Christian P Selinger

Leeds Teaching Hospitals NHS Trust · Leeds Gastroenterology Institute

Introduction: Inflammatory Bowel Disease (IBD) affects many women of child bearing age and rates of voluntary childlessness (VC) exceed those of the general population by far. The factors surrounding VC remain incompletely understood. Methods: Female members of the patient organisation Crohn's and Colitis UK aged 18-45 years were invited to comp...

Poor adherence frequently impaired the efficacy of therapy to maintain remission from inflammatory bowel diseases (IBD). There is a lack of practical and effective interventions to improve adherence. This study aimed to identify modifiable risk factors, which may yield targets for new interventions. Participants with IBD were recruited from hospita...

Introduction CDAD is the most common health care-acquired infection in the United Kingdom and causes significant morbidity and mortality. Previous studies have reported incidences of CDAD as high as 17%. Prevention of CDAD by Probiotics co-administration during antibiotic exposure is an appealing concept, but the few previously published trials sho...

Background: Enabling women with inflammatory bowel diseases (IBD) to have successful pregnancies requires complex decisions. The study aimed to assess patients' views on IBD and pregnancy and to evaluate any association with subject knowledge. Methods: General attitudes of females with IBD were assessed on fertility, medication use, delivery mode a...

Background Upadacitinib, a selective Janus Kinase inhibitor, is the newest advanced therapy in our armamentarium for the treatment of Crohn’s Disease (CD). It has been licensed for use in moderate-to-severely active CD. However, we have limited evidence of its effectiveness in a ‘real-world’ setting. Methods We undertook a retrospective cohort stu...

Background Tofacitinib, filgotinib, and upadacitinib are Janus Kinase inhibitors (JAKi) effective in inducing and maintaining remission in moderate-to-severe ulcerative colitis (UC). Limited data exists regarding outcomes in patients on a second JAKi after prior JAKi treatment failure. Here we describe the effectiveness of induction with a second J...

Maintenance of remission during pregnancy is vital for women with inflammatory bowel disease (IBD). The antenatal safety of novel small molecules for IBD is yet to be ascertained. We aimed to describe the current evidence on reproductive data regarding small-molecule drugs. We performed a systematic review searching Embase Classic + Embase and Ovid...

Background Opioid use is increasingly prevalent amongst patients with inflammatory bowel disease (IBD), but whether opioids have deleterious effects, or their use is merely linked with more severe disease, is unclear. We conducted a longitudinal follow-up study examining this issue. Methods Data on demographics, gastrointestinal and psychological...

Background Adherence to inflammatory bowel disease (IBD) medication is crucial to maintain remission, especially during pregnancy. Objective To examine the influence of family planning and pregnancy-related patient knowledge regarding IBD and pregnancy on adherence. Design Cross-sectional survey study Methods We surveyed female patients with IBD...

Background and aims: Despite intravenous (IV) vedolizumab being established for treatment of inflammatory bowel disease (IBD), the novel subcutaneous (SC) route of administration may provide numerous incentives to switch. However, large-scale real-world data regarding the long-term safety and effectiveness of this strategy are lacking. Methods:...

Background: Pregnant women with Inflammatory Bowel Disease (IBD) continue thiopurines to maintain remission. Other studies have reported intrahepatic cholestasis of pregnancy (ICP) in IBD pregnancies exposed to thiopurines. We aimed to investigate whether thiopurines are associated with an increased risk of ICP. Research design and methods: Sing...

Background: Mirikizumab, a p19-directed antibody against interleukin-23, showed efficacy in the treatment of ulcerative colitis in a phase 2 trial. Methods: We conducted two phase 3, randomized, double-blind, placebo-controlled trials of mirikizumab in adults with moderately to severely active ulcerative colitis. In the induction trial, patients...

Background: Women with Inflammatory Bowel Diseases (IBD) have fewer children and stay childless more often. The decision-making process around family planning choices remains incompletely understood. Methods: We examined family status in women who at recruitment to the UK IBD Bioresource had not had children yet via an electronic survey. The pri...

Introduction Despite established gastrointestinal side effects, opioid use has increased considerably among patients with inflammatory bowel disease (IBD) over the last decade.¹ Research suggests that their use in IBD is associated with increased healthcare utilization, and mortality. However, their effects on other disease outcomes are less consis...

Background Anti-tumour necrosis factor (anti-TNF) agents are associated with increased infection risk among elderly inflammatory bowel disease (IBD) patients and thus alternative biologics may be preferable. However, there is little data on the safety and efficacy of novel biologics compared to anti-TNF agents in the elderly. Aims To compare the s...

Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with IBD. Methods Data were coll...

