Fecal Transplant Failure, Hypertension and Liver Cancer Risk, and Finding IBD in Patients with Arthritic Disorders

Topics receiving news coverage at the American College of Gastroenterology Annual Scientific Meeting last week included factors associated with failure of fecal transplantation for Clostridium difficile infection (CDI), the effects of diabetes and hypertension on liver cancer risk, and a better approach to diagnosis of Crohn’s disease in patients with spondylarthropathies.

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-Being an inpatient while receiving a fecal transplant, immunosuppression, and a previous record of hospitalization from CDI-related events can all contribute to failure of fecal transplantation for CDI, reported Monika Fischer (Indiana University).

Her group collected data from 345 patients with CDI who received fecal transplants from 2011 through 2015 at 2 tertiary referral centers. They found that 23.7% of single fecal matter transplants had failed after a 3 month follow-up period (no complete resolution of CDI symptoms or a positive result from a PCR test for C difficile). The procedure failed for 18% of patients with non-severe CDI but for 50% of severe cases. With each additional hospitalization for CDI, the odds of failure increased by 45%, Fischer reported.

Based on the results, the authors devised a risk stratification system to identify patients most at risk. “We hope that physicians will find the proposed risk stratification helpful in planning and discussing fecal matter transplants with their patients, and also with regard to preparedness in treating high risk patients,” Fischer told MedPage Today.

-Diabetes and hypertension are both independent risk factors for hepatocellular carcinoma (HCC), even in the absence of cirrhosis or the common causes of cirrhosis, reported Allison Kasmari (Penn State Hershey Medical Center).

There is evidence that diabetes increases the risk for HCC, so Kasmari et al investigated whether other components of the metabolic syndrome, such as hypertension and hyperlipidemia, increase risk.

In an analysis of 7473 patients diagnosed with hepatocellular carcinoma from 2008 to 2012 (identified from the MarketScan insurance claims database) and 22,110- age- and sex- matched controls, they associated diabetes with the development of hepatocellular carcinoma (odds ratio [OR], 1.353). Other factors associated with HCC included hypertension (OR, 1.229) and hepatitis C (OR, 2.102).

In contrast, hyperlipidemia appeared to reduce risk for HCC (OR, 0.885).

There was a significant association between some diabetes medications, such as insulin, and an increased risk for HCC (OR, 1.640). But other diabetes medications, such as metformin, significantly reduced risk (OR, 0.706).

In sub-analyses, Kasmari et al found a 4-fold increase in the risk for HCC in patients with the combination of diabetes, hypertension, and hepatitis C (OR, 4.580). The risk was also increased in patients with just diabetes and hypertension (OR, 3.399).

According to MedPage TodayKasmari acknowledged that the patient population was relatively young (16–64 years old), and that data were collected from insurance claims, which could have led to underestimates of some conditions.

In addition, the team was unable to look at obesity as a variable, which is not commonly coded as a diagnosis.

Video capsule endoscopy is superior to ileocolonoscopy in detecting Crohn’s disease in patients with spondyloarthritis, reported Ernest G. Seidman (McGill University).

Seidman et al found that among 64 patients with spondyloarthropathy, significant inflammation of the bowel was detected in 45% by video capsule endoscopy, compared with only 14% using ileocolonoscopy.

Textbooks state that 5%–10% of patients with ankylosing spondylitis also have inflammatory bowel diseases, but Seidman and colleagues believed this to be an underestimate.

Seidman said that video capsule endoscopy is a superior diagnostic tool for detection of small bowel mucosal pathology, and therefore compared its accuracy, vs that of ileocolonoscopy, in finding small bowel lesions in patients with spondyloarthritis, with or without gastrointestinal symptoms.

MedPage Today explained that the patients were placed on a liquid diet and the capsule endoscopy was performed the next day, prior to the colonoscopy. Capsule results were assessed blindly using Lewis scores.

Among the 64 patients who have completed the study, 58% had symptoms and all but 3 were HLA-B27 positive. Four cases had been treated with the anti-tumor necrosis factor agent etanercept.

Seidman et al also found that the fecal calprotectin test identified patients with Crohn’s disease with 74% sensitivity and 87% specificity.

Seidman said that in the hands of a rheumatologist who’s interested in assessing a patient for Crohn’s disease, the fecal calprotectin test would provide a good screen, provided the patient is not on non-steroidal anti-inflammatory drugs, which interfere with the results.

 

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