Browsing by Author "Hanson, John"

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    Clinical Decision Making in Inflammatory Bowel Disease Mimics: Practice Management from Inflammatory Bowel Disease LIVE
    (Oxford University Press, 2024-04-11) Fiske, Hannah W.; Ward, Christopher; Shah, Samir A.; Holubar, Stefan D.; Al-Bawardy, Badr; Barnes, Edward L.; Binion, David; Bohm, Matthew; Brand, Myron; Clarke, Kofi; Cohen, Benjamin L.; Cross, Raymond K.; Dueker, Jeffrey; Engels, Michael; Farraye, Francis A.; Fine, Sean; Forster, Erin; Gaidos, Jill; Ginsburg, Philip; Goyal, Alka; Hanson, John; Herfath, Hans; Hull, Tracy; Kelly, Colleen R.; Lazarev, Mark; Levy, L. Campbell; Melia, Joanna; Philpott, Jessica; Qazi, Taha; Siegel, Corey A.; Watson, Andrew; Wexner, Steven D.; Williams, Emmanuelle D.; Regueiro, Miguel; Medicine, School of Medicine
    Background: Since 2009, inflammatory bowel disease (IBD) specialists have utilized "IBD LIVE," a weekly live video conference with a global audience, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed IBD, a substantial number were diseases that mimic IBD. We have categorized all IBD LIVE cases and identified "IBD-mimics" with consequent clinical management implications. Methods: Cases have been recorded/archived since May 2018; we reviewed all 371 cases from May 2018-February 2023. IBD-mimics were analyzed/categorized according to their diagnostic and therapeutic workup. Results: Confirmed IBD cases made up 82.5% (306/371; 193 Crohn's disease, 107 ulcerative colitis, and 6 IBD-unclassified). Sixty-five (17.5%) cases were found to be mimics, most commonly medication-induced (n = 8) or vasculitis (n = 7). The evaluations that ultimately resulted in correct diagnosis included additional endoscopic biopsies (n = 13, 21%), surgical exploration/pathology (n = 10, 16.5%), biopsies from outside the GI tract (n = 10, 16.5%), genetic/laboratory testing (n = 8, 13%), extensive review of patient history (n = 8, 13%), imaging (n = 5, 8%), balloon enteroscopy (n = 5, 8%), and capsule endoscopy (n = 2, 3%). Twenty-five patients (25/65, 38%) were treated with biologics for presumed IBD, 5 of whom subsequently experienced adverse events requiring discontinuation of the biologic. Many patients were prescribed steroids, azathioprine, mercaptopurine, or methotrexate, and 3 were trialed on tofacitinib. Conclusions: The diverse presentation of IBD and IBD-mimics necessitates periodic consideration of the differential diagnosis, and reassessment of treatment in presumed IBD patients without appropriate clinical response. The substantial differences and often conflicting treatment approaches to IBD versus IBD-mimics directly impact the quality and cost of patient care.
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    A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn’s Disease
    (Science Direct, 2021-09-01) Lewis, James D.; Sandler, Robert; Brotherton, Carol; Brensinger, Colleen; Li, Hongzhe; Kappelman, Michael D.; Daniel, Scott G.; Bittinger, Kyle; Albenberg, Lindsey; Valentine, John F.; Hanson, John; Suskind, David; Meyer, Andrea; Compher, Charlene W.; Bewtra, Meenakshi; Saxena, Akriti; Dobes, Angela; Cohen, Benjamin; Flynn, Ann D.; Fischer, Monika; Saha, Sumona; Swaminath, Arun; Yacyshyn, Bruce; Scherl, Ellen; Horst, Sara; Curtis, Jeffrey R.; Braly, Kimberly; Nessel, Lisa; McCauley, Maureen; Herfarth, Hans; Medicine, School of Medicine
    Background & Aims This study compared the effectiveness of the Specific Carbohydrate Diet (SCD) to the Mediterranean Diet (MD) as treatment for Crohn’s disease (CD) with mild to moderate symptoms. Methods Adult patients with CD and with mild-moderate symptoms were randomly assigned 1:1 to consume the MD or SCD for 12 weeks. For the first 6-weeks, participants received prepared meals and snacks according to their assigned diet. After 6-weeks, participants were instructed to follow the diet independently. The primary outcome was symptomatic remission at week 6. Key secondary outcomes at week 6 included: fecal calprotectin (FC) response (FC <250 μg/g and reduction by >50% among those with baseline FC >250 μg/g) and C-Reactive Protein (CRP) response (high-sensitivity CRP (hsCRP) <5 mg/L and >50% reduction from baseline among those with hsCRP >5mg/L). Results 194 patients were randomized, and 191 were included in the efficacy analyses. The percentage of participants who achieved symptomatic remission at week 6 was not superior with SCD (SCD 46.5%, MD 43.5%; P = .77). FC response was achieved in 8/23 participants (34.8%) with SCD and 4/13 participants (30.8%) with MD (P = .83). CRP response was achieved in 2/37 participants (5.4%) with SCD and 1/28 participant (3.6%) with MD (P = .68). Conclusions SCD was not superior to MD to achieve symptomatic remission, FC response and CRP response. CRP response was uncommon. Given these results, the greater ease of following the MD, and other health benefits associated with MD, the MD may be preferred to the SCD for most patients with CD with mild to moderate symptoms.