Background and aims Healthcare quality improvement (QI) is the systematic process to continuously improve the quality of care and outcomes for patients. The landmark Inflammatory Bowel Disease (IBD) UK National Audits provided a means to measure the variation in care, highlighting the need to define the standards of excellence in IBD care. Through...

Background and aims: Inflammatory Bowel Disease colitis-associated dysplasia is managed with either enhanced surveillance and endoscopic resection or prophylactic surgery. The rate of progression to cancer after a dysplasia diagnosis remains uncertain in many cases and patients have high thresholds for accepting proctocolectomy. Individualised dis...

Human papillomavirus (HPV) infections drive one in twenty new cancer cases. Despite the potential for improving treatment, screening, and vaccination strategies, little is known as to why the vast majority of HPV infections clear spontaneously within two years. To untangle the dynamics of these non-persisting infections, we performed a combined qua...

Objective Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD. Design A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/U...

Background Ulcerative colitis (UC) and Crohn’s disease (CD) can be associated with severe comorbidities, namely opportunistic infections and malignancies. We present the first systematic review and meta-analysis evaluating the burden of anal human papillomavirus disease in patients with UC and CD. Methods PubMed, Web of Science and Scopus were sea...

Background We aim to compare the real-life direct and indirect costs of switching patients from intravenous to subcutaneous (SC) CT-P13, an infliximab biosimilar, in a tertiary UK Inflammatory Bowel Disease (IBD) centre. Methods All adult patients with IBD on standard dosing CT-P13 (5 mg/kg 8 weekly) were eligible to switch. Of 169 patients eligib...

Background Lower serum free triiodothyronine-to-thyroxine (fT3/fT4) ratio has been linked to non-response to treatment in a range of diseases, including in biologic-treated patients with IBD. We sought to assess whether baseline serum fT3/fT4 ratio predicted primary non-response (PNR) and non-remission to infliximab and adalimumab in patients with...

Background Pregnant women with Inflammatory Bowel Disease (IBD) continue thiopurines to maintain remission. Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy, often causing distressing maternal symptoms and with potential implications for pregnancy outcome. Case studies have reported treatment-resistant intr...

Background Anti-tumour necrosis factor (anti-TNF) agents are associated with increased infection risk among elderly inflammatory bowel disease (IBD) patients and thus alternative biologics may be preferable. Previous cohort studies have demonstrated a superior safety profile for vedolizumab compared to anti-TNF agents in the elderly. However, there...

Background Acute severe ulcerative colitis (ASUC) is a severe manifestation of ulcerative colitis (UC) that requires hospitalisation. Despite significant advances in therapeutic options for UC and in the medical management of steroid-refractory ASUC, the initial treatment paradigm for ASUC has not changed since the 1950s and is based on the use of...

Background Infliximab has transformed the management of Inflammatory Bowel Disease (IBD) however it has a significant cost burden. Additionally, demand on our IBD day case infusion unit has tripled in the last 7 years leading to long delays in treatment initiation. Switching patients from intravenous (IV) to subcutaneous (SC) infliximab reduces the...

Crohn’s disease affects many women of childbearing age. Fecundity rates are often lower than in the general population due to reduced fertility during active inflammation, effects of pelvic surgery or voluntary childlessness. Many women have concerns regarding the effects of pregnancy on their Crohn’s, any potential effect of medication on the fetu...

Background Biologics and small molecules for inflammatory bowel disease (IBD) may increase infection risk. Herpes zoster causes acute and long‐term symptoms, but vaccination is not recommended in patients with IBD, unless >50 years of age. Aims To examine risk of Herpes zoster infection with all licensed biologics and small molecules for IBD using...

Background Medication adherence in inflammatory bowel disease (IBD) is crucial, particularly during pregnancy. Unplanned pregnancies are common; therefore, efforts to maximise adherence should not be restricted to pregnant women. Objectives We aimed to assess medication adherence in women with IBD of childbearing age, regardless of their reproduct...

Background Anti-TNF drugs, such as infliximab, are associated with attenuated antibody responses after SARS-CoV-2 vaccination. We aimed to determine how the anti-TNF drug infliximab and the anti-integrin drug vedolizumab affect vaccine-induced neutralising antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafte...

Introduction: Crohn's Anal Fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research. Methods: Candidate descriptors were generated from published lite...

Background Anti-tumour necrosis factor (anti-TNF) agents are associated with increased infection risk among elderly inflammatory bowel disease (IBD) patients, and thus, alternative biologics may be preferable. However, little comparative data exist on the safety and efficacy of vedolizumab and ustekinumab in elderly IBD patients. Aims To compare t...

