Athos Bousvaros

Harvard University, Cambridge, Massachusetts, United States

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Publications (213)1382.34 Total impact

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    ABSTRACT: Background: Only a minority of patients commenced on anti-TNF agents achieve and maintain clinical remission, even with adequate serum drug levels and in the absence of anti-drug antibodies. The variable responsiveness of immune and other cell types to anti-TNF agents may partly explain this phenomenon. A means of identifying individuals with "responsive" mucosal immunology prior to selecting a biological agent could enhance remission rates, reduce costs and avoid safety concerns from ineffective use of anti-TNFs. Methods: We developed an in vitro assay to test responsiveness of patients' biopsies to infliximab as determined by release of pro-inflammatory cytokines. Mucosal biopsies from 45 patients with IBD (24 males/21 females; 15% less than 16 years old, 42% between 17 and 40 years old; 29 with Crohn's disease/16 with ulcerative colitis) were cultured ex-vivo in the presence or absence of infliximab. Levels of 16 cytokines were measured in culture supernatants by multiplex ELISA. Patients were characterized as being "mucosal cytokine responders (MCRs)" if 3 or more cytokines were inhibited in the presence of infliximab. Cytokine responsiveness was correlated with clinical response to anti-TNF therapy in a subgroup of 28 patients with a follow-up of 6 to 54 weeks. Patients were categorized as clinical "non-responders" to anti-TNF treatment based on the following criteria (1) need for hospitalization or surgical intervention for IBD-related problems; (2) dose or frequency escalation of anti-TNF treatment or switching to another anti-TNF regimen; (3) switching to, or adding, another drug class. Results: Amongst all mucosal samples cultured with infliximab, 44% of patients were categorized as mucosal cytokine responders (MCRs). In the cohort with clinical follow-up, 39% of patients were classified as clinical responders. Clinical responders had a greater number of cytokines inhibited in the assay compared to non-responders (6.0 +/- 1.02 versus 1.29 +/- 0.63 respectively; P = 0.0012 by Mann-Whitney test). IL-13, IL-17A, IL-5 and IL-7 were inhibited in 70% to 90% of clinical responders versus 10% in non-responders (P < 0.001). Clinical response rates to infliximab were 83.3% for MCRs (10 out of 12) versus 6.25% for cytokine non-responders (1 out of 16) (P = 0.0014). Based on a Receiver Operating Characteristic (ROC) analysis, the mucosal cytokine assay had 91% sensitivity and 88% specificity for predicting clinical response to anti-TNF (area under the curve 0.87). Conclusions: These findings suggest that clinical responders to anti-TNF agents can be identified with high accuracy by testing mucosal biopsies in vitro in the presence of infliximab. If these results are replicated in a larger cohort, this mucosal cytokine assay could potentially be used to select patients for either starting or continuing anti-TNF therapy. Furthermore, in the future, it can be adapted to evaluate in parallel different candidate drugs and guide the delivery of personalized treatments in IBD.
    No preview · Article · Mar 2016 · Inflammatory Bowel Diseases
  • Anne Levine · David Keljo · David DeMaso · Athos Bousvaros · Eva Szigethy
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    ABSTRACT: Background: Youth with inflammatory bowel disease (IBD) are at increased risk of developing depression. Clinical depression is a heterogeneous disorder comprising different symptom clusters, which may derive from different psychopathologic etiologies. Previous studies identified distinct depressive subtypes among youth with IBD, with nearly 20% experiencing somatic-symptom predominant depression. We aimed to identify depressive symptoms related to inflammatory disease activity in a large sample of youth with Crohn's disease (CD), the subtype of IBD associated with more systemic inflammation. Methods: Youth (ages 9-17) with IBD (n = 765) were recruited at Boston Children's Hospital and Children's Hospital Pittsburgh. Subjects with ulcerative colitis were excluded. Subjects were screened for depression with the Children's Depressive Index (CDI). CDI scores ≥12 were considered to represent clinically significant depressive symptoms (CSDS). Disease activity was measured using the Pediatric Crohn's Disease Activity Index (PCDAI). For analysis, PCDAI scores were divided into subjective, objective laboratory, and objective exam subscales. Data regarding demographics, inflammatory markers, IBD medications, and prior surgery were obtained from the EMR. Exploratory factor analysis (EFA) was performed to identify symptom profiles and create factor subscales. Multiple regression modeling was used to identify predictors of each subscale. Results: Five hundred fifty CD patients (51.8% male, average age 14.4 years) were included. Mean PCDAI score was 13.6, indicating mild disease. Using validated cutoffs, 40.7% had scores indicating remission, 32.7% mild, 6.4% moderate, and 7.3% severe disease. At baseline, 38.8% met criteria for CSDS, of whom 9.4% had prior surgery, 12.3% ostomy, and 28.1% were on corticosteroids. EFA revealed 4 symptom profiles: (1) somatic-affective, (2) low self-esteem, (3) suicidality, and (4) anhedonia. Univariate analysis suggested that females, patients on corticosteroids, those with elevated PCDAI scores or ESR, or lower hematocrit or albumin were more likely to have somatic-affective symptoms (P < 0.01). Multiple regression modeling explained 27.9% of the variance in somatic-affective symptoms (P < 0.0005). Subjective PCDAI symptoms (pain, stool frequency, and functional impairment) made unique significant contributions to the model. Patients with elevated PCDAI subjective and objective lab scores, ESR, CRP, and those on corticosteroids were more likely to experience anhedonia (P < 0.01). Multiple regression modeling explained 8.4% of the variance in anhedonia, with subjective PCDAI symptoms making unique significant contributions. Low self-esteem and suicidality correlated with the subjective PCDAI subscale (P < 0.01), but not with inflammatory markers. Conclusions: Inflammatory markers and disease activity are significant predictors of somatic-affective symptoms and anhedonia in youth with IBD. Symptoms associated with other profiles may be driven more by functional symptoms than inflammation. Social support, coping styles, childhood trauma, and disease course should be evaluated as potential predictors of these clusters. Identification of symptom profiles can guide treatment of comorbid IBD and depression. Even if somatic-affective symptoms stem from inflammation, referral to psychotherapy can improve symptoms more rapidly.
    No preview · Article · Feb 2016 · Inflammatory Bowel Diseases
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    ABSTRACT: The objective of this study was to measure the prevalence of inflammatory bowel disease (IBD) among patients with autism spectrum disorders (ASD), which has not been well described previously. The rates of IBD among patients with and without ASD were measured in 4 study populations with distinct modes of ascertainment: a health care benefits company, 2 pediatric tertiary care centers, and a national ASD repository. The rates of IBD (established through International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes) were compared with respective controls and combined using a Stouffer meta-analysis. Clinical charts were also reviewed for IBD among patients with ICD-9-CM codes for both IBD and ASD at one of the pediatric tertiary care centers. This expert-verified rate was compared with the rate in the repository study population (where IBD diagnoses were established by expert review) and in nationally reported rates for pediatric IBD. In all of case-control study populations, the rates of IBD-related ICD-9-CM codes for patients with ASD were significantly higher than that of their respective controls (Stouffer meta-analysis, P < 0.001). Expert-verified rates of IBD among patients with ASD were 7 of 2728 patients in one study population and 16 of 7201 in a second study population. The age-adjusted prevalence of IBD among patients with ASD was higher than their respective controls and nationally reported rates of pediatric IBD. Across each population with different kinds of ascertainment, there was a consistent and statistically significant increased prevalance of IBD in patients with ASD than their respective controls and nationally reported rates for pediatric IBD.
    No preview · Article · Jul 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤5 years of age) inflammatory bowel disease (IBD). Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. One hundred twelve children were ≤5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohn's disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids (P < .01) and methotrexate (P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine (P < .0001) and thiopurine immunomodulators (P < .0002). Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · May 2015 · The Journal of pediatrics
  • Athos Bousvaros

