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Crohn Disease: HELP
Articles by Keith S. Sultan
Based on 12 articles published since 2010
(Why 12 articles?)
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Between 2010 and 2020, Keith Sultan wrote the following 12 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Review Combination therapy for inflammatory bowel disease. 2017

Sultan, Keith S / Berkowitz, Joshua C / Khan, Sundas. ·Keith S Sultan, Department of Medicine, Division of Gastroenterology, Hofstra Northwell School of Medicine, Manhasset, NY 11030, United States. ·World J Gastrointest Pharmacol Ther · Pubmed #28533919.

ABSTRACT: Biologic therapies such as infliximab and adalimumab have become mainstays of treatment for inflammatory bowel disease. Early studies suggested that combination therapy (CT) with infliximab and an immunomodulator drug such as azathioprine may help optimize biologic pharmacokinetics, minimize immunogenicity, and improve outcomes. The landmark SONIC trial in Crohn's disease and the UC SUCCESS trial in ulcerative colitis demonstrated CT with infliximab and azathioprine to be superior to monotherapy with either agent alone at inducing clinical remission in treatment naïve patients with moderate to severe disease. However, many unanswered questions linger. The role of CT in non-naive patients as well as the optimal duration of CT remains unknown. The effectiveness of CT with alternate biologics and/or alternate immunomodulators is not as clear, and it is unknown whether SONIC's conclusions can be extrapolated beyond infliximab and azathioprine. Also looming are the risks of CT including opportunistic infection and malignancy; specifically, lymphoma. This review lays out the evidence as it pertains to the risks and benefits of CT as well as the areas that require further research. With this information in hand, the practitioner may develop a treatment strategy that best suits each individual patient.

2 Review Hepatic manifestations of non-steroidal inflammatory bowel disease therapy. 2015

Hirten, Robert / Sultan, Keith / Thomas, Ashby / Bernstein, David E. ·Robert Hirten, Keith Sultan, Ashby Thomas, David E Bernstein, Division of Gastroenterology, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY 11030, United States. ·World J Hepatol · Pubmed #26644815.

ABSTRACT: Inflammatory bowel disease (IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.

3 Review Smoking and early infliximab response in Crohn’s disease: a meta-analysis. 2015

Inamdar, Sumant / Volfson, Ariy / Rosen, Lisa / Sunday, Suzanne / Katz, Seymour / Sultan, Keith. · ·J Crohns Colitis · Pubmed #25518060.

ABSTRACT: BACKGROUND: Infliximab is used to treat moderate to severe Crohn’s disease (CD), but its efficacy varies. Although cigarette smoking worsens CD, its impact on the infliximab response is unknown. We conducted a systematic review and meta-analysis of clinical trials to determine the effect of smoking on the induction response to infliximab. METHODS: A systematic search was performed of MEDLINE, EMBASE, CINAHL, the Cochrane central register of controlled trials, the Cochrane IBD Group Specialized Trials Register for publications, and abstracts from major conferences from January 1996 to December 2010. Random effects meta-analysis using the Mantel–Haenszel method was conducted. Heterogeneity across studies was assessed using the Q statistic, the I2 statistic, and τ2. RESULTS: We identified 12 articles; four were excluded due to use of non-validated scoring systems.The remaining eight included a total of 1658 patients, with 649 active smokers. Luminal response was assessed by the Crohn’s Disease Activity Index in four studies (three of which included fistula response) and the Harvey–Bradshaw index in two (both including fistula response), and two studies examined only the fistula response. The relative risk for response to infliximab among smokers was 0.99 (95% CI 0.88–1.11) (τ2 = 0.0143). Analyses of the five studies examining both inflammatory and fistulizing CD were similar to the analysis of all eight studies. The pooled relative risk was 0.92 (95% CI 0.80–1.06) (τ2 = 0.0154). CONCLUSION: Though smoking worsens CD, this meta-analysis does not show a negative effect of smoking on initial response to infliximab. This must be viewed in the proper context, as long-term maintenance of response may yet be influenced by smoking status.

4 Article Increased Transfusion Requirements with Pharmacologic Thromboembolism Prophylaxis During Inflammatory Bowel Disease Exacerbation. 2019

Sultan, Keith / Shah, Dev / Bhorania, Kush / Zhou, Elinor / Khan, Sundas / Kohn, Nina / Qiu, Michael / Spyropoulos, Alex. ·Division of Gastroenterology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 600 Northern Blvd Suite 111, Great Neck, NY, 11021, USA. ksultan@northwell.edu. · Department of Medicine, North Shore University Hospital, Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA. · Johns Hopkins School of Medicine, Baltimore, MD, USA. · The Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA. · The Merinoff Center for Patient-Oriented Research, The Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA. · Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA. · Deptartment of Medicine, Northwell Health, 600 Community Drive, Manhasset, NY, 11030, USA. · Department of Medicine, Northwell Health Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 100 E 77th St, New York, NY, 10075, USA. ·Dig Dis Sci · Pubmed #31065899.

