Abstract Background The goal of this study was to investigate differences in the management and demographic characteristics of older-onset and younger-onset adult patients with Ulcerative Colitis (UC) and Crohn’s Disease (CD). Methods We retrospectively compared the management and distinguishing characteristics of UC and CD patients who were older-onset (≥60 years) and younger-onset (18-60 years) between June 1993 and October 2023. Results A total of 1245 patients with 56 (4.5%) older-onset adults (Male 41, 73%) and 1189 (95.5%) younger-onset adults (Male 725, 58%) were admitted to the study. The median follow-up time was 11 years (Older-onset 6 and younger-onset 11 years) for both groups. Prevalence of UC 39 (69.6%) in the older-onset group was more common than that of younger-onset group 579 (48.7%), (p=0.002). There were no significant differences between the two disease onset groups in terms of UC extension, CD location, behavior, and perianal involvement. In younger-onset, active smokers 277 (23%) was more frequent than older-onsets 6 (10%) (p= 0.003). A family history of IBD in older onsets 2 (4%) was less common than younger-onsets 155 (13%) (p= 0.037). Prior major abdominal surgery was detected similar (Older-onset 20, 35.7% and younger-onset 464, 39%). At least one extraintestinal manifestation exist was less common in older-onsets 18 (32.1%) than younger-onsets 606 (51%) (p= 0.006). Baseline partial MAYO score 7 and CDAI 302 in older-onsets, and 297 in younger-onsets were similar in both groups. Thiopurine usage 391 (32.9%) in younger-onsets was the most frequent than in older-onsets 9 (16.1%) (p=0.008). There was no difference in both groups in terms of other conventional medications. At least one biological experience was less common in older-onsets 15 (26.8%) than the younger-onsets group 586 (49.3%) (p=0.001). The two biological therapies that were used the most frequently were adalimumab (Older-onset; 6, 10.7% and younger-onset; 384, 32.8%) (p=0.001) and infliximab (Older-onset; 15, 26.8% and younger-onset; 586, 49.3%) (p=0.02). Conclusion Our study showed that the prevalence of UC in older-onsets was more common than younger-onsets. A family history, extraintestinal manifestation, thiopurine, and biological usage in older-onsets were less common than in younger-onsets. Major abdominal surgery was similar in both groups. Older-onset patients demonstrated significant differences in medication utilization, including less thiopurine and biological therapy compared with younger-onset groups, these utilization patterns may have long-term effects on disease outcomes. Further investigation is needed to optimize care pathways in the older-onset population.

Abstract Background The studies show that diagnostic delay, especially in Crohn’s disease (CD), is associated with a higher risk of complications and major surgery. We aimed to investigate timing of the diagnostic delay (DD) and its impact on the CD outcomes. Methods We retrospectively evaluated demographic and clinical features of CD patients between June 1993 and October 2023. Diagnostic delay was defined as the time interval from the onset of the first symptoms to the making of the CD diagnosis. The first CD related symptoms were evaluated by a review of the physician’s notes and medical record. Specific symptoms of CD included chronic or recurrent bloody or non-bloody diarrhea, and/or abdominal pain accompanied by noticeable weight loss, general weakness, and fever. Results 514 patients with CD were included in the study. The median age of disease onset was 34.14 years (16–84 years). Male sex was 299 (58.2%). DD was detected median 13 months (5-47) (14 months in male and 12 months in female). DD was 12 months for diseases with onsets before the age of 40 and 15 months for diseases with onsets after the age of 40. DD was 25 months in isolated ileal involvement, in terminal ileal involvement was 21.5 months, ileo-colonic involvement was 20 months, and colonic location was 10 months. Ileal involvement was found to have a longer duration for DD than colonic involvement. Compared to stenosing behavior (20 months) and penetrating behavior (17 months), DD was shorter in non-stenosing non-penetrating behavior (12 months). DD was longer in perianal disease (18 months) than in those without (12 months). Current smokers had a longer duration of the DD (20 months) compared to non-smokers (11.5 months) and ex-smokers (10 months). The duration of DD (18 months) was longer in CD patients with extraintestinal manifestations than in those without (12 months). Regarding the biological treatment, CD patients who experienced multiple biologics and resistance had longer DD (24 months) than those who experienced biologic monotherapy and responded (12 months). Compared to patients who had not had surgery (12 months), DD was longer in CD patients who had undergone surgery (15 months). Conclusion Our study showed that ileal involvement, stenosing-penetrating behavior, perianal disease, current smoking and existing extraintestinal manifestations were connected with DD. DD was also associated with multiple biologic needed and surgery. DD may have a role a significantly increased risk of bowel damage.

