Latest news with #ClinicalGastroenterology
Medscape
11-07-2025
- Health
- Medscape
Good News for Tofacitinib in Recent Study of Acute Severe UC
A head-to-head comparison of the JAK inhibitor drug tofacitinib and chimeric monoclonal antibody infliximab in the treatment of acute severe ulcerative colitis (ASUC) shows that, contrary to concerns, tofacitinib is not associated with worse postoperative complications and in fact may reduce the risk of the need for colectomy. 'Tofacitinib has shown efficacy in managing ASUC, but concerns about postoperative complications have limited its adoption,' reported the authors in research published in Clinical Gastroenterology and Hepatology. 'This study shows that tofacitinib is safe and doesn't impair wound healing or lead to more infections if the patient needs an urgent colectomy, which is unfortunately common in this population,' senior author Jeffrey A. Berinstein, MD, of the Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, told Medscape Medical News. Recent treatment advances for UC have provided significant benefits in reducing the severity of symptoms; however, about a quarter of patients go on to experience flares, with fecal urgency, rectal bleeding, and severe abdominal pain of ASUC potentially requiring hospitalization. The standard of care for those patients is rapid induction with intravenous (IV) corticosteroids; however, up to 30% of patients don't respond to those interventions, and even with subsequent treatment of cyclosporine and infliximab helping to reduce the risk for an urgent colectomy, patients often don't respond, and ultimately, up to a third of patients with ASUC end up having to receive a colectomy. While JAK inhibitor therapies, including tofacitinib and upadacitinib, have recently emerged as potentially important treatment options in such cases, showing reductions in the risk for colectomy, concerns about the drugs' downstream biologic effects have given many clinicians reservations about their use. 'Anecdotally, gastroenterologists and surgeons have expressed concern about JAK inhibitors leading to poor wound healing, as well as increasing both intraoperative and postoperative complications, despite limited data to support these claims,' the authors wrote. To better understand those possible risks, first author Charlotte Larson, MD, of the Department of Internal Medicine, Michigan Medicine, and colleagues conducted a multicenter, retrospective, case-control study of 109 patients hospitalized with ASUC at two centers in the US and 14 in France. Of the patients, 41 were treated with tofacitinib and 68 with infliximab prior to colectomy. Among patients treated with tofacitinib, five (12.2%) received infliximab and four (9.8%) received cyclosporine rescue immediately prior to receiving tofacitinib during the index admission. In the infliximab group, one (1.5%) received rescue cyclosporine. In a univariate analysis, the tofacitinib-treated patients showed significantly lower overall rates of postoperative complications than infliximab-treated patients (31.7% vs 64.7%; odds ratio [OR], 0.33; P = .006). The tofacitinib-treated group also had lower rates of serious postoperative complications (12% vs 28.9; OR, 0.20; P = .016). After adjusting for multivariate factors including age, inflammatory burden, nutrition status, 90-day cumulative corticosteroid exposure and open surgery, there was a trend favoring tofacitinib but no statistically significant difference between the two treatments in terms of serious postoperative complications ( P = .061). However, a significantly lower rate of overall postoperative complications with tofacitinib was observed after the adjustment (odds ratio, 0.38; P = .023). Importantly, a subanalysis showed that the 63.4% of tofacitinib-treated patients receiving the standard FDA-approved induction dose of 10 mg twice daily did indeed have significantly lower rates than infliximab-treated patients in terms of serious postoperative complications (OR, .10; P = .031), as well as overall postoperative complications (OR, 0.23; P = .003), whereas neither of the outcomes were significantly improved among the 36.6% of patients who received the higher-intensity thrice-daily tofacitinib dose ( P = .3 and P = .4, respectively). Further complicating the matter, in a previous case-control study that the research team conducted, it was the off-label, 10 mg thrice-daily dose of tofacitinib that performed favorably and was associated with a significantly lower risk for colectomy than the twice-daily dose (hazard ratio 0.28; P = .018); the twice-daily dose was not protective. Berinstein added that a hypothesis for the benefits overall, with either dose, is that tofacitinib's anti-inflammatory properties are key. 