ABSTRACT: BACKGROUND: Inflammatory bowel disease (IBD) exacerbation requiring hospitalization increases the risk of venous thromboembolism (VTE), and current guidelines recommend pharmacologic VTE prophylaxis (PVTEP). AIMS: Bleeding risks with PVTEP in this population are poorly defined, and no study has investigated packed red blood cell (PRBC) transfusion requirements in this population. METHODS: We conducted a chart review of all adult hospitalizations for IBD exacerbation within the Northwell Healthcare system. Patient characteristics recorded included demographics, disease type ulcerative colitis or Crohn's disease, severe disease defined by inpatient corticosteroid or biologic use, and admission hemoglobin. Inpatient use of PVTEP and anti-platelet therapies were identified. The primary outcome was the occurrence of any packed red blood cell (PRBC) transfusion. RESULTS: In total, 717 patients met inclusion criteria, accounting for 891 admissions. PVTEP was used during 60.4% of admissions, and 11.1% of patient admissions included a transfusion event. Severe disease patients receiving PVTEP had an 18.6% transfusion risk, versus 11.1% for those not receiving PVTEP, OR 1.82, CI (1.04-3.17). One multivariable analysis transfusion was associated with PVTEP, OR 2.11, 95% CI 1.18, 3.77, p = 0.0120, disease severity OR 3.17, 95% CI 1.81,5.54, p < 0.0001, anti-platelet therapies OR 2.46, 95% CI 1.23-4.90, p = 0.0107, bowel resection OR 3.88, 95% CI 1.97,7.63, p < 0.0001 and decreased admission hemoglobin OR 2.01, 95% CI 1.73-2.32, p < 0.0001, but not disease type ulcerative colitis OR 0.71, 95% CI 0.42-1.20. CONCLUSION: PVTEP during IBD exacerbation is associated with increased PRBC transfusions. Our findings do not constitute a contraindication to PVTEP, but may be incorporated into patient counseling during inpatient IBD management.

5 Article Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn's Disease. 2018

Dulai, Parambir S / Boland, Brigid S / Singh, Siddharth / Chaudrey, Khadija / Koliani-Pace, Jenna L / Kochhar, Gursimran / Parikh, Malav P / Shmidt, Eugenia / Hartke, Justin / Chilukuri, Prianka / Meserve, Joseph / Whitehead, Diana / Hirten, Robert / Winters, Adam C / Katta, Leah G / Peerani, Farhad / Narula, Neeraj / Sultan, Keith / Swaminath, Arun / Bohm, Matthew / Lukin, Dana / Hudesman, David / Chang, John T / Rivera-Nieves, Jesus / Jairath, Vipul / Zou, G Y / Feagan, Brian G / Shen, Bo / Siegel, Corey A / Loftus, Edward V / Kane, Sunanda / Sands, Bruce E / Colombel, Jean-Frederic / Sandborn, William J / Lasch, Karen / Cao, Charlie. ·University of California-San Diego, La Jolla, California. Electronic address: pdulai@ucsd.edu. · University of California-San Diego, La Jolla, California. · Mayo Clinic, Rochester, Minnesota. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · Cleveland Clinic Foundation, Cleveland, Ohio. · Icahn School of Medicine at Mount Sinai, New York, New York. · Indiana University, Indianapolis, Indiana. · North Shore University Hospital, Manhasset, New York. · Icahn School of Medicine at Mount Sinai, New York, New York; University of Alberta, Edmonton, Alberta, Canada. · Icahn School of Medicine at Mount Sinai, New York, New York; McMaster University Medical Centre, Hamilton, Ontario, Canada. · Lenox Hill Hospital, New York, New York. · Montefiore Medical Center, New York, New York. · New York University (NYU), New York, New York. · University of Western Ontario, London, Ontario, Canada. · Takeda Pharmaceuticals USA Inc., Deerfield, Illinois. ·Gastroenterology · Pubmed #29857091.