OBJECTIVE:Long-term comparison studies between infliximab (IFX) and adalimumab (ADA) with or without immunomodulator therapy are still needed in Crohn's disease (CD). In this study, we evaluated IFX and ADA for long-term clinical effectiveness and safety in CD patients who had not previously received a biologic treatment.PATIENTS AND METHODS:The data of adult CD patients were collected retrospectively between December 2007 and February 2021. We compared CD-related hospitalization, CD-related abdominal surgery, steroid use, and serious infections.RESULTS:Out of 224 CD patients, 101 started IFX first (median age: 38.12 years, 61.4% male), while 123 started ADA first (median age: 30.2 years, 64.2% male). The disease durations were 7.01 years and 6.91 years for IFX and ADA, respectively. There were no significant differences between the two groups with respect to age, gender, smoking, immunomodulator usage, and disease activity score at the onset of anti-TNF therapy (p>0.05). Overall, the median follow-up time was 2.36 and 1.86 years after starting anti-tumor necrosis factor-alpha (anti-TNF) therapy in the IFX and ADA groups, respectively. Steroid use (4.0% vs. 10.6%, p=0.109), hospitalization for CD (13.9% vs. 22.8%, p=0.127), abdominal surgery for CD (9.9% vs. 13.0%, p=0.608), and major infections (1.0% vs. 0.8%, p>0.999) did not differ significantly from one another. There were also no significant differences in the rates of these outcomes between concomitant immunomodulator therapy and monotherapy (p>0.05).CONCLUSIONS:In this study, we observed no significant differences in the long-term effectiveness and safety of IFX and ADA in biologic-naïve patients with CD.

Abstract Background The comparative efficacy and safety of infliximab (IFX) and adalimumab (ADA) have revealed variable results in biologic-naïve patients with ulcerative colitis (UC), and long-term comparison studies between IFX and ADA with or without immunomodulator therapy are still needed in patients with UC. Methods The aim of this study was to evaluate the long-term effectiveness and safety of IFX compared to ADA in biologic-naïve adult patients with UC. All data of patients between June 2007 and March 2021 were collected retrospectively. We compared UC-related hospitalisation, colectomy, steroid use, and serious infections leading to treatment cessation. Results Out of 86 UC patients, 41 started IFX first (mean age at onset: 34.4 years, 61.0% male) and 45 started ADA first (mean age at onset: 31.4 years, 60.0% male). Disease duration was 7.2 years for IFX and 8.1 years for ADA. There were no significant differences between the two groups with respect to age, gender, smoking, extraintestinal manifestations, immunomodulator usage, or disease extent at the onset of anti-TNF therapy (p > 0.05). Concomitant rates of medication including mesalazine, sulphapyridine, thiopurine, and steroids were the same in both groups (p > 0.05). In the IFX group, baseline haemoglobin (11.7 vs 13.2, p = 0.05) and albumin (3.8 vs 4.2, p = 0.02) levels were lower than those of the ADA group, while C-reactive protein was higher (14.0 vs 6.0, p = 0.04) than in the ADA group. Total MAYO score at baseline was similar in both groups (p = 0.10). During anti-TNF therapy, steroid use was significantly higher in the ADA group (44.4%) compared to IFX (14.6%, p = 0.003). The rates of UC-related hospitalisation (IFX 9.8% vs ADA 13.3%, p=0.74) and colectomy (IFX 4.9% vs ADA 2.2%, p = 0.60) were similar in IFX and ADA groups. Serious infection leading to treatment cessation was not different between the two groups (IFX 2.4% vs ADA 4.4%, p=0.54). These outcomes were similar in UC patients treated with IFX or ADA monotherapy or in combination with an immunomodulator within each group, and there was no significant difference between IFX and ADA in combination with an immunomodulator regarding those outcomes (p > 0.05). Conclusion In this study, steroid use in the ADA group was significantly higher than in the IFX group, although UC-related hospitalisation, colectomy, and serious infections were not different in biologic-naïve adult patients with UC. We also observed that outcomes were similar in patients treated with IFX and ADA monotherapy or in combination with an immunomodulator. In the present study, IFX revealed better long-term outcomes for first-time treatment of UC patients.

Aims PEP has been reported at a rate of 1-15% in different studies. The risk of PEP varies depending on the patient, operator and many factors related to the procedure. The effectiveness of pancreatic stenting and NSAIDs has been proven to prevent PEP from occurring. Treatments that reduce the sphincter of Oddi pressure—except nitroglycerin—are not thought to reduce the risk of PEP. Nifedipine, a calcium channel blocker, has been shown not to be beneficial in PEP. In our study, we investigated the contribution of amlodipine, a different class of calcium channel blocker, to the severity of PEP, length of hospital stay, and mortality.