Introduction: Symptoms of common mental disorders, like anxiety or depression, are associated with adverse clinical outcomes in inflammatory bowel disease (IBD). We report trajectories of these symptoms in IBD, patient characteristics associated with different trajectories, and effects on healthcare utilization and prognosis. Methods: We collect...

Background: Recent trials support the clinical efficacy and safety of subcutaneous infliximab (IFX) or vedolizumab (VDZ) for Inflammatory Bowel Disease (IBD). We evaluated the uptake and rationale for choosing to switch from intravenous infusions to subcutaneous injections. Methods: Retrospective analysis of all adult patients receiving standard...

The vaginal ecosystem is a key component of women’s health. It also represents an ideal system for ecologists to investigate the consequence of perturbations on species diversity and emerging properties between organisational levels. Here, we study how exposure to different types of menstrual protection products is linked to microbial, immunologica...

Background Anti‐drug antibodies are associated with treatment failure to anti‐TNF agents in patients with inflammatory bowel disease (IBD). Aim To assess whether immunogenicity to a patient's first anti‐TNF agent would be associated with immunogenicity to their second, irrespective of drug sequence Methods We conducted a UK‐wide, multicentre, ret...

Inflammatory bowel disease has a high incidence and prevalence especially in young individuals in their reproductive years. Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, a...

LINKED CONTENT This article is linked to Rosiou et al papers. To view these articles, visit https://doi.org/10.1111/apt.17039 and https://doi.org/10.1111/apt.17137

Human papillomaviruses (HPVs), the most oncogenic virus known to humans, are often associated with Herpes Simplex Virus-2 (HSV-2) infections. The involvement of the latter in cervical cancer is controversial but its long-term infections might modulate the mucosal microenvironment in a way that favors carcinogenesis. We know little about coinfection...

Human papillomaviruses (HPVs), the most oncogenic virus known to humans, are often associated with Herpes Simplex Virus-2 (HSV-2) infections. The involvement of the latter in cervical cancer is controversial but its long-term infections might modulate the mucosal microenvironment in a way that favors carcinogenesis. We know little about coinfection...

Background: Interleukin (IL)-36 signaling has been shown to be increased in ulcerative colitis (UC). Spesolimab, a novel humanized monoclonal antibody, targets the IL-36 pathway. Research design and methods: We report safety, immunogenicity, and efficacy data of intravenous [IV] spesolimab in UC. Study 1: phase II randomized, placebo-controlled...

Background During illness, adaptations of the hypothalamic–pituitary‐thyroid axis reduce energy expenditure, protein catabolism and modulate immune responses to promote survival. Lower serum free triiodothyronine‐to‐thyroxine (fT3/fT4) ratio has been linked to non‐response to treatment in a range of diseases, including in biologic‐treated patients...

There are a range of sphincter-preserving procedures available to treat anorectal fistula, some of which can be precluded, or rendered more optimal by specific features of fistula anatomy. Magnetic resonance imaging (MRI) is the gold standard modality for assessing anorectal fistula. To maximise clinical utility, the MRI report should accurately de...

Background The management of pregnant women with inflammatory bowel disease (IBD) is complex. We aimed to assess health care professionals’ (HCPs) theoretical and applied knowledge of pregnancy-related IBD issues. Methods A cross-sectional international survey was distributed to HCPs providing IBD care between October 2020 and March 2021. Knowledg...

Background & Aims Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. This nationwide study assessed patients' experience of IBD and the healthcare they...

Background Recent trials support the clinical efficacy and safety of subcutaneous biologic treatment for IBD maintenance therapy. Administration of subcutaneous injections could reduce the financial burden and time required to attend for infusions and allow IBD service providers to manage increasing clinical demand. We evaluated the uptake and rati...

Introduction Corticosteroids remain an important option for managing Inflammatory Bowel Disease (IBD) flares, but steroid excess is common and may be a marker of poor care. Patients may access steroid prescriptions from primary or secondary care, but sources of prescriptions and association with clinical outcomes are not well described. Methods Pa...

Introduction Opioid exposure in inflammatory bowel disease (IBD) is associated with premature mortality, yet exposure in IBD increasing. International guidelines have been introduced to rationalise opioid use. While opioids may improve acute pain, long term exposure is rarely beneficial and is associated with side effects. We conducted a multicentr...

Introduction The management of pregnant women with inflammatory bowel disease (IBD) is complex. We aimed to assess healthcare professionals’ (HCP) theoretical and applied knowledge of pregnancy-related IBD issues. Methods A cross-sectional international survey was distributed to HCPs providing IBD care between October 2020 and March 2021. Knowledg...

Introduction Fecundity may be reduced in women with active inflammatory bowel disease (IBD) or prior IBD-related surgery, and these women may require assisted reproductive technology (ART). There are no guidelines for women with IBD to outline referral criteria for ART. Methods We performed a prospective, multicentre, international questionnaire o...

