Judicious Use of Ozanimod for Ulcerative Colitis and Multiple Sclerosis.

Clinical trials have demonstrated the efficacy of ozanimod, an oral sphingosine-1-phosphate receptor modulator, for the treatment of moderate-to-severe ulcerative colitis. Infrequently does an opportunity present itself to use one drug for two simultaneous disease states, proving especially beneficial in the case of this patient intolerant of numerous established therapies for ulcerative colitis. This case report describes the successful use of ozanimod for both ulcerative colitis and multiple sclerosis, achieving clinical remission in both diseases.

Endoscopic ultrasound-directed transgastric ERCP (EDGE): a systematic review describing the outcomes, adverse events, and knowledge gaps.

BACKGROUND : Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) has emerged as a viable completely endoscopic method for performing pancreaticobiliary interventions in patients with Roux-en-Y gastric bypass anatomy. The aims of this systematic review were: (1) to describe the indications, outcomes, and complications of EDGE; and (2) to identify deficiencies in our knowledge of important technical approaches and clinical outcomes. METHODS : A systematic review was conducted via comprehensive searches of Medline, Scopus, CINAHL, and Cochrane to identify studies focusing on EDGE outcomes. Simple descriptive statistics were derived from case series only. Case reports were only included to qualitatively describe additional indications, techniques, and adverse events. RESULTS : The initial search identified 2143 abstracts. Nine case series and eight case reports were included. In the nine case series, 169 patients underwent EDGE. The technical success rate was 99 % (168 /169) for gastrogastrostomy/jejunogastrostomy creation and 98 % (166 /169) for subsequent ERCP. Minor adverse events specifically related to EDGE occurred in 18 % (31/169) and included intraprocedural stent migration/malposition (n = 27) and abdominal pain (n = 4). Moderate adverse events specific to EDGE occurred in 5 % (9/169): including bleeding (2 %), persistent fistula (1 %), and perforation (1 %). Severe adverse events occurred in one patient with a perforation requiring surgery. Deficiency in reporting on the clinical significance of adverse events was identified. CONCLUSION : Based on limited observational data, in expert hands, EDGE has a high rate of technical success and an acceptable rate of adverse events. As a novel procedure, many knowledge gaps need to be addressed to inform the design of meaningful comparative studies and guide informed consent.

COVID-19 Pandemic Increased Anxiety Among Patients with Inflammatory Bowel Disease: A Patient Survey in a Tertiary Referral Center.

BACKGROUND: COVID-19 is the first global pandemic in more than 100 years, and at its onset, the effects were largely unknown. Immunocompromised patients, including IBD, were presumed to have higher risk. AIMS: We hypothesized patients with IBD would have higher-than-baseline anxiety, high perceived vulnerability and significant lifestyle impacts as a result of the pandemic. We sought to assess the impact of these changes on disease and management. METHODS: A cross-sectional study of patients with Crohn's disease, ulcerative colitis and IBD-unspecified was conducted. Patients were invited to participate by email in an IRB-approved brief, voluntary survey. Survey questions focused on disease characteristics, healthcare access and self-reported psychological well-being. RESULTS: Responses from 492 (CD = 337, UC = 141,IC = 14) patients were included in the analysis. The majority of patients with IBD had increased anxiety since the pandemic, which correlated with an increase in GI symptoms. This risk of symptoms was mitigated by communication with their provider. Many patients had lifestyle changes including requesting time off work due to perceived vulnerability and changes in eating habits. CONCLUSIONS: Our findings support an increase in illness-associated anxiety and perceived vulnerability among patients with IBD during the COVID-19 pandemic. Open communication with providers is important to maintain adequate control of disease and reduce symptoms of flares triggered by ongoing stress.