    No preview · Article · May 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: It is important to determine the effects of immunomodulators on the ability of children to remain on infliximab therapy for Crohn's disease (durability of therapy), given the potential benefits and risks of concomitant therapy-especially with thiopurines in male patients. We investigated how immunomodulatory treatment affects the durability of infliximab therapy. We collected data from the Pediatric Inflammatory Bowel Disease Registry, from January 2002 through August 2014, on 502 children with Crohn's disease who participated in a prospective multi-center study. Data were collected from patients who received at least a 3-dose induction regimen of infliximab, and their concomitant use of immunomodulators: no thiopurine or methotrexate treatment, treatment for 6 months or less during infliximab therapy, or treatment for more than 6 months during infliximab therapy. The probabilities (± standard error) that children remained on infliximab therapy 1 y, 3 y, and 5 y after the treatment began were 0.84±0.02, 0.69±0.03, and 0.60±0.03, respectively. Age, sex, and disease extent or location did not affect the durability of infliximab therapy. Greater length of concomitant use of immunomodulators was associated with increased time of infliximab therapy. The probability that patients with more than 6 months of immunomodulator use remained on infliximab therapy for 5 y was 0.70±0.04, compared to 0.48±0.08 for patients who did not receive immunomodulators and 0.55 ± 0.06 for those who received them for 6 months or less (P<.001). In boys who received immunomodulators for 6 months or more after starting infliximab, the overall durability of infliximab therapy was greater among those receiving methotrexate than thiopurine (P<.01); the probabilities that they remained on infliximab therapy for 5 y were 0.97±0.03 vs 0.58±0.08, respectively. In children with Crohn's disease, concomitant treatment with an immunomodulator for more than 6 months after starting infliximab therapy increases the chances that patients will remain on infliximab. In boys, methotrexate appears to increase the durability of infliximab therapy compared with thiopurine. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association