Background Corticosteroids remain important for managing inflammatory bowel disease (IBD) flares. Steroid excess, however, may be a marker of poor care. Patients access steroid prescriptions from primary (General Practitioners [GP]) or secondary care (hospital‐based). Sources of prescriptions and associated outcomes are not well described. Methods...

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of adverse outcomes from pregnancy. It is unclear whether IBD indications account for the higher rate of Caesarean section (CS) in IBD patients. Methods: A retrospective cohort study of 179 IBD patients cared for in a dedicated combined IBD antenatal clinic and 31,5...

There is known heterogeneity between individuals in infectious disease transmission patterns. The source of this heterogeneity is thought to affect epidemiological dynamics but studies tend not to control for the overall heterogeneity in the number of secondary cases caused by an infection. To explore the role of individual variation in infection d...

LINKED CONTENT This article is linked to Kumar et al papers. To view these articles, visit https://doi.org/10.1111/apt.16839 and https://doi.org/10.1111/apt.16918

LINKED CONTENT This article is linked to Lenti et al papers. To view these articles, visit https://doi.org/10.1111/apt.16742 and https://doi.org/10.1111/apt.16871

Introduction Fecundity may be reduced in women with active inflammatory bowel disease (IBD) or prior IBD-related surgery, and these women may require assisted reproductive technology (ART). There are no guidelines for women with IBD to outline referral criteria for ART. Methods We performed a prospective, multicentre, international questionnaire o...

Background Anti-tumour necrosis factor (anti-TNF) therapies are the most commonly used biologics for inflammatory bowel disease (IBD), but for patients with a comorbidity, newer agents may be a more appropriate treatment choice. Aims To investigate the impact of comorbidities in patients with IBD, on first-line biologic prescribing habits of IBD-s...

The Covid-19 outbreak was followed by a huge amount of modelling studies in order to rapidly gain insights to implement the best public health policies. Most of these compartmental models involved ordinary differential equations (ODEs) systems. Such a formalism implicitly assumes that the time spent in each compartment does not depend on the time a...

Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF...

Background The COVID-19 pandemic has led to an unprecedented daily use of RT-PCR tests. These tests are interpreted qualitatively for diagnosis, and the relevance of the test result intensity, i.e. the number of quantification cycles (Cq), is debated because of strong potential biases. Aim We explored the possibility to use Cq values from SARS-CoV...

Background This retrospective study aims to determine steroid prescription practice across primary and secondary care, quantify the proportion of primary care prescriptions communicated to secondary care, and assess outcomes associated with excessive steroid use. Methods The study cohort consists of all patients attending IBD clinics under Leeds T...

Background The optimal choice of biological agents after failure of anti-tumour-necrosis-factor-(TNF)α agent in Crohn’s disease (CD) is yet to be defined. Aims To assess the effectiveness and safety of ustekinumab compared to vedolizumab as second-line treatment in CD patients who failed anti-TNFα therapy. Methods Retrospective analysis of clinic...

Background: Perianal Crohn's disease is a disabling condition, with little known about anorectal function in healed/inactive perianal Crohn's disease; Aim: To evaluate anorectal function in a cohort of patients with treated/healed perianal Crohn's disease; Methods: Prospective cohort study, including high-resolution anorectal manometry, balloon ex...

Objective To determine if the use of menstrual cups rather than tampons is associated with more or less health risk. Design Analysing biological, demographic, and behavioural data in a cohort of women who reported using mostly tampons ( n = 81) or menstrual cups ( n = 22). Setting A cross-sectional analysis using the inclusion data of a single ce...

Introduction There is a paucity of data on pregnancies in women with stomas due to Inflammatory Bowel Disease (IBD) with the existing literature focused on fertility and conception rather than patient experience and outcome of pregnancy after stoma surgery. The aim of this study was to assess stoma, IBD, obstetric and neonatal outcomes in pregnant...

Background Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. In a previous phase 2 induction study, etrolizumab significantly improved clinical remission versus placebo in patients with moderately to severely active ulcerative colitis. We aimed to compare the safety and efficacy of etrolizumab with infliximab in patients with mode...

Background and aims: Few data are available regarding the combination of biologics or small molecules in inflammatory bowel disease (IBD) patients. We report safety and efficacy of such combinations through a retrospective multicentre series. Methods: Combination therapy was defined as the concomitant use of two biologics or one biologic with a...

The Covid-19 pandemic outbreak was followed by an huge amount of modeling studies in order to rapidly gain insights to implement the best public health policies. However, most of those compartmental models used a classical ordinary differential equations (ODEs) system based formalism that came with the tacit assumption the time spent in each compar...