Abhishek Dimopoulos-Verma, MD

All Publications

• Statin use is associated with lower rates of stricture development in patients with Crohn's disease: a propensity score-matched study of two nationwide population databases. Journal of Crohn's & colitis Dimopoulos-Verma, A., Kulkarni, C., Pike, C. W., Gombar, S., Dasarathy, D., Rieder, F., Sinha, S. R. 2026; 20 (3)

  Abstract

  Intestinal stricture affects over half of patients with Crohn's disease (CD) and has significant associated morbidity. Statins possess both anti-inflammatory and anti-fibrotic properties and may improve CD outcomes, although current data are limited. This study assessed whether statin use is associated with a reduced risk of new stricture development in CD in a diverse US population, and evaluated the role of IBD therapy in any association.We conducted a retrospective cohort study comparing patients with CD with and without statin exposure using the EVERSANA US electronic health records database. Findings were independently validated in a second database (Merative MarketScan). Patient demographics, co-morbidities, laboratory measurements, and CD medications were assessed. The primary outcome was development of new stricture as defined by a composite endpoint of an encounter for stricture diagnosis or occurrence of a stricture-related procedure. Propensity score (PS)-matched Cox proportional hazards models were used to estimate associations.The EVERSANA cohort comprised 1210 statin recipients and 25 000 non-statin users. Over a mean follow-up of 3.8 years, PS-matched statin users had a 28% reduction in the risk of new-onset stricture (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.53-0.99, P = .043). The Merative cohort contained 9577 statin users and 56 918 non-statin users. Over a mean follow-up of 3.6 years, PS-matched statin use had a 29% risk reduction in new-onset stricture (HR 0.71, 95% CI 0.66-0.77, P < .001).Statin use is independently associated with reduced progression to stricture formation in two PS-matched large and diverse cohorts of patients with CD.

  View details for DOI 10.1093/ecco-jcc/jjag034

  View details for PubMedID 41903936

• Oral vancomycin is associated with less therapy intensification in adults with symptomatic inflammatory bowel disease and underlying primary sclerosing cholangitis. Annals of gastroenterology Kulkarni, C., Talamantes, S., Dimopoulos-Verma, A., Fardeen, T., Khan, S., Cholankeril, G., Triadafilopoulos, G., Sinha, S. R. 2025; 38 (4): 409-414

  Abstract

  Case reports describe the use of oral vancomycin therapy (OVT) in adult patients with concomitant symptomatic inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). OVT is associated with a higher likelihood of IBD remission in pediatric IBD-PSC patients. However, there are limited data on the association between OVT and IBD disease course in adult IBD-PSC patients.We retrospectively evaluated IBD therapy intensification in adults with IBD-PSC prescribed OVT at 2 centers. Subjects were stratified by time "on" and "off" OVT. Only those who spent a minimum of 12 months in each period were included. The primary outcome was the frequency of IBD therapy intensification events.Of 31 patients initially considered, 22 met the inclusion criteria. Most patients (68.2%) had fewer or no intensification events while "on OVT" compared to those "off OVT". OVT was associated with fewer therapy intensification events (1.7 vs. 6.7, P=0.021) and steroid prescriptions (0.6 vs. 3.2, P=0.013) per 10 person-years.OVT use is associated with less need for IBD therapy intensification in symptomatic IBD-PSC adult patients. Prospective trials of OVT in such patients are warranted.

