WorldWideScience

Sample records for bowel disease patients

  1. Helping Patients Cope with Inflammatory Bowel Disease.

    Science.gov (United States)

    1984-01-01

    Recovery (mastectomy patients) and the Ostomy Association. They consist of people with Inflammatory Bowel Disease. Members support one another by sharing...problems 10 unique to single people. Subjects such as dating, social relationships, sexuality , and career planning are discussed. The couples group

  2. Outcomes of Bowel Resection in Patients with Crohn's Disease.

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    Moghadamyeghaneh, Zhobin; Carmichael, Joseph C; Mills, Steven D; Pigazzi, Alessio; Stamos, Michael J

    2015-10-01

    There is limited data regarding outcomes of bowel resection in patients with Crohn's disease. We sought to investigate complications of such patients after bowel resection. The Nationwide Inpatient Sample databases were used to examine the clinical data of Crohn's patients who underwent bowel resection during 2002 to 2012. Multivariate regression analysis was performed to investigate outcomes of such patients. We sampled a total of 443,950 patients admitted with the diagnosis of Crohn's disease. Of these, 20.5 per cent had bowel resection. Among patients who had bowel resection, 51 per cent had small bowel Crohn's disease, 19.4 per cent had large bowel Crohn's disease, and 29.6 per cent had both large and small bowel Crohn's disease. Patients with large bowel disease had higher mortality risk compared with small bowel disease [1.8% vs 1%, adjusted odds ratio (AOR): 2.42, P Crohn's disease (AOR: 1.90, P Crohn's disease, 20.5 per cent underwent bowel resection during 2002 to 2012. Although colonic disease has a higher mortality risk, small bowel disease has a higher risk of postoperative fistula.

  3. What do patients with irritable bowel syndrome dream about? A comparison with inflammatory bowel disease.

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    Lal, S; Whorwell, P J

    2002-07-01

    It is a common experience for people to dream of events about which they are either anxious or concerned. We therefore hypothesised that the dreams of patients with irritable bowel syndrome may reflect their worries about their problem especially as hospital out-patients with this disorder tend to exhibit some anxiety. In addition, dreaming about, for instance bowels, in patients with irritable bowel syndrome in excess of that observed in other gastrointestinal disorders may be of importance. To establish whether patients with irritable bowel syndrome dream about bowel-related issues more than controls or patients with inflammatory bowel disease. A total of 57 patients with irritable bowel syndrome and 57 patients with inflammatory bowel disease were compared with 60 healthy controls. All subjects completed a structured questionnaire concerning sleeping habits and dream characteristics as well as an assessment of anxiety and depression. There were no differences in the sleeping habits between any of the groups. However, significantly more patients with irritable bowel syndrome and inflammatory bowel disease dreamt about their bowels (22% inflammatory bowel disease patients, 18% irritable bowel syndrome patients vs 3% of controls, p disorders, of both a functional and organic nature, may influence the nature of dreams. In those patients who dream about their symptoms, it would be interesting to know whether this affects the course of their disease, either positively or negatively, in any way.

  4. Care of the Pregnant Patient With Inflammatory Bowel Disease.

    Science.gov (United States)

    Mahadevan, Uma; Matro, Rebecca

    2015-08-01

    Inflammatory bowel disease affects women in their peak reproductive years. Patients and physicians often have questions regarding the effect of inflammatory bowel disease on a woman's ability to conceive and to carry a pregnancy safely to term as well as the effect of inflammatory bowel disease and the medications used to treat it on pregnancy outcomes. Women with inflammatory bowel disease have the same rates of fertility as women without inflammatory bowel disease unless they have had prior surgery in the pelvis or active disease. However, women with inflammatory bowel disease do have higher rates of adverse pregnancy outcomes. A multidisciplinary approach involving gastroenterologists, obstetricians, and maternal-fetal medicine physicians should focus on preconception planning and disease optimization before pregnancy. Women with inflammatory bowel disease should be followed as high-risk obstetric patients. Most medications used to treat inflammatory bowel disease can be continued safely during pregnancy and lactation. The greatest risk to the pregnancy is active disease, which can be precipitated by discontinuation of effective maintenance medications. Preconception counseling should include education regarding the low risk of most inflammatory bowel disease medications during pregnancy and lactation and the high risk of a significant disease flare during pregnancy. This review outlines important considerations for obstetricians caring for women with inflammatory bowel disease before and during pregnancy and in the postpartum period.

