hyperamylasemia happened in around 28% of patients in both groups. Overall transient events and other complications occurred equally in both groups. A post hoc subgroup analysis showed that the benefit was pronounced in females, idiopathic chronic pancreatitis, pancreas divisum, intact exocrine function, and nontype 3c diabetes. Few doubts linger. Imaging may have added to the increased diagnosis of pancreatitis. The protective role shown in the post hoc subgroups needs more studies for validation when no such delineation exists to prevent post-ERCP( Endoscopic retrograde cholangiopancreatopraphy) pancreatitis. Nonetheless, rectal indomethacin is safe and easy to administer in those without contraindications.
| Losartan Does Not Improve Alanine Transaminase in Pediatric Nonalcoholic Fatty Liver Disease|| |
Vos MB, Van Natta ML, Blondet NM, Dasarathy S, Fishbein M, Hertel P, et al. Randomized placebo-controlled trial of losartan for pediatric NAFLD. Hepatology 2022;00:1-16.
Lifestyle changes remain the cornerstone of the management of this disease. No specific pharmacological therapy exists for nonalcoholic fatty liver disease (NAFLD) in adults and kids. Studies have demonstrated an association between angiotensin receptor blockers (ARBs) and low incidence of advanced liver fibrosis in adults. Researchers aimed to study whether losartan improves biochemical markers of inflammation in biopsy-proven NAFLD in kids aged 8–17 years who had a NAFLD activity score of ≥3. Researchers gave 100 mg of losartan (n = 43) a day or placebo pills (n = 40) for 24 weeks. The predetermined sample size was 110, but enrolment was paused due to the COVID-19 pandemic. The conditional power analysis to detect significant group differences was low in an unplanned interim analysis. Researchers followed the existing patients up to 24 weeks with this background and found no significant reduction in alanine transaminase (ALT) between the two groups. ALT, a surrogate marker of fibrosis progression, may not truly reflect fibrosis due to its fluctuations. Pediatric NAFLD still relies on mindful eating and physical activity, though Vitamin E is used, as supported by the TONIC study. Newer therapies and better noninvasive diagnostic methods are goals for future research.
| Guselkumab in Crohn's Disease Results from the GALAXI-1 Study|| |
Sandborn WJ, D'Haens GR, Reinisch W, Panés J, Chan D, Gonzalez S, et al. Guselkumab for the treatment of Crohn's disease: Induction results from the phase 2 GALAXI-1 study. Gastroenterology 2022;162:1650-64.e8.
Guselkumab is a novel biologic acting on the p19 subunit of the IL-23 receptor used in psoriatic arthritis. In this study, researchers evaluated for safety and efficacy of guselkumab in patients with moderately severe Crohn's disease (Crohn's disease activity index [CDAI] 220–450) who had inadequate response or intolerance to conventional therapy or biologics. Randomized patients (n = 309) in 1:1:1:1:1 ratio received either guselkumab in three doses (200 mg, n = 61; 600 mg, n = 63; 1200 mg, n = 61) or placebo (n = 61) for 12 weeks. 63 patients received ustekinumab which served as the reference arm. Guselkumab, at all doses, achieved the primary end point, which was a reduction in CDAI scores from baseline compared to placebo (P < 0.05). In the biologic-experienced subgroup (54.6% of total combined guselkumab arm), all doses achieved significant clinical remission, clinical response, patient-related outcomes PRO-2, biomarker improvement, and endoscopic remission compared to placebo. Similar responses were seen in biologic naïve patients. This new agent is promising as the disease burden of IBD and the proportion of nonresponders to conventional biologics keep expanding. As our understanding of IBD grows, targeted therapies will help us achieve harder treatment goals, including deep remission.
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