  View details for DOI 10.20524/aog.2025.0978

  View details for PubMedID 40697439

  View details for PubMedCentralID PMC12277516

• Oral vancomycin is associated with less therapy intensification in adults with symptomatic inflammatory bowel disease and underlying primary sclerosing cholangitis ANNALS OF GASTROENTEROLOGY Kulkarni, C., Talamantes, S., Dimopoulos-Verma, A., Fardeen, T., Khan, S., Cholankeril, G., Triadafilopoulos, G., Sinha, S. R. 2025

  View details for DOI 10.20524/aog.2025.0978

  View details for Web of Science ID 001530973900001

• PCR-based stool testing for enteric infections in flares of inflammatory bowel disease: Is more data worth the cost? Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology Dimopoulos-Verma, A., Axelrad, J. E. 2025

  View details for DOI 10.1007/s12664-025-01793-5

  View details for PubMedID 40377862

  View details for PubMedCentralID 9115373

• Enteric Infection at Flare of Inflammatory Bowel Disease Impacts Outcomes at 2 Years. Inflammatory bowel diseases Dimopoulos-Verma, A., Hong, S., Axelrad, J. E. 2023

  Abstract

  BACKGROUND: Outcomes of inflammatory bowel disease (IBD) following flare complicated by enteric infection (EI) are limited by follow-up duration and insufficient assessment of the role of non-Clostridioides difficile pathogens. We compared 2-year IBD outcomes following flare with and without EI.METHODS: We performed a retrospective cohort study of adults evaluated with stool PCR testing for IBD flare. Subjects were stratified by presence of EI at flare and were matched for age, sex, and date to those without EI. The primary outcome was a composite of steroid-dependent IBD, colectomy, and/or IBD therapy class change/dose escalation at 2 years. Additional analyses were performed by dividing the EI group into C. difficile infection (CDI) and non-CDI EI, and further subdividing non-CDI EI into E. coli subtypes and other non-CDI EI.RESULTS: We identified 137 matched subjects, of whom 62 (45%) had EI (40 [29%] CDI; 17 [12%] E. coli). Enteric infection at flare was independently associated with the primary outcome (adjusted odds ratio, 4.14; 95% confidence interval [CI], 1.62-11.5). After dividing EI into CDI and non-CDI EI, only CDI at flare was independently associated with the primary outcome (adjusted odds ratio, 4.04; 95% CI, 1.46-12.6). After separating E. coli subtypes from non-CDI EI, E. coli infection and CDI at flare were both independently associated with the primary outcome; other EI was not.CONCLUSIONS: Enteric infection at flare-specifically with CDI-is associated with worse IBD outcomes at 2 years. The relationship between E. coli subtypes at flare and subsequent IBD outcomes requires further investigation.

  View details for DOI 10.1093/ibd/izad253

  View details for PubMedID 37861390

• Differences by transplant type in stool multiplex PCR testing for acute diarrhea in post-solid organ transplantation. Frontiers in gastroenterology (Lausanne, Switzerland) Verma, A., Hine, A. M., Joelson, A., Mei, R., Lebwohl, B., Axelrad, J. E. 2022; 1: 1064187

  Abstract

  Diarrhea in solid organ transplant (SOT) recipients is common, morbid, and increasingly evaluated using multiplex gastrointestinal PCR panel (GI panel) testing. We aimed to characterize differences between transplant organ types in GI panel evaluation of acute diarrhea in SOT recipients.We performed a dual-center retrospective cross-sectional study of adult SOT recipients with acute diarrhea who underwent GI panel testing. Demographic, transplant, testing context, and GI panel data were collected. Patients were stratified by transplant type. The primary outcome was a positive GI panel.Of 300 transplant recipients (58 heart, 65 liver, 68 lung, and 109 renal), 118 had a positive GI panel. Renal transplant status correlated with more frequently positive GI panel and less frequent hospitalization. In a multivariate analysis adjusting for demographic factors, hospitalization, immunosuppression, and transplant age, renal transplantation was independently associated with a positive GI panel compared to lung transplantation (aOR 2.98, 95% CI 1.27-7.16). Older transplant age and outpatient testing were also independently associated with a positive GI panel. The GI panel result was associated with changes to antibiotic management.In the evaluation of SOT recipients with acute diarrhea, GI panel result varies by transplant type, transplant age, and testing location and may affect subsequent antimicrobial therapy.