  • No preview · Article · Apr 2015 · Gastroenterology

  • No preview · Article · Apr 2015 · Gastroenterology
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    ABSTRACT: Foreign body ingestion remains a common reason for emergency room visits and operative interventions in the pediatric population. Rare earth magnet ingestion represents a low percentage of all foreign bodies swallowed by children; however, magnets swallowed in multiplicity can result in severe injuries. Pediatric surgeons with membership in the Surgical Section of the American Academy of Pediatrics were surveyed to determine the magnitude and consequences of magnet ingestions in the pediatric population. About 100 (16%) participant responses reported on 99 magnet ingestions. The median age at ingestion was 3.7 y, and the majority of ingestions (71%) occurred after year 2010. Thirty-two children underwent endoscopy with successful removal in 70% of cases, and multiple magnets were found in 65% of these patients. Seventy-three children required either laparotomy (51) or laparoscopy (22) for magnet removal, and 90% of these children were discovered to have ingested more than one magnet. In addition, 17% of the children were found to have at least one perforation or fistula, and 34% of the children had multiple perforations or fistulae. Nine children required long-term care for their injuries including repeat endoscopies. One child died after hemorrhage from an esophago-aortic fistula. These results demonstrated the increasing need for magnet regulations and public awareness to prevent potentially serious complications. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Journal of Surgical Research
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    ABSTRACT: Crohn's disease (CD) is associated with depression. It is unclear if psychosocial interventions offer benefit for depressive symptoms during active CD. In this secondary analysis of a larger study of treating depression in pediatric inflammatory bowel disease, we assessed whether cognitive behavioral therapy (CBT) would differentiate from supportive nondirective therapy in treating depression and disease activity in youth with CD. We also explored whether somatic depressive symptoms showed a different pattern of response in the overall sample and the subset with active inflammatory bowel disease. Youth with depression and CD (n = 161) were randomized to 3 months of CBT (teaching coping skills) or supportive nondirective therapy (supportive listening). Depressive severity was measured using the Children's Depression Rating Scale-Revised (CDRS-R) with the somatic depressive subtype consisting of those CDRS-R items, which significantly correlated with CD activity. Disease activity was measured by the Pediatric Crohn's disease Activity Index. Given the potential confound of higher dose steroids, subanalyses excluded subjects on >20 mg/d prednisone equivalent (n = 34). Total CDRS-R scores in the overall sample significantly decreased over time after both treatments (P < 0.0001). Treatment with CBT was associated with a significantly greater improvement in the Pediatric Crohn's disease Activity Index (P = 0.05) and somatic depressive subtype (P = 0.03) in those with active inflammatory bowel disease (n = 95) compared with supportive nondirective therapy. After excluding those on steroids (n = 34), there was a significant improvement in total CDRS-R (P = 0.03) and in Pediatric Crohn's disease Activity Index (P = 0.03) after CBT. Psychotherapy may be a useful adjunct to treat depression in the context of CD-related inflammation in youth who are not concurrently on higher dose steroids.
    Full-text · Article · Mar 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: Recent data from mainly homogeneous European and African populations implicate a 140-bp region 5' to the transcriptional start site of LCT (the lactase gene) as a regulatory site for lactase persistence and nonpersistence. Because there are no studies of US nonhomogeneous populations, we performed genotype/phenotype analysis of the -13910 and -22018 LCT single nucleotide polymorphisms (SNPs) in New England children, mostly of European ancestry. Duodenal biopsies were processed for disaccharidase activities, RNA quantification by reverse transcription polymerase chain reaction (RT-PCR), allelic expression ratios by PCR, and genotyping and SNP analysis. Results were compared with clinical information. Lactase activity and mRNA levels, and sucrase-to-lactase ratios of enzyme activity and mRNA, showed robust correlations with genotype. None of the other LCT SNPs showed as strong a correlation with enzyme or mRNA levels as did -13910. Data were consistent, with the -13910 being the causal sequence variant instead of -22018. Four individuals heterozygous for -13910T/C had allelic expression patterns similar to individuals with -13910C/C genotypes; of these, 2 showed equal LCT expression from the 2 alleles and a novel variant (-13909C>A) associated with lactase persistence. The identification of -13910C/C genotype is likely to predict lactase nonpersistence, consistent with prior published studies. A -13910T/T genotype will frequently, but not perfectly, predict lactase persistence in this mixed European-ancestry population; a -13910T/C genotype will not predict the phenotype. A long, rare haplotype in 2 individuals with -13910T/C genotype but equal allele-specific expression contains a novel lactase persistence allele present at -13909.
    No preview · Article · Feb 2015 · Journal of Pediatric Gastroenterology and Nutrition
