Kian Keyashian

All Publications

• Effects of Age on Inflammatory Bowel Disease Presentation and Management in Older Adults. Digestive diseases and sciences Sisliyan, C., Andres, J. T., Keyashian, K. 2026

  Abstract

  Inflammatory bowel disease (IBD) is facing a demographic shift with a growing number of older adults.Advanced age affects treatment patterns and as a result older IBD patients often face conservative treatment regimens. Complications associated with aging such as frailty, comorbidities, and polypharmacy pose challenges in management.This review critically examines the influence of aging on IBD presentation and evaluates evolving treatment frameworks in older adults. It further explores the interplay of key age-related factors and their combined impact on therapeutic decision-making, clinical outcomes, and treatment-related adverse events.Studies for this narrative review were collected from Pubmed, Embase, and Web of Science. Studies addressing IBD presentation, disease outcomes, and treatment patterns in older versus younger adults were considered. Additionally, studies investigating age-related factors such as, frailty, comorbidity, and polypharmacy on treatment tolerance were considered.Disease activity and disease-related complications do not wane in severity with advanced age. Older IBD patients face overutilization of corticosteroids and reduced use of advanced therapies despite emerging data showing that certain advanced therapies such as, vedolizumab and ustekinumab, are well tolerated in this age group. Advanced therapies are often deferred due to age. However, our review highlights that frailty, comorbidity, and polypharmacy better predict treatment tolerability than chronologic age.IBD management should shift from age-based assumptions to risk-stratified care. Our review found thatage alone did not increase most adverse events related to advanced therapy usage. This calls for a paradigm shift in treatment approaches for older adults with IBD.

  View details for DOI 10.1007/s10620-026-10161-y

  View details for PubMedID 42572077

  View details for PubMedCentralID 5469700

• Update on Novel Biologic Therapies for Crohn Disease and the Impact of Imaging on Clinical Decision Making. Radiographics : a review publication of the Radiological Society of North America, Inc Patel, R. D., Keyashian, K., Nazarian, M., Dillman, J. R., Deepak, P., Fletcher, J. G., Fidler, J. L., Anupindi, S. A., Dane, B., Gee, M. S. 2026; 46 (6): e250162

  Abstract

  As Crohn disease treatment rapidly evolves, imaging has a critical role in treatment response assessment and clinical decision making. Therapy is often "top down," with the most powerful and potent therapies selected first. Disease activity assessment remains multifactorial, integrating source data from biomarkers, symptoms, endoscopy, and imaging. The "treat-to-target" approach also integrates these markers to escalate, de-escalate, or switch therapies. Given the transmural nature of Crohn disease, endoscopic mucosal healing (ie, the current treatment target) may not be sufficient evidence of remission, and imaging assessment of transmural healing could prove a better predictor of treatment response and long-term patient outcomes. Quantitative imaging methods have been developed to standardize treatment response assessment, including emerging radiologic techniques such as contrast-enhanced US, T1 mapping at MRI, standardized stricture assessment, and velocity-encoded phase contrast imaging. Morphologic changes of resolving inflammation at imaging may lag behind clinical response, and complete normalization of inflamed bowel segments may occur infrequently. In these cases, evaluating changes in bowel motility may be may be more helpful for detection of early treatment response. The radiologist is critical in the assessment of Crohn disease, providing insight into disease management and endoscopically occult and subclinical inflammation. The goal of this article is to highlight the role of imaging in driving management of Crohn disease, including endoscopically occult and subclinical disease, transmural healing, and treatment decision making in patients undergoing biologic therapies. ©RSNA, 2026 See the invited commentary by Srinivasan and Taylor in this issue.

  View details for DOI 10.1148/rg.250162

  View details for PubMedID 42207683

• Advancing the Efficacy and Safety of Advanced Therapies in Older Adults with Inflammatory Bowel Disease DIGESTIVE DISEASES AND SCIENCES Keyashian, K. 2026

  View details for DOI 10.1007/s10620-026-09947-x

  View details for Web of Science ID 001756862900001

  View details for PubMedID 42084720

• Incidence of Anti-Drug Antibody Development in Older Adults with Inflammatory Bowel Disease Treated with Tumor Necrosis Factor Alpha Inhibitors: A Large Multicenter Cohort Study. Inflammatory bowel diseases Frost, S., Ambastha, C., Patel, D., Roney, A., Greb, A., Rangel-Garcia, M., Sauk, J. S., Chang, C., Park, S., Parian, A., Suchan, A., Moughames, E., Krishna, M., Chowdhury, R., Sharma, S., Maas, L., Ho, A., Lazarev, M., Limketkai, B. N., Limsui, D., Keyashian, K. 2025

  Abstract

  It has been theorized that age related immunosenescence reduces the risk of developing anti-drug antibodies (ADAs). This has significant implications regarding choice of therapy and need for routine drug monitoring in this group. We investigated the incidence of ADAs in older adults compared to younger adults with inflammatory bowel disease (IBD).We conducted a multicenter retrospective cohort study including all older adults (ages ≥60 years) with IBD treated with a tumor necrosis factor inhibitors (TNFi); adults ages 18-59 years old were included in a 4:1 ratio. Kaplan-Meier and Cox regression methods compared longitudinal risk of ADA development between groups. Multivariable models evaluated the association of potential risk factors with ADA development.182 (19.7%) older adults and 738 (80.2%) younger adults were included in the study. The risk of ADAs was higher in older adults compared to younger adults (adjusted hazard ratio [aHR] 2.20; 95% confidence interval [CI] 1.44-3.36). Proactive therapeutic drug monitoring (TDM) was inversely associated with ADA development (aHR 0.36; 95% CI 0.25-0.52).Older adults are more likely to develop ADAs against TNFi compared to younger adults. Proactive TDM may be considered in this population for early identification of ADAs and subtherapeutic trough levels, enabling timely dose escalation or treatment modification.