'We believe that lowering inflammation as much as possible, with the colon less inflamed, could be providing the benefit in lowering complications rate in surgery,' he explained. Regarding the dosing, 'it's a careful trade-off,' Berinstein added. 'Obviously, we want to avoid the need for a colectomy in the first place, as it is a life-changing surgery, but we don't want to increase the risk of infections.' In other findings, the tofacitinib group had no increased risk for postoperative venous thrombotic embolisms (VTEs), which is important as tofacitinib exposure has previously been associated with an increased risk for VTEs independent of other prothrombotic factors common to patients with ASUC, including decreased ambulation, active inflammation, corticosteroid use, and major colorectal surgery. 'This observed absence of an increased VTE risk may alleviate some of the hypothetical postoperative safety concern attributed to JAK inhibitor therapy in this high-risk population,' the authors wrote. Overall, the results underscore that 'providers should feel comfortable using this medication if they need it and if they think it's most likely to help their patients avoid colectomy,' Berinstein said. 'They should not give pause over concerns of postoperative complications because we didn't show that,' he said. Commenting on the study, Joseph D. Feuerstein, MD, of the Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, noted that, in general, in patients with ASUC who fail on IV steroids, 'the main treatments are infliximab, cyclosporine, or a JAK inhibitor like tofacitinib or upadacitinib, [and] knowing that if someone needs surgery, the complication rates are similar and that pre-operative use is okay is reassuring.' Regarding the protective effect observed with some circumstances, 'I don't put too much weight into that,' he noted. '[One] could speculate that it is somehow related to faster half-life of the drug, and it might not sit around as long,' he said. Feuerstein added that 'the study design being retrospective is a limitation, but this is the best data we have to date.'
CNET
23-06-2025
- Health
- CNET
Is Your Bloating Normal or Something More Serious? Here's How to Tell
Bloating is an all-too-common issue, and it can occur for a variety of reasons, some of which may be avoidable. You can get bloated from overeating or even stress. Abdominal bloating can often be normal and not a cause for concern, but it can sometimes be a sign of other issues. You should watch out for these signs, just in case. A lot of people suffer from bloating. A study by the Clinical Gastroenterology and Hepatology Journal found that of nearly 89,000 survey respondents, almost 14% reported bloating within the past seven days. One notable finding from the study was that women and people who usually have abnormal issues were most likely to report bloating. If having a flatter stomach all the time is your primary reason for worrying about bloating, you might be chasing an unrealistic goal, despite what you've heard from those TikTok "gurus." However, if your bloating arrives with other digestive symptoms, it could be hinting at an underlying issue. No two people function the same way, but bloating throughout the day or month is routine for many of us. I, for example, tend to get a visible food baby by the end of the day. For a good while, I felt ashamed of that post-meal bloat and found myself sucking in my stomach, hiding it or avoiding the mirror altogether. But dietitians and wellness influencers have done some good work to normalize bloating, which has helped me learn to shake off the shame, tune into my own body and learn what's "normal" for me. I spoke with a registered dietitian nutritionist and a family doctor to find out the truth about bloating and when you should be concerned. Here's what you need to know. What is bloating? Kitsada Wetchasart/EyeEm/Getty Images Bloating refers to a swollen, tight or full feeling in the abdomen. In everyday usage, "bloating" is used to describe a wide range of causes for a larger-than-usual belly. Gaby Vaca-Flores, registered dietitian nutritionist and founder of Glow+Greens, says that "bloating, in most cases, is perfectly normal." As your food is digested into smaller pieces, some types of foods ferment and release gas, she explains: "Under normal circumstances, 'food babies' are simply made up of intestinal gas." As the digestion process continues, the bloating goes down. "After eating a meal we all get a degree of bloating," explains Dr. David Beatty, who's worked as a general practitioner for over 30 years in England. Because of the way your bones and muscles