ABSTRACT: BACKGROUND & AIMS: As more treatment options for inflammatory bowel diseases become available, it is important to identify patients most likely to respond to different therapies. We created and validated a scoring system to identify patients with Crohn's disease (CD) who respond to vedolizumab. METHODS: We collected data from the GEMINI 2 phase 3 trial of patients with active CD treated with vedolizumab for 26 weeks (n = 814) and performed logistic regression analysis to identify factors associated with clinical, steroid-free, and durable remission (derivation set). We used these data to develop a clinical decision support tool, which we validated using data from 366 participants in a separate clinical practice observational cohort of patients with active CD treated with vedolizumab for 26 weeks (the VICTORY cohort). We evaluated the ability of this tool to identify patients in clinical remission or corticosteroid-free remission, or those with mucosal healing (MH), clinical remission with MH, or corticosteroid-free remission with MH after vedolizumab therapy using receiver operating characteristic area under the curve (AUC) analyses. The primary outcome was to develop and validate a list of factors associated with achieving remission by vedolizumab in patients with active CD. RESULTS: In the derivation analysis, we identified absence of previous treatment with a tumor necrosis factor antagonist (+3 points), absence of prior bowel surgery (+2 points), absence of prior fistulizing disease (+2 points), baseline level of albumin (+0.4 points per g/L), and baseline concentration of C-reactive protein (reduction of 0.5 points for values between 3.0 and 10.0 mg/L and 3.0 points for values >10.0 mg/L) as factors associated with remission. In the validation set, our model identified patients in clinical remission with an AUC of 0.67, patients in corticosteroid-free remission with an AUC of 0.66, patients with MH with an AUC of 0.72, patients in clinical remission with MH with an AUC of 0.73, and patients in corticosteroid-free clinical remission with MH with an AUC of 0.75. A cutoff value of 13 points identified patients in clinical remission after vedolizumab therapy with 92% sensitivity, patients in corticosteroid-free remission with 94% sensitivity, patients with MH with 98% sensitivity, patients with clinical remission and MH with 100% sensitivity, and patients with corticosteroid-free clinical remission with MH with 100% sensitivity. CONCLUSIONS: We developed and validated a scoring system to identify patients with CD most likely to respond to 26 weeks of vedolizumab therapy. Further studies are needed to optimize its accuracy in select populations and determine its cost-effectiveness.

6 Article Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease. 2018

Shmidt, Eugenia / Kochhar, Gursimran / Hartke, Justin / Chilukuri, Prianka / Meserve, Joseph / Chaudrey, Khadija / Koliani-Pace, Jenna L / Hirten, Robert / Faleck, David / Barocas, Morris / Luo, Michelle / Lasch, Karen / Boland, Brigid S / Singh, Siddharth / Vande Casteele, Niels / Sagi, Sashidhar Varma / Fischer, Monika / Chang, Shannon / Bohm, Matthew / Lukin, Dana / Sultan, Keith / Swaminath, Arun / Hudesman, David / Gupta, Nitin / Kane, Sunanda / Loftus, Edward V / Sandborn, William J / Siegel, Corey A / Sands, Bruce E / Colombel, Jean-Frederic / Shen, Bo / Dulai, Parambir S. ·Icahn School of Medicine at Mount Sinai, New York, NY, USA. · University of Minnesota, Minneapolis, MN, USA. · Cleveland Clinic Foundation, Cleveland, OH, USA. · Indiana University, Indianapolis, IN, USA. · University of California, San Diego, La Jolla, CA, USA. · Mayo Clinic, Rochester, MN, USA. · Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA. · New York University (NYU), New York, NY, USA. · Montefiore Medical Center, New York, NY, USA. · North Shore University Hospital, Manhasset, NY, USA. · Lenox Hill Hospital, New York, NY, USA. · University of Mississippi, Jackson, MS, USA. ·Inflamm Bowel Dis · Pubmed #29788240.

ABSTRACT: Background: We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. Methods: Retrospective review (May 2014-December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. Results: Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn's disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25-2.97] in all patients. For Crohn's disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01-1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. Conclusions: LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.

7 Article Declining use of combination infliximab and immunomodulator for inflammatory bowel disease in the community setting. 2018

Berkowitz, Joshua C / Stein-Fishbein, Joanna / Khan, Sundas / Furie, Richard / Sultan, Keith S. ·Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States. · Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States. · Department of Medicine, Division of Rheumatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States. · Department of Medicine, Division of Gastroenterology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States. ·World J Gastrointest Pharmacol Ther · Pubmed #29430323.