  View details for DOI 10.1093/ibd/izaf170

  View details for PubMedID 40971840

• Efficacy and Safety of Ustekinumab and Vedolizumab for Crohn's Disease of the Pouch. Inflammatory bowel diseases Park, S., Keyashian, K., Ho, A., Limsui, D., Frost, S., Vazquez, R., Yang, E., Ebriani, J., Maas, L., Parian, A., Lazarev, M., Parekh, N., Sauk, J. S., Limketkai, B. 2025

  Abstract

  Medically refractory ulcerative colitis may require colectomy with ileal pouch-anal anastomosis. Complications of the J-pouch include pouchitis, occurring in 50%-80% of patients, and Crohn's disease (CD) of the pouch, occurring in 3%-17%. Our aim was to evaluate the efficacy and safety of ustekinumab (UST) and vedolizumab (VDZ) in patients with CD of the pouch.This was a retrospective, multicenter cohort study of adults with CD of the pouch treated with UST or VDZ. The primary outcome was clinical response at 3 or 6 months. Secondary outcomes included clinical remission, endoscopic response, histologic response, pouch failure or surgery, and adverse effects of therapy. Multivariable logistic regression evaluated the efficacy and safety of UST versus VDZ, adjusted for age, smoking status, disease duration, corticosteroid use, and antibiotic use. Kaplan-Meier survival analysis evaluated the durability of UST versus VDZ for CD of the pouch.One hundred and four patients were included in this analysis. Seventy-seven patients were treated with UST and 57 patients were treated with VDZ between 2011 and 2021. A total of 64/77 (83%) UST-treated patients and 45/57 (79%) VDZ-treated patients had prior biologic exposure. Clinical response occurred in 62% UST-treated patients and 53% VDZ-treated patients at 3 months, and in 56% and 46% at 6 months, respectively. Clinical remission occurred in 32% UST-treated patients and 18% VDZ-treated patients at 3 months and 29% and 21% at 6 months, respectively. Among those treated with UST, 41% achieved endoscopic response, 10% achieved endoscopic remission, 46% achieved histologic response, and 7% achieved histologic remission. Among those treated with VDZ, 27% achieved endoscopic response, 16% achieved endoscopic remission, 26% achieved histologic response, and 8% achieved histologic remission. Over a follow-up period of 3 years, 5% UST-treated patients had inflammatory bowel disease (IBD)-related hospitalization, and 9% required pouch-failure surgery. In total, 3% VDZ-treated patients had IBD-related hospitalization and 5% required pouch-failure surgery. Reported adverse effects were uncommon, including arthralgias (1), hair loss (1), syncope (1), and upper respiratory infection (1) for UST and wrist edema (1) and elevated transaminases (1) for VDZ. In multivariable analyses, patients on UST were more likely to have a clinical response compared to VDZ at 3 months (OR 2.73, 95% [CI] 1.13-6.56, P = .025) and 6 months (OR 2.53, 95% CI: 1.01-6.29, P = .046). UST had significantly longer durability of treatment than VDZ (log-rank P < .005).In one of the largest cohorts evaluating UST and VDZ for CD of the pouch thus far, these biologics were found to be safe and effective treatments for CD of the pouch.

  View details for DOI 10.1093/ibd/izaf146

  View details for PubMedID 40708501

• Fistulizing and Stricturing Esophageal Crohn's Disease Requiring Esophagectomy. ACG case reports journal Dimopoulos-Verma, C., Ott, A., Yeoh, A., Barakat, M., Bingham, D., Keyashian, K., Barber, G. 2025; 12 (2): e01604

  Abstract

  Esophageal Crohn's disease is uncommon and difficult to identify, especially in the adult population. In this study, we report a biologic-naïve patient with colonic Crohn's disease complicated by recurrent esophageal strictures despite many dilations, who presented to our center with recurrent aspiration pneumonia. He was found to have a tracheoesophageal fistula as the likely etiology. After multidisciplinary discussion, he underwent esophagectomy given the severity of his stenosis. The patient's surgical course was complicated by dysphonia and aspiration due to unilateral vocal cord paralysis, which resolved with vocal cord injection. This case highlights a severe manifestation of esophageal Crohn's disease.

  View details for DOI 10.14309/crj.0000000000001604

  View details for PubMedID 39901879

  View details for PubMedCentralID PMC11789893

• Factors associated with long-term clinical outcome in microscopic colitis. Annals of medicine Miyatani, Y., Komaki, Y., Komaki, F., Micic, D., Keyashian, K., Sakuraba, A. 2024; 56 (1): 2365989

  Abstract

  Microscopic colitis has been increasingly recognized as a cause of chronic diarrhoea. We aimed to characterize the role of disease-related factors and treatments on the clinical outcomes of microscopic colitis.We retrospectively reviewed the medical records of patients with microscopic colitis who were treated at the University of Chicago and Oregon Health & Science University between August 2010 and May 2016. Patient characteristics and treatments were evaluated as predictors of clinical outcomes using univariate and multivariate analyses. Clinical remission was defined as no symptoms associated with microscopic colitis based on physician assessment and histologic remission was defined as no evidence of histological inflammation of microscopic colitis.Seventy-two patients with microscopic colitis were included in the study (28 with lymphocytic colitis and 44 with collagenous colitis). Non-steroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors were used in 23 (31.9%), 14 (19.4%) and 15 (20.8%), respectively, at the time of diagnosis. Among 46 patients with adequate follow-up data, 25 (54.3%) patients achieved clinical remission. Response to budesonide (p = .0002) and achieving histologic remission (p = .0008) were associated with clinical remission on univariate analysis. On multivariate analysis, budesonide response (p = .0052) was associated with clinical remission (odds ratio 25.00, 95% confidence interval 2.63-238.10). Among 22 patients who underwent a follow-up colonoscopy, five patients (22.7%) achieved histologic remission. All patients with histologic remission maintained clinical remission without medication, whereas only two patients (11.8%) were able to discontinue medical therapy when histologic inflammation was present (p = .0002).In the present cohort of patients with microscopic colitis, a favourable response to budesonide was significantly associated with long-term clinical remission, and all patients achieving histological remission were able to maintain clinical remission without further medical therapy. Larger studies are required to confirm these findings.