Abstract Background Studies on the efficacy and safety of Infliximab (IFX) biosimilar CT-P13 and IFX originator are needed in Crohn’s disease (CD) and ulcerative colitis (UC). Methods The aim of this study was to evaluate the short and long-term clinical efficacy and safety of IFX biosimilar CT-P13 compared to IFX originator in adult patients with inflammatory bowel disease (IBD). Data were retrospectively collected. Therapeutic failure was defined as discontinuation of biological therapy because of primary lack of response (p-LOR), secondary loss of response (s-LOR, including steroid needed, IBD-related hospitalization, IBD-related surgery, and switch to other biotherapy) and serious adverse events (SAE). Results 252 patients who received IFX were identified between January 2007 and November 2021 (66 IFX biosimilar CT-P13 and 186 IFX originator). Data were analyzed for 188 CD (62.2% males; 34.6% biologics experienced; 27.7% IFX biosimilar CT-P13 / 72.3% IFX originator and 64 UC (59.4% males; 20.3% biologics experienced; 21.9% IFX biosimilar CT-P13 / 78.1% IFX originator). There were no significant differences between the two groups with respect to all demographic features at the beginning of the treatment (p>0.05). Median follow-up time was 1.58 years and 1.74 years after starting IFX in biosimilar CT-P13 and originator, respectively. There were no significant differences in the rates of p-LOR (4.5% vs. 5.4%, p>0.999) and SAE (6.1% vs. 15.6%, p=0.078) between IFX biosimilar CT-P13 and IFX originator, while the rate of s-LOR was significantly higher in IFX originator group (13.6% vs. %31.2, p=0.009). Considering all types of s-LOR, we did not detect significant differences between IFX biosimilar CT-P13 and IFX originator in the rates of IBD-related hospitalization (10.6% vs. 15.6%, p=0.430) and IBD-related surgery (7.6% vs. 12.4%, p=0.403). Nevertheless, the rates of steroid needed (0.0% vs. 6.5%, p=0.040), and switch to another biotherapy (4.5% vs. 19.4%, p=0.008) were significantly higher in IFX originator. There were also no significant differences in terms of these outcomes between concomitant immunomodulator therapy and monotherapy within IFX biosimilar CT-P13 and IFX originator (p>0.05). Conclusion In this study, outcomes did not reveal significant differences between IFX biosimilar CT-P13 and IFX originator in terms of the p-LOR and SAE. There was no difference between the two groups in the IBD-related hospitalization and IBD-related surgery, however the rates of steroid needed and switch to another biotherapy were significantly higher in the IFX originator within the s-LORs group. No difference was observed in terms of all outcomes between the two groups treated with monotherapy or concomitant immunomodulator therapy.

Background and study aim: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis.Patients and methods: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups.Results: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008).Conclusions: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

Abstract Background The comparative efficacy and safety of infliximab (IFX) and adalimumab (ADA) have shown variable results in biologic-naïve patients with Crohn’s disease (CD). Thus, long-term comparisons between IFX and ADA with or without immunomodulator therapies are still needed. The purpose of this study was to evaluate the long-term clinical effectiveness and safety profile of IFX compared to ADA in biologic-naïve patients with CD. Methods Data of all adult CD patients treated with IFX or ADA as their first biologic agent was collected retrospectively between December 2007 and February 2021. We compared CD-related hospitalization, CD-related major abdominal surgery, steroid use and serious infections leading to treatment cessation. Results Out of 224 biologic-naïve patients with CD, 101 started IFX first (median age at onset: 38.12 years, 61.4% male) and 123 started ADA first (median age at onset: 30.2 years, 64.2% male). Median disease duration was 6.94 years (IQR: 3.82–12.17) and 6.91 years (IQR: 3.94–10.95) for IFX and ADA, respectively, of whom 33% and 37.4% had active smokers, 10.9% and 13.4% had family history of inflammatory bowel disease (IBD) 22.8% and 19.5% had perianal disease, 43.6% and 43.9 had prior major abdominal surgery and 52.6% and 49.6% had extraintestinal manifestations. There were no significant differences between the two groups with respect to the age at onset of tumor necrosis factor antagonist, gender, smoking status, family history of IBD, perianal disease, prior major abdominal surgery, extraintestinal manifestations, prior immunomodulator (Thiopurine or Methotrexate) or steroid usage, all laboratory test results and Crohn’s Disease Activity Index (CDAI) score at baseline (p>0.05). Overall, the median follow-up time was 2.81 and 3.55 years after starting the first IFX and ADA group, respectively. There were no significant differences in the rate of steroid use (4% IFX vs. 10.6% ADA p=0.109), CD-related hospitalization (13.9% IFX vs. 22.8% ADA p=0.127), CD-related major abdominal surgery (9.9% IFX vs. 13% ADA p=0.608) and serious infections leading to treatment cessation (1% IFX vs 0.8% ADA p>0.999) between IFX and ADA. These outcomes were similar in patients treated with IFX or ADA monotherapy or in combination with an immunomodulator. Conclusion In this retrospective observational tertiary referral center study, we observed that there was no significant difference in long-term effectiveness and safety of infliximab and adalimumab in biologic-naïve patients with CD.