  5. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Pedersen, Natalia; Ankersen, Dorit Vedel; Felding, Maria

    2017-01-01

    AIM: To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD). METHODS: This was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS...

  6. Nonocclusive ischaemic bowel disease in patients on chronic haemodialysis

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    Engel, A.; Adler, O.B.; Loberant, N.; Rosenberger, A.; Weissman, I.

    1989-06-01

    Six patients with chronic renal failure on longstanding haemodialysis are presented, in whom nonocclusive bowel ischaemia occurred as a rare complication of their underlying disorder. Factors implicated in the development of bowel ischaemia in these patients are chronic constipation resulting in increased intraluminal pressure on the bowel wall, premature and progressive arterial disease and bouts of hypotension accompanying the haemodialysis procedure. Contrast studies of the bowel and computed tomography examination can suggest the diagnosis, but angiography alone provides the exact answer in demonstrating nonocclusive mesenteric ischaemia. In patients with chronic renal failure and longstanding dialysis presenting with abdominal symptoms this diagnosis should be considered. (orig.).

  7. Endoscopic evaluation of surgically altered bowel in patients with inflammatory bowel diseases.

    Science.gov (United States)

    Sinh, Preetika; Shen, Bo

    2015-06-01

    Patients with inflammatory bowel diseases often undergo surgical procedures for medically refractory disease or colitis associated dysplasia. Endoscopic evaluation of the surgically altered bowel is often needed to assess for disease recurrence, its severity, and for therapy. It is important to obtain and review the operative report and abdominal imaging before performing the endoscopy. Diagnostic and therapeutic endoscopy can be safely performed in most patients with inflammatory bowel disease with altered bowel anatomy under conscious sedation without fluoroscopy. Carefully planned stricture therapy with balloon dilation or needle knife stricturotomy can be performed for simple, short, and fibrotic strictures. A multidisciplinary approach involving a team of endoscopist, endoscopy nurse, colorectal surgeon, gastrointestinal pathologist, and gastrointestinal radiologist is important for a safe and effective endoscopy. We attempt to review the aspects that need consideration before the endoscopy, the technique of endoscopy, and briefly the therapies that can be performed during endoscopy of the bowel through an ileostomy, a colostomy, in the diverted large bowel or ileal pouch, and small bowel after stricturoplasty and bowel bypass surgery in patients with inflammatory bowel diseases.

  8. Steroid allergy in patients with inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Malik, M

    2007-11-01

    Background: Contact allergy to a steroid enema leading to worsening of inflammatory bowel disease (IBD) has recently been reported. This study was designed to look for evidence of steroid allergy in patients with IBD.

  9. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  10. Small bowel ultrasound in patients with celiac disease

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    Bartusek, D. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: dbartusek@fnbrno.cz; Valek, V. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: v.valek@fnbrno.cz; Husty, J. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: jhusty@fnbrno.cz; Uteseny, J. [Department of Pediatric Internal Medicine, Masaryk University hospital Brno (Czech Republic)], E-mail: juteseny@fnbrno.cz

    2007-08-15

    Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease.

  11. Ultrasonographic imaging of inflammatory bowel disease in pediatric patients

    Science.gov (United States)

    Chiorean, Liliana; Schreiber-Dietrich, Dagmar; Braden, Barbara; Cui, Xin-Wu; Buchhorn, Reiner; Chang, Jian-Min; Dietrich, Christoph F

    2015-01-01

    Inflammatory bowel disease (IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients. Choosing the optimal imaging modality for the assessment of gastrointestinal disease in pediatric patients can be challenging. The invasiveness and patient acceptance, the radiation exposure and the quality performance of the diagnostic test need to be considered. By reviewing the literature regarding imaging in inflammatory bowel disease the value of ultrasound in the clinical management of pediatric patients is highlighted. Transabdominal ultrasound is a useful, noninvasive method for the initial diagnosis of IBD in children; it also provides guidance for therapeutic decisions and helps to characterize and predict the course of the disease in individual patients. Ultrasound techniques including color Doppler imaging and contrast-enhanced ultrasound are promising imaging tools to determine disease activity and complications. Comparative studies between different imaging methods are needed. PMID:25954096

  12. Perceptions of medication safety among patients with inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2010-09-01

    The aim of this study was to assess attitudes towards and knowledge of medication safety in inflammatory bowel disease (IBD). IBD patients frequently require long-term treatment with potentially toxic medications. Techniques are employed to improve patient awareness of medication safety, but there are sparse data on their effectiveness.