ABSTRACT: AIM: To describe trends of combination therapy (CT) of infliximab (IFX) and immunomodulator (IMM) for inflammatory bowel disease (IBD) in the community setting. METHODS: A retrospective study was conducted of all IBD patients referred for IFX infusion to our community infusion center between 04/01/01 and 12/31/14. CT was defined as use of IFX with either azathioprine, 6-mercaptopurine, or methotrexate. We analyzed trends of CT usage overall, for Crohn's disease (CD) and ulcerative colitis (UC), and for the subgroups of induction patients. We also analyzed the trends of CT use in these groups over the study period, and compared the rates of CT use prior to and after publication of the landmark SONIC trial. RESULTS: Of 258 IBD patients identified during the 12 year study period, 60 (23.3%) received CT, including 35 of 133 (26.3%) induction patients. Based on the Cochran-Armitage trend test, we observed decreasing CT use for IBD patients overall ( CONCLUSION: We observed a trend away from CT use in IBD. A disconnect appears to exist between expert opinion and evidence favoring CT with IFX and IMM, and evolving community practice.

8 Article Analysis of the clinical indications for opiate use in inflammatory bowel disease. 2017

Gao, Youran / Khan, Sundas / Akerman, Meredith / Sultan, Keith. ·Department of Gastroenterology and Hepatology, Hofstra Northwell School of Medicine, Manhasset, NY, USA. · Department of Internal Medicine, Northwell Health Systems, Hofstra Northwell School of Medicine, Manhasset, NY, USA. · Feinstein Institute for Medical Research Biostatistics Unit, Manhasset, NY, USA. ·Intest Res · Pubmed #28239317.

ABSTRACT: BACKGROUND/AIMS: Opiate use for inflammatory bowel disease (IBD), particularly high-dose (HD) use, is associated with increased mortality. It's assumed that opiate use is directly related to IBD-related complaints, although this hasn't been well defined. Our goal was to determine the indications for opiate use as a first step in developing strategies to prevent or decrease opiate use. METHODS: A retrospective cohort was formed of adults who were diagnosed with IBD and for whom outpatient evaluations from 2009 to 2014 were documented. Opiate use was defined if opiates were prescribed for a minimum of 30 days over a 365-day period. Individual chart notes were then reviewed to determine the clinical indication(s) for low-dose (LD) and HD opiate use. RESULTS: After a search of the electronic records of 1,109,277 patients, 3,226 patients with IBD were found. One hundred four patients were identified as opiate users, including 65 patients with Crohn's and 39 with ulcerative colitis; a total of 134 indications were available for these patients. IBD-related complaints accounted for 49.25% of the opiate indications, with abdominal pain (23.13%) being the most common. Overall, opiate use for IBD-related complaints (81.40% vs. 50.82%; CONCLUSIONS: Our findings show that most IBD patients using opiates, particularly HD users, used opiates for IBD-related complaints. Future research will need to determine the degree to which these complaints are related to disease activity and to formulate non-opiate pain management strategies for patients with both active and inactive IBD.

9 Article Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents. 2016

Axelrad, Jordan / Bernheim, Oren / Colombel, Jean-Frederic / Malerba, Stefano / Ananthakrishnan, Ashwin / Yajnik, Vijay / Hoffman, Gila / Agrawal, Manasi / Lukin, Dana / Desai, Amit / McEachern, Elisa / Bosworth, Brian / Scherl, Ellen / Reyes, Andre / Zaidi, Hina / Mudireddy, Prashant / DiCaprio, David / Sultan, Keith / Korelitz, Burton / Wang, Erwin / Williams, Renee / Chen, LeaAnn / Katz, Seymour / Itzkowitz, Steven / Anonymous5970838. ·Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, New York. · Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. · Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. · Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts. · Albert Einstein College of Medicine, New York, New York. · Department of Medicine, Montefiore Medical Center, New York, New York. · Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, New York, New York. · Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York. · Weill Cornell Medical College, New York, New York. · Department of Medicine, North Shore-Long Island Jewish University Hospital, Manhasset, New York. · Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York. · Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York. · Department of Medicine, North Shore- Long Island Jewish Lenox Hill Hospital, New York, New York. · Department of Medicine, NYU Langone Medical Center, New York, New York. · Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York. · Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: steven.itzkowitz@mountsinai.org. ·Clin Gastroenterol Hepatol · Pubmed #26247164.

ABSTRACT: BACKGROUND & AIMS: Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer. METHODS: We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test. RESULTS: During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22). CONCLUSION: On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.

