Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare in the United States. AIM: To investigate COVID-19-related and non-COVID-19-related death and characteristics associated with excess death among inflammatory bowel disease (IBD) decedents. METHODS: We performed a register-based study using data from the National Vital Statistics System, which reports death data from over 99% of the United States population, from January 1, 2006 through December 31, 2021. IBD-related deaths among adults 25 years and older were stratified by age, sex, race/ethnicity, place of death, and primary cause of death. Predicted and actual age-standardized mortality rates (ASMRs) per 100000 persons were compared. RESULTS: 49782 IBD-related deaths occurred during the study period. Non-COVID-19-related deaths increased by 13.14% in 2020 and 18.12% in 2021 [2020 ASMR: 1.55 actual vs 1.37 predicted, 95% confidence interval (CI): 1.26-1.49; 2021 ASMR: 1.63 actual vs 1.38 predicted, 95%CI: 1.26-1.49]. In 2020, non-COVID-19-related mortality increased by 17.65% in ulcerative colitis (UC) patients between the ages of 25 and 65 and 36.36% in non-Hispanic black (NHB) Crohn's disease (CD) patients. During the pandemic, deaths at home or on arrival and at medical facilities as well as deaths due to neoplasms also increased. CONCLUSION: IBD patients suffered excess non-COVID-19-related death during the pandemic. Excess death was associated with younger age among UC patients, and with NHB race among CD patients. Increased death at home or on arrival and due to neoplasms suggests that delayed presentation and difficulty accessing healthcare may have led to increased IBD mortality.

Reduced fecal short-chain fatty acids in hispanic children with ulcerative colitis.

BACKGROUND: It is known that patients with ulcerative colitis (UC) have reduced numbers of short-chain fatty acid (SCFA) producing bacteria and reduced SCFA concentration in feces. There is also evidence that Hispanic patients have increased incidence of UC and increased likelihood of developing disease at a younger age. To understand why this might be, we compared fiber intake and fecal SCFA concentrations in Hispanic children with UC and non-Hispanic children with UC. METHODS: In this cross-sectional study conducted at the Children's Hospital of Los Angeles, stool was collected from 22 Hispanic and 31 non-Hispanic children with UC. SCFAs in the stool were quantified using mass spectrometry. Diet information was collected at the time of stool collection using food frequency questionnaires. RESULTS: Acetic acid, butyric acid, isovaleric acid, and propionic acid concentrations are significantly lower in Hispanic children with UC compared to age, gender, and disease activity matched non-Hispanic children with UC (p < 0.001). Butyric acid showed the most significant decrease (p = 1.6e-7) There was no significant difference in fiber intake between Hispanic and non-Hispanic children with UC. CONCLUSION: To our knowledge, this is the first study to find that Hispanic children with UC had further reduced SCFAs, independent of disease activity and fiber intake. It is possible that the reduction in SCFAs is related to the colonic disease in Hispanic patients with UC. This may provide more evidence to support the use of SCFA targeted therapies for UC.

Decreased secondary faecal bile acids in children with ulcerative colitis and Clostridioides difficile infection.

BACKGROUND: Patients with ulcerative colitis (UC) have an increased risk of Clostridioides difficile infection (CDI). There is a well-documented relationship between bile acids and CDI. AIMS: To evaluate faecal bile acid profiles and gut microbial changes associated with CDI in children with UC. METHODS: This study was conducted at Children's Hospital Los Angeles. Faecal bile acids and gut microbial genes related to bile acid metabolism were measured in 29 healthy children, 23 children with mild to moderate UC without prior CDI (UC group), 16 children with mild to moderate UC with prior CDI (UC+CDI group) and 10 children without UC with prior CDI (CDI group). RESULTS: Secondary faecal bile acids, especially lithocholic acid (3.296 vs 10.793, P ≤ 0.001) and ursodeoxycholic acid (7.414 vs 10.617, P ≤ 0.0001), were significantly lower in children with UC+CDI when compared to UC alone. Secondary faecal bile acids can predict disease status between these groups with 84.6% accuracy. Additionally, gut microbial genes coding for bile salt hydrolase, 7α-hydroxysteroid dehydrogenase and 7α/ß-dehydroxylation were all diminished in children with UC+CDI compared to children with UC alone. CONCLUSIONS: Bile acids can distinguish between children with UC based on their prior CDI status. Bile acid profile changes can be explained by gut microbial genes encoding for bile salt hydrolase, 7α-hydroxysteroid dehydrogenase and 7α/ß-dehydroxylation. Bile acid profiles may be helpful as biomarkers to identify UC children who have had CDI and may serve as future therapeutic targets.

Chronic diarrhea.

Chronic diarrhea is a complex and common problem faced by primary care clinicians. Its causes can range from the common and relatively benign excessive juice consumption to the more alarming inflammatory bowel disease (IBD). This paper will review the definition and etiology of chronic diarrhea and aims to provide a simple approach to its diagnosis and management including when, if appropriate, to refer to GI specialist.