  View details for DOI 10.1080/07853890.2024.2365989

  View details for PubMedID 38900021

• Acute severe ulcerative colitis: using JAK-STAT inhibitors for improved clinical outcomes. Frontiers in gastroenterology (Lausanne, Switzerland) Karthikeyan, S., Ambastha, C., Keyashian, K. 2024; 3: 1488288

  Abstract

  Acute Severe Ulcerative Colitis (ASUC) is a well-known and potentially fatal disease state, characterized by symptoms of systemic toxicity including fever, severe anemia, elevated inflammatory markers, and autonomic instability. The life-threatening nature of this condition requires clinicians to make prompt diagnoses and take rapid action, either directing patients towards surgical interventions or medical management. Failure to treat ASUC may lead to toxic dilation of the colon, hemorrhage, or sepsis. Current algorithms suggest the use of intravenous (IV) corticosteroids upon diagnosis, with transition to oral corticosteroids, calcineurin inhibitors or tumor necrosis factor (TNF) inhibitors upon reduction of severe symptoms for candidates deemed to be amenable to medical management. Within these classes, TNF inhibitors such as Infliximab (IFX) have proven to be the most safe, efficacious, and tolerable for patients. While IFX has much data supporting its benefits in achieving short term remission, there are still high rates of long-term need for colectomy and failure to maintain remission. This is due to interactions between the inflamed gastrointestinal tract, the increased metabolic activity seen in ASUC, and intrinsic pharmacodynamic properties of IFX. Certain novel studies suggest that Janus Kinase (JAK-STAT) inhibitors such as Tofacitinib and Upadacitinib are potent agents to salvage clinical remission achieved by IFX, upon its failure. Here we discuss methods to optimize the dosing of IFX to maximize its efficacy, while exploring recent work done on the safety and efficacy of JAK-STAT inhibitors as a salvage therapy, therefore suggesting a novel treatment algorithm to improve clinical outcomes in medically managed ASUC patients.

  View details for DOI 10.3389/fgstr.2024.1488288

  View details for PubMedID 41822704

  View details for PubMedCentralID PMC12952307

• Acute severe ulcerative colitis: using JAK-STAT inhibitors for improved clinical outcomes FRONTIERS IN GASTROENTEROLOGY Karthikeyan, S., Ambastha, C., Keyashian, K. 2024; 3

  View details for DOI 10.3389/fgstr.2024.1488288

  View details for Web of Science ID 001538294900001

• Small bowel adenocarcinoma in neoterminal ileum in setting of stricturing Crohn's disease: A case report and review of literature. World journal of clinical cases Karthikeyan, S., Shen, J., Keyashian, K., Gubatan, J. 2023; 11 (9): 2021-2028

  Abstract

  Small bowel adenocarcinomas (SBA) are rare malignancies with exceedingly low survival rates, with different presentation in Crohn's disease (CD). CD-induced SBA poses diagnostic challenges given overlapping presentation with stricturing CD and lack of diagnostics for early detection. Moreover, guidance is lacking on the impact of recently approved therapeutics in CD on SBA management. Here, we aim to highlight the future of CD-induced SBA management and discuss the potential merit of balloon enteroscopy and genetic testing for earlier detection.We report the case of a 60-year-old female with longstanding Crohn's ileitis, presenting with acute obstructive symptoms attributed to stricturing phenotype. Her obstructive symptoms were refractory to intravenous (IV) steroids, with further investigation via computed tomography enterography not providing additional diagnostic yield. Ultimately, surgical resection revealed SBA in the neoterminal ileum, with oncologic therapy plan created. However, this therapy plan could not be initiated due to continued obstructive symptoms attributed to active CD. Ultimately, infused biologic therapy was initiated, but her obstructive symptoms continued to remain dependent on IV corticosteroids. Review of diagnostics by a multidisciplinary care team suggested metastatic disease in the peritoneum, lending to a shift in the goals of care to comfort.With the diagnostic and therapeutic challenges of concurrent SBA and CD, multidisciplinary care and algorithmic management can optimize outcomes.

  View details for DOI 10.12998/wjcc.v11.i9.2021

  View details for PubMedID 36998944

  View details for PubMedCentralID PMC10044945

• Pentosan Polysulfate-Associated Dysplasia in Patients With Inflammatory Bowel Disease: A Case Series. The American journal of gastroenterology Anderson, J., Frost, S., Keyashian, K., Modiano, N. 2023

  Abstract

  INTRODUCTION: This study evaluates the potential association of pentosan polysulfate (PPS) with inflammatory bowel disease (IBD) or dysplasia.METHODS: We searched electronic medical records to identify patients with IBD using PPS.RESULTS: Ten of 30 identified patients (33.3%) had colonic dysplasia. Six of them (60%) underwent colectomy for endoscopically unresectable dysplasia. Three (10%) discontinued PPS, each with an apparent benefit.DISCUSSION: Patients with IBD at 2 institutions who had taken PPS had high rates of colonic dysplasia leading to surgery. Patients who stopped PPS showed improvement in their colitis. PPS may play a causal role in the development of colitis and dysplasia.