10 Article Clinical markers of Crohn's disease severity and their association with opiate use. 2015

Cheung, Mary / Khan, Sundas / Akerman, Meredith / Hung, Chun Kit / Vennard, Kaitlyn / Hristis, Nicholas / Sultan, Keith. ·Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA. · Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA. · The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA. ·J Clin Med Res · Pubmed #25368699.

ABSTRACT: BACKGROUND: The safety of opiate use for patients with Crohn's disease (CD) has long been a concern. The recent Crohn's therapy, resource, evaluation, and assessment tool (TREAT) registry update has added to these concerns by demonstrating an association of opiate use with an increased risk of infection and death in CD. While the association is clear, the relationship of opiates to these negative outcomes is not. It is unknown whether opiates are a contributing factor to these negative outcomes or if their use is merely a marker of more severe disease. We hypothesized that opiate use is not harmful in CD but is a marker of disease severity and would be associated with commonly accepted clinical markers of severe CD such as early age at CD onset, disease duration, small intestinal involvement, a history of fistula or stricture, and lower quality of life (QOL) scores. METHODS: Data on CD history including pain medication usage were obtained from an interviewer directed survey of patients admitted to two tertiary care hospitals over a 2-year period. CD as the primary admitting diagnosis was not required. Active opiate use was defined by usage within the past month prior to admission. RESULTS: A total of 133 patients were approached to participate, of whom 108 consented to the survey, and 51 were active opiate users. Opiate using CD patients were more commonly smokers (22% vs. 3.45%, P < 0.010), had fistulas (40% vs. 22.4%, P < 0.048) and had a poorer quality of life score by short form inflammatory bowel disease questionnaire (mean 3.80 vs. 4.34, P < 0.036) than non-opiate users. No difference was found between opiate users and non-users for age of diagnosis, disease duration, or a history of strictures. CONCLUSIONS: The study findings demonstrate that opiate use in CD is associated with markers of disease severity including fistulas, smoking, and lower QOL scores. The findings suggest that opiates may not be directly harmful to patients with CD, but may merely be another marker of disease severity. However, given opiates unproven benefits for long term CD pain control and risk of dependence, caution should still be exercised in their use.

11 Article Prognosis of lymphoma in patients following treatment with 6-mercaptopurine/azathioprine for inflammatory bowel disease. 2012

Sultan, Keith / Korelitz, Burton I / Present, Daniel / Katz, Seymour / Sunday, Suzanne / Shapira, Iuliana. ·North Shore University Hospital, Manhasset, New York, USA. ·Inflamm Bowel Dis · Pubmed #22241664.

ABSTRACT: BACKGROUND: 6-Mercaptopurine (6-MP) and azathioprine (AZA) are effective for induction and maintenance therapy of Crohn's disease (CD) and ulcerative colitis (UC). There is an increased risk of lymphoma in patients with inflammatory bowel disease (IBD) treated with 6-MP/AZA. Little, however, is known about the prognosis of IBD patients treated with 6-MP/AZA who develop lymphoma. METHODS: We conducted a retrospective review of 8780 records from three tertiary IBD centers and the records of 600 lymphoma patients from an academic Hematology and Oncology Center. The primary endpoint variable was survival of IBD patients with a lymphoma diagnosis treated or not treated with 6-MP/AZA. A secondary endpoint was the relative survival rate (by gender, race, and ethnicity) extrapolated from the Surveillance Epidemiology and End Results (SEER) database, computed for each subject. RESULTS: Fourteen IBD patients were diagnosed with lymphoma. Twelve had CD and two had UC. Seven patients had treatment with 6-MP/AZA and seven had not. Two patients who received 6-MP/AZA died (both 1 year after diagnosis) and two patients who had not received 6-MP/AZA died (one after 2 years, another 3 years after diagnosis), all from lymphoma. Survival at last follow-up was similar to expected survival based on extrapolated SEER data for both 6-MP/AZA treated and untreated patients. CONCLUSIONS: We found no differences of survival with lymphoma between IBD patients and expected survival for the general population. Also, the prognosis for those IBD patients treated with 6-MP/AZA was not worse than lymphoma patients not treated with 6-MP/AZA. Statistical analysis, however, was limited by the small sample size and heterogeneity of the patients studied.

12 Minor The Uncertain Role of Immunomodulator Maintenance After Cessation of Anti-Tumor Necrosis Factor α Therapy. 2015

Sultan, Keith / Inamdar, Sumant / Hirten, Robert. ·Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York. ·Clin Gastroenterol Hepatol · Pubmed #25599656.

ABSTRACT: -- No abstract --