are shaped, the front and sides of the belly are most likely to stretch and distend to make room for the extra volume after you eat or drink, Beatty says. But if bloating is so common, why does it have such a negative connotation? "Bloating can change the size and shape of your stomach," Vaca-Flores says. "I think this temporary change in appearance can be upsetting since we often see healthy people depicted as having a flat-looking stomach. The good news is that bloating happens to everyone and it's perfectly normal for our body's appearance to fluctuate throughout the day." What causes bloating? CatherineMany people assume that bloating must be caused by some sort of health issue, but in most cases, it's just part of digestion, Vaca-Flores says. Still, why do some people bloat more than others, and why do you only bloat at certain times? Common causes of bloating include: Eating or chewing quickly Eating a large meal Bubbly drinks Not enough water or fiber Hormonal changes (e.g. your menstrual cycle) Stress Some medications However, bloating is one symptom of certain health issues. It's important to know the difference between normal, everyday bloating and the type of bloating that may be associated with a health condition so that you can get the right treatment. Normal vs. abnormalLike with other unrealistic beauty standards, people on social media have worked to dismantle the idea that bloating is inherently bad by sharing photos of their stomachs before and after they eat, or during their periods. One content creator, @claraandherself on TikTok, has built a 1-million-strong follower base, thanks in large part to her viral "outfits before and after I eat" videos. "If I'm totally honest with you, I only have abs in the morning," an Instagram influencer, @stephelswood, wrote in a post in 2017. "It's natural. Don't punish yourself for it." One common refrain on social media is that the difference between normal and abnormal bloating is pain — if it doesn't hurt, it's nothing to worry about. But the truth isn't quite that simple, Vaca-Flores says, because pain is a subjective experience. "Some people might describe the abdominal pressure from normal bloating as painful whereas others might say it's uncomfortable," she says. "Similarly, people with underlying health conditions may experience bloating that is constant, but not painful." A better way to identify abnormal bloating is by looking for other accompanying symptoms. This type of bloating usually occurs alongside at least one other symptom, like nausea, diarrhea or constipation, Vaca-Flores explains. Also, keep track of when and how often you experience bloat. "People with digestion-related health conditions are likely to experience bloating at most meals," she says. Some health conditions that may contribute to bloating include: Irritable bowel syndrome Inflammatory bowel disease Gastroesophageal reflux disease, also known as GERD Celiac disease Other food sensitivities or intolerances Constipation Dr. Beatty emphasizes that more serious health conditions can also result in a bloated abdominal area, including ovarian cysts, uterine fibroids and swelling of the liver, spleen, kidneys or lymph glands. If you experience continuous bloating that doesn't come and go, it's important to see a doctor. "This is more likely to be due to one of the more serious causes," Dr. Beatty says. Even if your bloating is caused by a health condition, that's no reason to beat yourself up about what it looks like, any more than you would beat yourself up about getting a headache. Bellies simply change shape, and that's OK. How to prevent bloatingRegardless of how you feel about your bloat, you should never avoid eating just to avoid bloating. Instead, try these management techniques for prevention, courtesy of Dr. Beatty. Eat with your mouth closed Increase physical activity to help speed up digestion Avoid drinking fizzy drinks and chewing gum Eat the most gas-producing foods, like beans, lentils and cruciferous vegetables, in moderation Try probiotics in moderation Eat more frequent, smaller meals and snacks Manage your stress levels How to get rid of"Usually, normal bloating can be relieved with common remedies like taking digestive enzymes, drinking warm beverages and walking," Vaca-Flores says. "Nevertheless, passing gas and having a bowel movement should help bloating go away within a few hours." If these remedies aren't working for you, a healthcare provider can assist you with finding a more effective and reliable solution. Be wary of using over-the-counter "detox" supplements to address bloating -- many of these products have a laxative effect and are potentially dangerous to use over time.