  View details for DOI 10.14309/ajg.0000000000002137

  View details for PubMedID 36689730

• Pentosan Polysulfate-Associated Dysplasia in Inflammatory Bowel Disease: A Case Series Anderson, J., Frost, S., Keyashian, K., Modiano, N. LIPPINCOTT WILLIAMS & WILKINS. 2022: S15

  View details for Web of Science ID 000897927000059

• Pentosan Polysulfate-Associated Dysplasia in Inflammatory Bowel Disease: A Case Series Anderson, J., Frost, S., Keyashian, K., Modiano, N. LIPPINCOTT WILLIAMS & WILKINS. 2022: S15

  View details for Web of Science ID 001433514400059

• Rates and Predictors of Long-term Clinical Outcomes in Patients With Perianal Crohn's Disease on Biologic Therapy. Journal of clinical gastroenterology Gubatan, J., Frost, S., Levitte, S., Keyashian, K. 2022

  Abstract

  Perianal Crohn's disease (pCD) represents an aggressive phenotype with limited studies on long-term outcomes. We evaluated 5-year outcomes of these patients on biologic therapies.We performed a retrospective analysis of patients with pCD at a tertiary medical center. We used Kaplan-Meier curves to estimate rates and multivariate logistic regression to identify predictors of long-term outcomes.We included 311 patients with pCD of which 168 patients were started on biologics [138 anti-tumor necrosis factor (TNF) α, 14 vedolizumab, 16 ustekinumab] at the time of diagnosis. Anti-TNF use at the time of diagnosis was associated with decreased rates of perianal abscess recurrence [hazard ratio (HR)=0.48, 95% confidence interval (CI): 0.32-0.74], whereas ustekinumab use was associated with increased rates of perianal fistula closure (HR=3.58, 95% CI: 1.04-12.35) and decreased rates of perianal abscess recurrence (HR=0.20, 95% CI: 0.07-0.56) at follow-up. Among patients who failed their first anti-TNF, switching to another anti-TNF was associated with decreased rates of colectomy (HR=0.20, 95% CI: 0.04-0.90) and permanent diversion (HR=0.16, 95% CI: 0.03-0.94) compared with ustekinumab, whereas vedolizumab use was associated with decreased perianal fistula closure (HR=0.22, 95% CI: 0.05-0.96) compared with ustekinumab. Predictors of colectomy included colonic disease (odds ratio=2.71, 95% CI: 1.36-5.38) and anal stenosis (odds ratio=4.44, 95% CI: 1.59-12.43).Type of biologic use at the time of pCD diagnosis or after first anti-TNF failure may be associated with long-term outcomes in patients with pCD.

  View details for DOI 10.1097/MCG.0000000000001729

  View details for PubMedID 35703262

• Biologic Therapy in Patients With Perianal Crohn's Disease and Association With Long-Term Rates of Surgical and Clinical Outcomes Gubatan, J., Frost, S., Levitte, S., Keyashian, K. LIPPINCOTT WILLIAMS & WILKINS. 2021: S354

  View details for Web of Science ID 000717526101241

• Anti-Integrins for the Treatment of Inflammatory Bowel Disease: Current Evidence and Perspectives. Clinical and experimental gastroenterology Gubatan, J., Keyashian, K., Rubin, S. J., Wang, J., Buckman, C. A., Sinha, S. 2021; 14: 333-342

  Abstract

  Leukocyte trafficking to the gastrointestinal tract is recognized to play a role in the pathogenesis of inflammatory bowel disease (IBD). Integrins are expressed on immune cells and interact with cell adhesion molecules (CAM) to mediate leukocyte trafficking. Blockade of the gut-tropic integrin α4β7 and its subunits has been exploited as a therapeutic target in IBD. Natalizumab (anti-α4) is approved for moderate to severe Crohn's disease (CD), but its use is limited due to potential risk of progressive multifocal leukoencephalopathy. Vedolizumab (anti-α4β7) is approved for the treatment of ulcerative colitis (UC) and CD. It is the most widely used anti-integrin therapy in IBD and has been shown to be effective in both induction and maintenance therapy, with a favorable safety profile. Several models incorporating clinical, genetic, immune, gut microbial, and vitamin D markers to predict response to vedolizumab in IBD have been developed. Etrolizumab (anti-β7) blocks leukocyte trafficking via α4β7 and cell adhesion via αEβ7 integrins. Large phase 3 clinical trials evaluating efficacy of etrolizumab in the induction and maintenance of patients with IBD are underway. Other investigational anti-integrin therapies include abrilumab (anti-α4β7 IgG2), PN-943 (orally administered and gut-restricted α4β7 antagonist peptide), AJM300 (orally active small molecule inhibitor of α4), and ontamalimab (anti-MAdCAM-1 IgG).