  View details for DOI 10.3389/fgstr.2022.1064187

  View details for PubMedID 41822068

  View details for PubMedCentralID PMC12952319

• The influence of hospitalization and HIV severity on gastrointestinal PCR panel evaluation of HIV-related acute diarrhea in New York City: a retrospective, cross-sectional study. Therapeutic advances in gastroenterology Verma, A., Hine, A. M., Joelson, A., Mei, R., Pitts, R. A., Lebwohl, B., Axelrad, J. E. 2022; 15: 17562848221092593

  Abstract

  Diarrhea is common in persons living with HIV (PLWH)/AIDS. With the increasing utilization of multiplex gastrointestinal PCR panel (GI panel) testing, we aimed to characterize the roles of CD4 count and hospitalization in GI panel assessments of PLWH with acute diarrhea.We performed a cross-sectional study of adult PLWH with acute diarrhea who underwent GI panel testing at two urban academic centers. Demographic, HIV disease, GI panel result, and hospitalization data were collected, and patients were cohorted by CD4 count (CD4 < 200, CD4 200-499, CD4 > = 500). The primary outcome was enteric infection as detected by GI panel, and hospitalization.Of 298 PLWH, 119 (39.9%) had a CD4 count below 200, 195 (65.4%) were hospitalized, and 137 (46.0%) had enteric infection. Bacterial infection correlated with higher CD4 count (41.9% (CD4 > = 500) vs 31.2% (CD4 200-499) vs 25.2% (CD4 < 200), p = 0.041). Hospitalization correlated with poorly controlled HIV and fewer enteric infections (34.4% vs 68.0%, p < 0.001). After adjusting for HIV disease severity, a negative GI panel remained independently associated with hospitalization (adjusted odds ratio (aOR) 5.32, 95% confidence interval (CI) 2.72-10.9), even in patients tested within 72 hours of hospitalization. Despite better HIV control, men who have sex with men (MSM) had more frequent infectious diarrhea, including from E. coli, giardiasis, and multiple pathogens. MSM status independently predicted enteric infection (aOR 1.93, 95% CI: 1.02-3.67).GI panel results vary by HIV disease severity and hospitalization in PLWH. Clinicians - especially in the inpatient setting - should carefully consider these factors when interpreting GI panel results. Further characterization of diarrheal etiology in PLWH with a negative GI panel is needed.PCR stool test results are affected by certain factors in HIV-related diarrhea Diarrhea is common in people living with HIV (PLWH) and has a variety of causes, including infections, medications, and HIV itself. Multiplex polymerase chain reaction (PCR) stool testing simultaneously evaluates for a variety of common viral, bacterial, and parasitic infections of the gastrointestinal tract, and is increasingly being used in patients with diarrhea. However, patients with HIV and diarrheal illness may have uncommon infections not typically present in those with normal immune function - and thus not routinely evaluated for in stool testing. It is not known what factors, if any, might affect the results of PCR testing in HIV-related diarrhea.In this study, we examined all PLWH who underwent stool PCR testing for diarrhea over a 4-year period. We separated the patients into groups based on HIV disease severity as measured by CD4 T-cell count, or the count of the immune cells affected by HIV. We examined whether there were differences among groups in infection rates as detected by PCR stool testing. Separately, we studied the role of hospitalization in stool PCR test results.Of 298 PLWH who underwent stool PCR testing for diarrhea, 119 had a CD4 count less than 200 (low CD4 count), 195 were hospitalized at time of testing, and 137 had a positive stool PCR test. Compared to those with a low CD4 count, subjects with less severe HIV disease were more likely to have a bacterial infection on stool PCR testing and less likely to be hospitalized. Hospitalized patients were more likely to have a negative PCR stool test, regardless of CD4 count. Many patients with a low CD4 count had diarrheal etiologies not evaluated by multiplex stool PCR. In PLWH who experience diarrhea, stool PCR testing results vary by CD4 count and hospitalization. Providers should be mindful of these factors when interpreting stool PCR test results.