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    ABSTRACT: Adult studies suggest antibodies to infliximab (ATI) correlate with loss of response in inflammatory bowel disease but pediatric data are limited. We conducted a cross-sectional study of trough infliximab levels and ATI in 134 pediatric and young adult patients receiving infliximab. At the time serum was obtained demographics, disease phenotype, duration of infliximab therapy, use of combination therapy (methotrexate or 6-mercaptopurine with infliximab), and surgery were recorded. Assays were performed on 134 subjects currently receiving infliximab (85 male; mean age, 17.3 ± 4.3 years; 114 Crohn's disease and 20 ulcerative colitis). Infliximab use ranged from 12 days to 12 years: median 2.0 (interquartile range (1.1-4.3) years. Twenty-seven of 134 (20%) patients had ATI ≥5 U/mL. Of patients with ATI ≥5 U/mL, 59% had infliximab levels <5 μg/mL, compared with 14% of patients with ATI <5 U/mL (P < 0.001). Ten (7%) patients (9 Crohn's disease, 1 ulcerative colitis) underwent bowel resections after beginning infliximab infusions. Sixty percent who underwent surgery had ATI ≥12 U/mL; in contrast, only 8% of patients who did not undergo surgery had ATI ≥12 U/mL (P = 0.01). At the time of serum sampling, 50 (37%) patients were receiving combination therapy, compared with 84 (63%) on infliximab alone. Combination therapy at the time of serum sampling did not correlate with either increase infliximab levels or lower ATI compared with infliximab monotherapy. However, prior immunomodulator use was associated with lower antibody levels (P = 0.007). ATI correlates with reduction in infliximab level and a higher risk of surgery in patients with inflammatory bowel disease.
    No preview · Article · Jan 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: Oral methotrexate (MTX) administration avoids weekly injections, reduces costs and may improve quality of life of patients with Crohn's disease (CD), especially children. Routes of administration have never been systematically compared in CD. We aimed to compare effectiveness and safety of orally (PO) versus subcutaneously (SC) administered MTX in paediatric CD. 226 children with CD treated with oral or subcutaneous MTX were included in a multicentre, retrospective 1-year cohort study (62% boys, mean age 13.8±2.8 years, 88% previous thiopurines). 38 (17%) were initially commenced on oral, 98 (43%) started subcutaneous and switched to oral and 90 (40%) were treated with subcutaneous only. Matching and 'doubly robust' weighted regression models were based on the propensity score method, controlling for confounding-by-indication bias. 11/23 pretreatment variables were different between the groups, but the propensity score modelling successfully balanced the treatment groups. 76 children (34%) had sustained steroid-free remission with a difference that did not reach significance between the PO and the SC groups (weighted OR=1.72 (95% CI 0.5 to 5.9); p=0.52). There were no differences in need for treatment escalation (p=0.24), elevated liver enzymes (p=0.59) or nausea (p=0.85). Height velocity was lower in the PO group (p=0.006) and time to remission was delayed in the PO group (p=0.036; Fleming (0, 1) test). In this largest paediatric CD cohort to date, SC administered MTX was superior to PO, but only in some of the outcomes and with a modest effect size. Therefore, it may be reasonable to consider switching children in complete remission treated with subcutaneous MTX to the oral route with close monitoring of inflammatory markers and growth. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    No preview · Article · Nov 2014 · Gut
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    Full-text · Article · Sep 2014 · Journal of Crohn s and Colitis
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    ABSTRACT: Objective: Pediatric inflammatory bowel disease (IBD) is associated with high rates of depression. This study compared the efficacy of cognitive behavioral therapy (CBT) to supportive nondirective therapy (SNDT) in treating youth with comorbid IBD and depression. Method: Youth (51% female and 49% male; age 9-17 years, mean age 14.3 years) with depression and Crohn's disease (n = 161) or ulcerative colitis (n = 56) were randomly assigned to a 3-month course of CBT or SNDT. The primary outcome was comparative reduction in depressive symptom severity; secondary outcomes were depression remission, increase in depression response, and improved health-related adjustment and IBD activity. Results: A total of 178 participants (82%) completed the 3-month intervention. Both psychotherapies resulted in significant reductions in total Children's Depression Rating Scale Revised score (37.3% for CBT and 31.9% for SNDT), but the difference between the 2 treatments was not significant (p = .16). There were large pre-post effect sizes for each treatment (d = 1.31 for CBT and d = 1.30 for SNDT). More than 65% of youth had a complete remission of depression at 3 months, with no difference between CBT and SNDT (67.8% and 63.2%, respectively). Compared to SNDT, CBT was associated with a greater reduction in IBD activity (p = .04) but no greater improvement on the Clinical Global Assessment Scale (p = .06) and health-related quality of life (IMPACT-III scale) (p = .07). Conclusion: This is the first randomized controlled study to suggest improvements in depression severity, global functioning, quality of life, and disease activity in a physically ill pediatric cohort treated with psychotherapy. Clinical trial registration information-Reducing Depressive Symptoms in Physically Ill Youth; http://clinical; NCT00534911.
    Full-text · Article · Jul 2014 · Journal of the American Academy of Child and Adolescent Psychiatry
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    ABSTRACT: Background: Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD and (2) determine predictors of abdominal pain in Crohn's disease (CD) and ulcerative colitis (UC). Methods: Seven hundred sixty-five patients aged 9 to 17 years with IBD seen over 3 years at 2 sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results: Two hundred seventeen patients with IBD (161 CD, 56 UC) were depressed. One hundred sixty-three (120 CD, 43 UC) patients had complete abdominal pain index scores. In CD, abdominal pain was associated with depression (r = 0.33; P < 0.001), diarrhea (r = 0.34; P = 0.001), erythrocyte sedimentation rate (r = 0.22; P = 0.02), low albumin (r = 0.24; P = 0.01), weight loss (r = 0.33; P = 0.001), and abdominal tenderness (r = 0.38, P = 0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (P = 0.03), weight loss (P = 0.04), and abdominal tenderness (P = 0.01) predicted pain for patients with CD. In UC, pain was associated with depression (r = 0.46; P = 0.002) and nocturnal stools (r = 0.32; P = 0.046). In the multivariate model with these significant correlates, 23% of the variance was explained and only depression (P = 0.02) predicted pain. Conclusions: The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications.
    Full-text · Article · Jun 2014 · Inflammatory Bowel Diseases
  • Athos Bousvaros