  View details for DOI 10.2147/CEG.S293272

  View details for PubMedID 34466013

  View details for PubMedCentralID PMC8402953

• Thiopurine Monotherapy Is Effective in Maintenance of Mild-Moderate Inflammatory Bowel Disease. Digestive diseases and sciences Barber, G. E., Hendler, S., Choe, M., Keyashian, K., Lechner, S., Limketkai, B. N., Limsui, D. 2021

  Abstract

  BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are complex, inflammatory bowel diseases (IBD) with debilitating complications. While severe IBD typically requires biologic agents, the optimal therapy for mild-moderate IBD is less clear.AIMS: To assess the efficacy of thiopurine monotherapy for maintenance of mild-moderate IBD and clinical variables associated with treatment outcome.METHODS: This retrospective study included adults with mild-moderate IBD who were started on thiopurines without biologic therapy. The primary outcome was therapy failure, defined by disease progression based on clinical, endoscopic, and radiologic criteria. Clinical variables were extracted at time of thiopurine initiation. Univariable and multivariable Cox proportional hazards models were used to examine the independent contribution of the clinical variables on treatment response.RESULTS: From 230 CD patients, 64 (72%) were free of treatment failure with mean follow-up of 3.3years. In our multivariable model, thiopurine failure was associated with concomitant systemic steroid administration (aHR 2.43, p=0.001), whereas protective factors included concomitant oral 5-aminosalicylic acid (5-ASA) therapy (aHR 0.54, p=0.02) and non-fistulizing, non-stricturing disease (aHR 0.57, p=0.047). From 173 UC patients, 50 (71%) were free from treatment failure with mean follow-up of 3.3years. On multivariable analysis, concomitant oral steroids were associated with thiopurine failure (aHR 2.71, p=0.001). Only 13 (4%) discontinued thiopurines from adverse effects.CONCLUSIONS: In mild-moderate uncomplicated IBD, thiopurine monotherapy was associated with longitudinal maintenance of remission and may represent a lower-cost, convenient, and effective alternative to biologics. Multiple clinical variables were predictive of treatment response.

  View details for DOI 10.1007/s10620-021-06947-x

  View details for PubMedID 33755823

• Anti-Integrins for the Treatment of Inflammatory Bowel Disease: Current Evidence and Perspectives CLINICAL AND EXPERIMENTAL GASTROENTEROLOGY Gubatan, J., Keyashian, K., Rubin, S. J. S., Wang, J., Buckman, C. A., Sinha, S. 2021; 14: 333-342

  View details for DOI 10.2147/CEG.S293272

  View details for Web of Science ID 000688310400001

• Comparative Incidence of Inflammatory Bowel Disease in Different Age Groups in the United States INFLAMMATORY BOWEL DISEASES Keyashian, K., Dehghan, M., Sceats, L., Kin, C., Limketkai, B. N., Park, K. T. 2019; 25 (12): 1983–89

  View details for DOI 10.1093/ibd/izz092

  View details for Web of Science ID 000504314600024

• Mass Transition: From Cecal Mass to Small Bowel Ischemia. Digestive diseases and sciences Lechner, S., Keyashian, K. 2019

  View details for DOI 10.1007/s10620-019-05726-z

  View details for PubMedID 31292782

• Protein-Calorie Malnutrition Reduces the Durability of Biologic Therapy in Inflammatory Bowel Disease Lechner, S., Hendler, S., Keyashian, K., Limsui, D., Li, K., Wolf, A., Limketkai, B. NATURE PUBLISHING GROUP. 2018: S356–S357

  View details for Web of Science ID 000464611001221

• Prevalence and Outcomes of Chronic Hepatitis B and C in Hospitalized Patients With Inflammatory Bowel Disease Li, K., Hendler, S., Chang, M., Okafor, P. N., Keyashian, K., Lechner, S., Limsui, D., Goel, A., Ho, A., Limketkai, B. NATURE PUBLISHING GROUP. 2018: S1557–S1558

  View details for Web of Science ID 000464611005356

• Gender disparities in gastroenterology fellowship director positions in the United States. Gastrointestinal endoscopy Woodward, Z., Rodriguez, Z., Jou, J. H., Keyashian, K., Chen, Y., Thomas, C. R., Elta, G. H., D'Souza, S. L. 2017

  Abstract

  Despite a paucity of women occupying leadership positions in academic medicine, studies have shown a higher ratio of female representation in the program director position compared with division chief in multiple specialties. This study aims to determine whether this trend exists in 3-year gastroenterology fellowships in the United States and to evaluate for any factors that may affect these differences.In 2015, data were collected for the 163 U.S. gastroenterology fellowship programs including program director, associate program director, division chief, gender distribution, program size, academic center affiliation, and geographic region.A higher percentage of men than women held the role of program director (82% vs 18%), associate program director (72% vs 28%), and division chief (93% vs 7%). Women in program leadership held lower academic rank than their male counterparts (P < .0001). The program director was more likely to be female if the division chief also was female (P = .03). Programs with a higher number of trainees tended to be led by a female program director (P = .06).A gender disparity exists in all gastroenterology leadership roles, although the magnitude is smaller for program director and associate program director than the role of division chief. Further studies are needed to investigate the impact of this disparity on promotion and academic productivity.

  View details for DOI 10.1016/j.gie.2017.01.019

  View details for PubMedID 28153570

• Uses and limitations of IgG4 positive plasma cells in evaluating ulcerative colitis. Journal of gastrointestinal and liver diseases : JGLD Keyashian, K. n., Duregon, E. n., Brinkerhof, B. T., Bradley, L. n., Larson, B. n., Lim, J. n., Modiano, N. n., Collins, J. n., Morgan, T. K., Hooper, J. E. 2017; 26 (4): 428–29

  View details for DOI 10.15403/jgld.2014.1121.264.igg

  View details for PubMedID 29253063

• A Model for Identifying Actionable Findings on Computed Tomography in Crohn’s Disease Patients in the Emergency Department Journal of Digestive Disorders and Diagnosis Loudin, M., Johnson, K., Lum, J., Laird, A., Wiedrick, J., Keyashian, K. 2017; 1 (3)
• The role of a nurse telephone call to prevent no-shows in endoscopy GASTROINTESTINAL ENDOSCOPY Childers, R. E., Laird, A., Newman, L., Keyashian, K. 2016; 84 (6): 1010-?