  View details for DOI 10.1177/17562848221092593

  View details for PubMedID 35509422

  View details for PubMedCentralID PMC9058368

• A Simple Emergency Department-Based Score Predicts Complex Hospitalization in Patients with Inflammatory Bowel Disease. Digestive diseases and sciences Verma, A., Varma, S., Freedberg, D. E., Axelrad, J. E. 2022; 67 (2): 629-638

  Abstract

  Thirty percent of inflammatory bowel disease (IBD) patients hospitalized with flare require salvage therapy or surgery. Additionally, 40% experience length of stay (LOS) > 7 days. No emergency department (ED)-based indices exist to predict these adverse outcomes at admission for IBD flare. We examined whether clinical, laboratory, and endoscopic markers at presentation predicted prolonged LOS, inpatient colectomy, or salvage therapy in IBD patients admitted with flare.Patients with ulcerative colitis (UC) or colonic involvement of Crohn's disease (CD) hospitalized with flare and tested for Clostridioides difficile infection (CDI) between 2010 and 2020 at two urban academic centers were studied. The primary outcome was complex hospitalization, defined as: LOS > 7 days, inpatient colectomy, or inpatient infliximab or cyclosporine. A nested k-fold cross-validation identified predictive factors of complex hospitalization.Of 164 IBD admissions, 34% (56) were complex. Predictive factors included: tachycardia in ED triage (odds ratio [OR] 3.35; confidence interval [CI] 1.79-4.91), hypotension in ED triage (3.45; 1.79-5.11), hypoalbuminemia at presentation (2.54; 1.15-3.93), CDI (2.62; 1.02-4.22), and endoscopic colitis (4.75; 1.75-5.15). An ED presentation score utilizing tachycardia and hypoalbuminemia predicted complex hospitalization (area under curve 0.744; CI 0.671-0.816). Forty-four of 48 (91.7%) patients with a presentation score of 0 (heart rate < 99 and albumin ≥ 3.4 g/dL) had noncomplex hospitalization.Over 90% of IBD patients hospitalized with flare with an ED presentation score of 0 did not require salvage therapy, inpatient colectomy, or experience prolonged LOS. A simple ED-based score may provide prognosis at a juncture of uncertainty in patient care.

  View details for DOI 10.1007/s10620-021-06877-8

  View details for PubMedID 33606139

  View details for PubMedCentralID PMC8373997

• Patients with More Severe IBD Get Clostridioides difficile Rather than Clostridioides difficile Increasing the Severity of IBD. Digestive diseases and sciences Varma, S., Faye, A. S., Kannan, A., Lawlor, G., Verma, A., Axelrad, J., Freedberg, D. E. 2021; 66 (9): 3113-3123

  Abstract

  Inflammatory bowel disease (IBD) patients who have Clostridioides difficile infection (CDI) have worse outcomes.We aimed to determine whether such outcomes are the result of CDI or whether CDI occurs in patients who have more severe IBD.This was a retrospective study of patients hospitalized for ≥ 2 IBD flares from 2010 to 2019. The primary outcome was time to IBD flare between hospitalizations. First, time to flare was compared between patients who were hospitalized for a flare complicated by CDI and subsequently for a CDI-negative flare (cohort A, denoted +/-) versus patients who were hospitalized for two CDI-negative flares (cohort B, -/-). Second, time between flares was compared within the subset of cohort A patients who had three flares (cohort C, -/+/-) before and after CDI.Time between flares was a median of 4 months (IQR 1-9) among 51 cohort A patients versus 12 months (IQR 6-38) among 51 cohort B patients (log-rank P < 0.01). In contrast, the median time between flares was similar within cohort C before and after CDI (log-rank P = 0.54). At time of the second IBD flare, patients in cohort A (+/-) were more likely to have moderate or severe disease compared to patients in cohort B (-/-).Patients with prior CDI had shorter time to subsequent IBD flare relative to their CDI-negative counterparts. This is not likely due to CDI itself because there was no difference in time between flares before versus after acquiring CDI. Rather, patients who acquire CDI may have more severe IBD.