    No preview · Article · Jun 2014 · Gastroenterology
  • Ying Lu · Athos Bousvaros
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    ABSTRACT: The vast majority of patients with inflammatory bowel disease (IBD) will receive immunosuppressive therapy at some point for their disease, whether for the short term (such as a course of corticosteroids) or long term (such as maintenance therapy with immunomodulators or biologics). The systemic immunosuppression places patients at increased risk for infections. Therefore, it is important that patients are up-to-date with immunizations to minimize vaccine-preventable infections. However, the literature shows that the rate of immunization in patients with IBD is low. Ideally, the vaccination status is checked at diagnosis, and patients are immunized with the vaccines they need. Drawing titers is helpful in cases in which vaccination history is unclear or to confirm that titers are at an adequate level in cases in which patients have been vaccinated. Current guidelines recommend that patients with IBD follow the same routine immunization schedule as healthy children, but patients should not be administered live vaccines if they are receiving immunosuppressive therapy. Therefore, it is ideal to administer any necessary vaccinations as early as possible, prior to starting immunosuppressive therapy. Patients may receive inactivated vaccines regardless of immunosuppressive status. The IBD literature suggests that inactivated vaccines are safe and do not worsen disease activity. In general, patients with IBD mount an immune response to vaccines, but the response may be lower if patients are receiving immunosuppressive therapy, especially tumor necrosis factor inhibitors.
    No preview · Article · Jun 2014 · Gastroenterology and Hepatology