  Abstract

  Preventing missed appointments, or "no-shows," is an important target in improving efficient patient care and lowering costs in gastrointestinal endoscopy practices. We aimed to investigate whether a nurse telephone call would reduce no-show rates for endoscopic appointments, and to determine if hiring and maintaining a nurse dedicated to pre-endoscopy phone calls is economically advantageous. Our secondary aim was to identify predictors of no-shows to endoscopy appointments.We hired and trained a full-time licensed nurse to make a telephone call to patients 7 days before their scheduled upper endoscopy or colonoscopy. We compared this intervention with a previous reminder system involving mailed reminders. The effect of the intervention and impact of other predictors of no-shows were analyzed in 2 similar preintervention and postintervention patient cohorts. A mixed effects logistic regression model was used to estimate the association of the odds of being a no-show to the scheduled appointment and the characteristics of the patient and visit. An analysis of costs was performed that included the startup and maintenance costs of the intervention.We found that a nurse phone call was associated with a 33% reduction in the odds of a no-show visit (odds ratio, 0.67; 95% confidence interval, 0.50-0.91), adjusting for gender, age, partnered status, insurer type, distance from the endoscopy center, and visit type. The recovered reimbursement during the study period was $48,765, with net savings of $16,190 when accounting for the maintenance costs of the intervention; this resulted in a net revenue per annum of $43,173.We found that endoscopy practices may increase revenue, improve scheduling efficiency, and maximize resource utilization by hiring a nurse to reduce no-shows. Predictors of no-shows to endoscopy included unpartnered or single patients, commercial or managed care, being scheduled for colonoscopy as opposed to upper endoscopy, and being scheduled for a screening or surveillance colonoscopy.

  View details for DOI 10.1016/j.gie.2016.05.052

  View details for Web of Science ID 000389611900021

  View details for PubMedID 27327847

• Novel Topics in Inflammatory Bowel Disease BIOMED RESEARCH INTERNATIONAL Sakuraba, A., Armuzzi, A., Keyashian, K., Naganuma, M. 2016

  View details for DOI 10.1155/2016/8958751

  View details for PubMedID 27006952

• Prevalence of Antibodies Against JC Virus in Patients With Refractory Crohn's Disease and Effects of Natalizumab Therapy CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Bellaguarda, E., Keyashian, K., Pekow, J., Rubin, D. T., Cohen, R. D., Sakuraba, A. 2015; 13 (11): 1919-1925

  Abstract

  Natalizumab, a humanized antibody against the α4 integrin subunit, effectively induces and maintains remission in patients with Crohn's disease (CD) refractory to conventional treatments. Progressive multifocal leukoencephalopathy is a rare but fatal brain infection caused by John Cunningham (JC) virus and has been associated with natalizumab use. We assessed the prevalence of and risk factors for antibodies to JC virus in serum of patients with refractory CD who were candidates for, or already were receiving, natalizumab. We also assessed the effects of natalizumab treatment of these patients.In a retrospective study, we analyzed clinical charts from 191 patients with CD (74 males; mean age, 38.7 y; mean duration of disease, 14.9 y) tested for serum JC virus antibody from December 2012 through May 2014 at 2 medical centers in the United States. We calculated JC virus antibody prevalence and compared the characteristics of patients who tested negative vs those who tested positive, to identify risk factors. We also assessed the rate of subsequent natalizumab use, surgery, and seroconversion during natalizumab therapy.A total of 129 of the patients (67.5%) tested positive for serum JC virus antibody. Multivariate analysis showed that past use of thiopurine was a risk factor for testing positive for JC virus antibody (odds ratio, 7.8; 95% confidence interval, 2.0-30.4; P = .003). Twenty-two of the patients who tested negative for JC virus antibody (35.5%) and 16 of the 129 patients who tested positive (12.4%) had been treated with natalizumab. Cox regression analysis determined that natalizumab use was the only factor associated with avoiding subsequent surgery (hazard ratio, 0.23; 95% confidence interval, 0.06-0.98). Seroconversion (from testing negative to positive for JC virus antibody) occurred in 1 of the 22 patients (4.5%) who initially tested negative during natalizumab therapy.The prevalence of CD patients exposed to JC virus is comparable with that of the general population. In this retrospective study, prior thiopurine use was associated with an increased risk for testing positive for JC virus antibody. Natalizumab use reduced the risk of subsequent surgery.

  View details for DOI 10.1016/j.cgh.2015.05.022

  View details for Web of Science ID 000363165700014

  View details for PubMedID 26001336

  View details for PubMedCentralID PMC4795937

• Strictureplasty for Treatment of Crohn's Disease: an ACS-NSQIP Database Analysis JOURNAL OF GASTROINTESTINAL SURGERY Geltzeiler, C. B., Young, J. I., Diggs, B. S., Keyashian, K., Deveney, K., Lu, K. C., Tsikitis, V. L., Herzig, D. O. 2015; 19 (5): 905-910

  Abstract

  Strictureplasty is an alternative to resection for treatment of Crohn's disease (CD) strictures. It preserves bowel length, and specialized centers report favorable outcomes. Strictureplasty rates, however, are thought to be low, and it was recently removed from required cases for colon and rectal surgery residents. We examined operative characteristics, and trends in its use using a large national database.We examined the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2012, identifying patients with CD who underwent strictureplasty. We identified patient characteristics, outcome variables, and trends in utilization of strictureplasty.A total of 9172 patients underwent surgery for CD. Two hundred fifty-six (2.8 %) underwent strictureplasty. Median preoperative albumin was 3.6. Preoperative steroid use and weight loss rates were 39 and 8 %. Rates of wound infection and organ space infection were 11 and 4 %. Rate of reoperation was 6 %. Outcomes did not change significantly over time (all p = NS). The proportion of CD operations that included a strictureplasty decreased from 5.1 to 1.7 % (OR 0.902 with each additional year, 95 % CI (0.852, 0.960), p < 0.001).Strictureplasty as treatment for CD is decreasing in the ACS-NSQIP database. Infectious complications and reoperation rates following strictureplasty are low and have not changed over time.