  View details for DOI 10.1007/s10620-020-06504-y

  View details for PubMedID 32729015

• The Colonic Mucosal MicroRNAs, MicroRNA-219a-5p, and MicroRNA-338-3p Are Downregulated in Irritable Bowel Syndrome and Are Associated With Barrier Function and MAPK Signaling. Gastroenterology Mahurkar-Joshi, S., Rankin, C. R., Videlock, E. J., Soroosh, A., Verma, A., Khandadash, A., Iliopoulos, D., Pothoulakis, C., Mayer, E. A., Chang, L. 2021; 160 (7): 2409-2422.e19

  Abstract

  Alterations in microRNA (miRNA) and in the intestinal barrier are putative risk factors for irritable bowel syndrome (IBS). We aimed to identify differentially expressed colonic mucosal miRNAs, their targets in IBS compared to healthy controls (HCs), and putative downstream pathways.Twenty-nine IBS patients (15 IBS with constipation [IBS-C], 14 IBS with diarrhea [IBS-D]), and 15 age-matched HCs underwent sigmoidoscopy with biopsies. A nCounter array was used to assess biopsy specimen-associated miRNA levels. A false discovery rate (FDR) < 10% was considered significant. Real-time polymerase chain reaction (PCR) was used to validate differentially expressed genes. To assess barrier function, trans-epithelial electrical resistance (TEER) and dextran flux assays were performed on Caco-2 intestinal epithelial cells that were transfected with miRNA-inhibitors or control inhibitors. Protein expression of barrier function associated genes was confirmed using western blots.Four out of 247 miRNAs tested were differentially expressed in IBS compared to HCs (FDR < 10%). Real-time PCR validation suggested decreased levels of miR-219a-5p and miR-338-3p in IBS (P = .026 and P = .004), and IBS-C (P = .02 and P = .06) vs. HCs as the strongest associations. Inhibition of miR-219a-5p resulted in altered expression of proteasome/barrier function genes. Functionally, miR-219a-5p inhibition enhanced the permeability of intestinal epithelial cells as TEER was reduced (25-50%, P < .05) and dextran flux was increased (P < .01). Additionally, inhibition of miR-338-3p in cells caused alterations in the mitogen-activated protein kinase (MAPK) signaling pathway genes.Two microRNAs that potentially affect permeability and visceral nociception were identified to be altered in IBS patients. MiR-219a-5p and miR-338-3p potentially alter barrier function and visceral hypersensitivity via neuronal and MAPK signaling and could be therapeutic targets in IBS.

  View details for DOI 10.1053/j.gastro.2021.02.040

  View details for PubMedID 33617890

  View details for PubMedCentralID PMC8169529

• Human Endothelial Cell Collection from the Middle Cerebral Artery in Acute Ischemic Stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association Sheth, S. A., Verma, A., Malhotra, K., Tang, X., Tateshima, S., Jahan, R., Hinman, J. D. 2018; 27 (3): 669-672

  Abstract

  Endovascular treatment for large-vessel acute ischemic stroke (AIS) has rapidly emerged. However, the understanding of the complex biology involving endothelial cells (ECs) remains scarce.Using stent retrievers during endovascular thrombectomy (ET) in patients with AIS, ECs were segregated, centrifuged in a dissociation buffer, and suspended in endothelial specific antibody solution. Subsequently, fluorescence-activated cell sorting (FACS) and microscopic analyses were performed.Three stent-retriever devices (2 Solitaire, 1 Trevo) were collected as separate deployments. Of 5.0% (±.48%) total events using FACS, 6.8% (±.68%) of cells were specific for ECs using fluorescent markers and were further visualized on fluorescence microscopy for consistence with the positive controls.We describe a novel, minimally invasive biopsy technique to collect and harvest ECs from stent retrievers during ET and validate the approach in the treatment of AIS. Further work for detailed characterization and viability assessment of ECs is needed to compare their biology with in vitro and animal models.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2017.09.054

  View details for PubMedID 29103865