  • No preview · Article · May 2014 · Gastrointestinal Endoscopy
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    ABSTRACT: Despite advances in medical therapies, many children with Crohn's disease (CD) will require bowel resection. Although previous registry studies have attempted to identify risk factors for surgery, the effect of immunomodulators and biologics (IMB) on surgical indications has not been well characterized. We reviewed a series of 125 children with CD who underwent bowel resection with reanastomosis between 1977 and 2011 and were followed up for at least 6 months. We compared patients who underwent surgery for perforating disease (abscess or internal fistula) and patients who were operated on for medically refractory or fibrostenosing disease. Between these 2 groups, we examined medications received before surgery. Other demographic and disease-specific covariates were examined. Of the 82 patients who received IMB before surgery, only 19 patients (23%) required surgery for a perforating complication of CD, whereas 63 patients (77%) required surgery for strictures or medically refractory disease. In contrast, of the 43 patients who did not receive IMB preoperatively, 20 patients (45%) developed a perforating complication and 23 patients (53%) required surgery for strictures or refractory disease. These differences across groups were significant, with a lower rate of operation for perforating disease among patients receiving preoperative IMB therapy (P = 0.007). In our surgical cohort, children with CD who were treated with IMB were less likely to have surgery for perforating disease. This finding raises the possibility that the administration of IMB in children who require surgery may be associated with a difference in disease behavior.
    No preview · Article · Apr 2014 · Inflammatory Bowel Diseases

Publication Stats

5k Citations
1,382.34 Total Impact Points


  • 2007-2015
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1996-2015
    • Boston Children's Hospital
      • • Division of Gastroenterology, Hepatology and Nutrition
      • • Center for Inflammatory Bowel Disease
      Boston, Massachusetts, United States
  • 2014
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1997-2013
    • Harvard Medical School
      • • Department of Medicine
      • • Department of Pathology
      • • Department of Surgery
      Boston, Massachusetts, United States
  • 2006
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, Massachusetts, United States
    • The Children’s Hospital of Eastern Ontario
      Ottawa, Ontario, Canada
  • 2004
    • Massachusetts General Hospital
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2001
    • Beth Israel Deaconess Medical Center
      • Division of Gastroenterology
      Boston, Massachusetts, United States
    • Valley Children's Hospital
      Мадера, California, United States
  • 2000
    • University of Adelaide
      Tarndarnya, South Australia, Australia