  View details for DOI 10.1007/s11605-015-2749-8

  View details for Web of Science ID 000353198400014

  View details for PubMedID 25617078

• Initial Surgical Management of Ulcerative Colitis in the Biologic Era DISEASES OF THE COLON & RECTUM Geltzeiler, C. B., Lu, K. C., Diggs, B. S., Deveney, K. E., Keyashian, K., Herzig, D. O., Tsikitis, V. L. 2014; 57 (12): 1358-1363

  Abstract

  The initial minimum operation for ulcerative colitis is a total abdominal colectomy. Healthy patients may undergo proctectomy at the same time; however, for ill patients, proctectomy is delayed. Since the introduction of biologic medications in 2005, ulcerative colitis medical management has changed dramatically.We examined how operative management for ulcerative colitis has changed from the prebiologic to biologic eras.We conducted a retrospective review of data on patients with ulcerative colitis who were included in the Nationwide Inpatient Sample database.This study was conducted at a single university.A total of 1,547,852 patients with ulcerative colitis who were admitted to a US hospital from 1991 to 2011 were included in the study.We examined patients whose initial operation consisted of total abdominal colectomy without proctectomy versus a total proctocolectomy with or without a pouch. We also examined which operation was done at the time of the construction of an ileoanal pouch. Patients who underwent colectomy and pouch construction in the same hospitalization were compared with those who received pouch formation at a subsequent hospitalization.Ulcerative colitis-related admissions rose by 170% during the years examined, and the number of patients who required total abdominal colectomy increased by 44%. Total abdominal colectomy increased by 15%, as opposed to total proctocolectomy (p < 0.001). Pouch construction at a subsequent operation increased by 16% (p = 0.002). Since 2008, total abdominal colectomy has surpassed total proctocolectomy as the most common initial surgical intervention for ulcerative colitis.The Nationwide Inpatient Sample is a retrospective database, and we were limited to examining the variables within it.Total abdominal colectomy is currently the most common initial operation for patients with ulcerative colitis, and an ileoanal pouch is more frequently constructed at a subsequent hospitalization. These trends coincide with the initiation of biologic treatments and may imply that patients are acutely ill at the time of initial operation. Alternately, there may be surgeon-perceived bias of increased surgical risk or a shift in care to specialized surgeons for pouch construction.

  View details for DOI 10.1097/DCR.0000000000000236

  View details for PubMedID 25380000

• Does Endoscopic Assessment of Mucosal Healing Affect IBD Management? DIGESTIVE DISEASES AND SCIENCES Keyashian, K. 2014; 59 (10): 2351-2353

  View details for DOI 10.1007/s10620-014-3311-3

  View details for PubMedID 25129105

• Monitoring and management of toxicities in long-term thiopurine therapy. Gastroenterology & hepatology Keyashian, K. 2013; 9 (10): 672-674

  View details for PubMedID 24764783

• Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy ALIMENTARY PHARMACOLOGY & THERAPEUTICS Sheibani, S., Kim, J. J., Chen, B., Park, S., Saberi, B., Keyashian, K., Buxbaum, J., Laine, L. 2013; 38 (2): 144-150

  Abstract

  Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours.To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding.Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied.Tumours were the source of bleeding in 106 (5%) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16%), gastric in 77 (73%) and duodenal in 12 (11%). At presentation, 84 (79%) did not have known cancer previously, and 79 (75%) had metastatic disease. Seventy-seven (73%) received transfusions at index hospitalisation. At endoscopy, 32 (30%) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86%) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49%) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95% CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95% CI 1.08-5.46) were associated with rebleeding.Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.

  View details for DOI 10.1111/apt.12347

  View details for Web of Science ID 000320472400007

  View details for PubMedID 23710797

• Natalizumab in Crohn's Disease: Results From a US Tertiary Inflammatory Bowel Disease Center INFLAMMATORY BOWEL DISEASES Sakuraba, A., Keyashian, K., Correia, C., Melek, J., Cohen, R. D., Hanauer, S. B., Rubin, D. T. 2013; 19 (3): 621-626

  Abstract

  Natalizumab is an efficacious agent for the induction and maintenance of remission in patients with Crohn's disease (CD) who have failed anti-tumor necrosis factor (TNF) agents. We aimed to assess the efficacy and safety of natalizumab outside of clinical trial at a US tertiary center.Retrospective case review of patients with CD receiving natalizumab.Forty-nine patients with CD (28 women; median age, 33 years) receiving natalizumab from April 2008 to November 2011 were identified. Median duration of disease was 180 months (range, 36-576 months); 40 patients had ileocolonic disease, 1 had ileal disease, and 8 had colonic disease. Twenty-one patients had penetrating disease, and 28 had a history of CD-related surgical treatment. Forty-seven patients previously failed treatment with at least 1 anti-TNF agent. Median duration of natalizumab treatment was 7 months (interquartile range, 3-21.5 months). Twenty-four patients (49%) were continuing natalizumab at the time of this review, and 25 discontinued treatment because of the lack of response, side effects, or positive JC virus antibody. Seventeen patients (35%) successfully continued treatment with natalizumab for longer than 12 months, and nonpenetrating disease phenotype was identified as a predictor of longer response (compared with penetrating phenotype; P = 0.013). Nine patients (18.4%) experienced adverse effects, 5 of which were serious, but no case of progressive multifocal leukoencephalopathy occurred.This is the largest series of natalizumab-treated patients with CD. Our results show that natalizumab is an efficacious and safe treatment agent for patients refractory to anti-TNF agents and that nonpenetrating disease phenotype has more durable response over time.

  View details for DOI 10.1097/MIB.0b013e31827eea78

  View details for Web of Science ID 000316450200035

  View details for PubMedID 23429449

  View details for PubMedCentralID PMC4779049

• Barrett's esophagus in Latinos undergoing endoscopy for gastroesophageal reflux disease symptoms DISEASES OF THE ESOPHAGUS Keyashian, K., Hua, V., Narsinh, K., Kline, M., Chandrasoma, P. T., Kim, J. J. 2013; 26 (1): 44-49

  Abstract

  Previous studies comparing the prevalence of Barrett's esophagus in Latinos and non-Latino whites are inconsistent. The aim of the study is to compare the prevalence of Barrett's esophagus in Latinos and non-Latino whites and to determine risk factors associated with Barrett's esophagus. Between March 2005 and January 2009, consecutive Latino and non-Latino white patients who underwent endoscopy for primary indication for symptoms of gastroesophageal reflux disease were identified by examining the internal endoscopy database at Los Angeles County + USC Medical Center. Barrett's esophagus was defined by columnar-lined distal esophagus on endoscopy confirmed by intestinal metaplasia on histology. Clinical features and endoscopic findings were retrospectively reviewed. The mean age of the 663 patients was 50 ± 12 years, 30% were male, and 92% were Latino. Compared with non-Latino whites, Latinos had more females (72% vs. 46%; P = 0.0001) and more Helicobacter pylori infection (53% vs. 24%; P = 0.003) but less tobacco use (7% vs. 17%; P = 0.01). Overall, 10% (68/663) of all patients had Barrett's esophagus whereas the prevalence was 10% (62/611) among the Latinos and 12% (6/52) among the non-Latino whites (OR 0.9, 95% CI 0.4-2.1; P = 0.75). One patient in the Latino group had high-grade dysplasia. On multivariate analysis, male gender (AOR 2.3, 95% CI 1.4-4.1; P = 0.002), diabetes (AOR 2.2, 95% CI 1.1-4.5; P = 0.03), and age ≥55 years (AOR 2.2, 95% CI 1.3-3.8; P = 0.006) were independently associated with Barrett's esophagus; Latino ethnicity remained nonsignificant (AOR 1.1, 95% CI 0.4-2.7; P = 0.88). In Latinos undergoing endoscopy for gastroesophageal reflux disease symptoms, the prevalence of Barrett's esophagus was 10%, comparable with non-Latino white controls as well as the prevalence previously reported among Caucasians. In addition to established risk factors, diabetes was associated with Barrett's esophagus.

  View details for DOI 10.1111/j.1442-2050.2011.01316.x

  View details for Web of Science ID 000313251600007

  View details for PubMedID 22332868

• Pleural effusion caused by a pancreatic pleural fistula GASTROINTESTINAL ENDOSCOPY Keyashian, K., Buxbaum, J. 2012; 76 (2): 422-423

  View details for DOI 10.1016/j.gie.2012.03.1396

  View details for Web of Science ID 000306520400032

  View details for PubMedID 22658391

• Management of inflammatory bowel disease: past, present and future EXPERT REVIEW OF CLINICAL IMMUNOLOGY Keyashian, K., Annunziata, M. L., Sakuraba, A., Hanauer, S. 2012; 8 (4): 303-305

  View details for DOI 10.1586/ECI.12.13

  View details for Web of Science ID 000306158800003

  View details for PubMedID 22607175

• Effect of alvimopan and codeine on gastrointestinal transit: A randomized controlled study CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Gonenne, J., Camilleri, M., Ferber, I., Burton, D., Baxter, K., Keyashian, K., Foss, J., Wallin, B., Du, W., Zinsmeister, A. R. 2005; 3 (8): 784-791

  Abstract

  background & aims: Opiate bowel dysfunction is a significant clinical problem. Our aim was to evaluate the ability of a peripheral mu-opioid antagonist, alvimopan, to reverse the effect of codeine on gastric, small-bowel, and colonic transit time in healthy volunteers.Seventy-four healthy participants (43 women) were randomized in a double-blind, placebo-controlled manner to 1 of 4 groups: alvimopan 12 mg twice daily in the presence and absence of codeine sulfate 30 mg 4 times/day, or codeine or placebo alone. Gastric emptying, small-bowel, and colonic transit were measured by scintigraphy using a 99m-labeled technetium egg meal and 111-labeled indium charcoal delivered to the proximal colon via a delayed-release capsule. The primary end points for colonic transit were geometric center of the colonic counts at 24 hours and time for 50% ascending colon emptying. Analysis of covariance was used to assess the significance of the primary and secondary end points.Codeine delayed gastric, small-bowel, proximal, and overall colonic transit (P < .05). Alvimopan reversed codeine's effect on small bowel and colon (ascending colon and overall colonic transit). Alvimopan also accelerated overall colonic transit compared with placebo. Thus, the mean colonic geometric center at 24 hours was 2.33 with placebo/placebo, 3.25 with alvimopan/placebo (P < .05), 1.5 with placebo/codeine (P < .05), and 2.63 with alvimopan/codeine. Alvimopan did not reverse codeine's delay of gastric emptying.Alvimopan reverses codeine's inhibitory effect on small-bowel and colon transit and has potential for treatment of opiate bowel dysfunction. Alvimopan alone accelerates colonic transit, suggesting that mu-opiate mechanisms participate in the physiologic control of colonic transit.

  View details for DOI 10.1053/S1542-3565(05)00434-9

  View details for Web of Science ID 000234105700012

  View details for PubMedID 16234007