  13. Functional bowel disease

    DEFF Research Database (Denmark)

    Rumessen, J J; Gudmand-Høyer, E

    1988-01-01

    Twenty-five patients with functional bowel disease were given fructose, sorbitol, fructose-sorbitol mixtures, and sucrose. The occurrence of malabsorption was evaluated by means of hydrogen breath tests and the gastrointestinal symptoms, if any, were recorded. One patient could not be evaluated...... with functional bowel disease. The findings may have direct influence on the dietary guidance given to a major group of patients with functional bowel disease and may make it possible to define separate entities in this disease complex....

  14. Caloric requirements in patients with inflammatory bowel disease.

    Science.gov (United States)

    Barot, L R; Rombeau, J L; Feurer, I D; Mullen, J L

    1982-01-01

    Measured resting energy expenditure (REE) was compared to predicted basal energy expenditure (BEE) in 35 consecutive patients with nonseptic inflammatory bowel disease (IBD) and 20 healthy volunteers. Patients with IBD were groups greater or less than 90% ideal body weight (IBW). The BEE in kcal/day was found to be equivalent to the measured REE in both patient groups. It is suggested that the BEE be used to determine caloric requirements in nonseptic patients with inflammatory bowel disease. Patients less than 90% IBW had significantly higher measured energy expenditure (26.4 +/- 1.0) per kg body weight than either controls (21.2 +/- 0.7) or patients greater than or equal to 90% IBW (21.2 +/- 0.8), p less than 0.001. It is suggested that this increased expenditure is due to a combined effect of weight loss and intrinsic disease. PMID:7055399

  15. COPING STRATEGIES OF PATIENTS WITH CHRONIC INFLAMMATORY BOWEL DISEASES

    Directory of Open Access Journals (Sweden)

    A. Ye. Baksht

    2013-01-01

    Full Text Available Research aim was definition of prevailing coping strategies of patients with inflammatory bowel diseases of in comparison with healthy people. 49 patients with ulcer colitis are surveyed. Coping strategies were defined by means of E.Heim's test. Patients with ulcerative colitis more often than healthy used to maladaptive coping strategies in the emotional and cognitive sphere that can testify to violation of psychological adaptation. 

  16. Nutritional support of surgical patients with inflammatory bowel disease.

    Science.gov (United States)

    Wagner, I Janelle; Rombeau, John L

    2011-08-01

    Patients with inflammatory bowel disease (IBD) in need of surgery are often malnourished, which in turn increases the risk for postoperative complications. Malnutrition in IBD patients who must undergo surgery is due to the disordered activity of the diseased intestine, decreased dietary intake, and adverse effects of potent medications. IBD operations predispose patients to both macronutrient and micronutrient deficiencies. If the gut can be used safely it is the preferential route for feeding, though preoperative and postoperative parenteral nutrition remains a viable alternative for severely malnourished patients. New nutrient therapies include immunonutrition, fish oils, and probiotics. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Healthcare maintenance in elderly patients with inflammatory bowel disease.

    Science.gov (United States)

    Shrestha, Manish P; Ruel, Joannie; Taleban, Sasha

    2017-01-01

    The increasing number of older patients (age ≥60 years) with inflammatory bowel disease (IBD) highlights the importance of healthcare maintenance in this vulnerable population. Older IBD patients are more susceptible and have higher rates of many disease- and treatment-related adverse effects. Compared to younger IBD patients, older patients are at increased risk for infection, malignancy, bone disease, eye disease, malnutrition and thrombotic complications. Preventive strategies in the elderly differ from those in younger adults and are imperative. Changes to the immune system with aging can decrease the efficacy of vaccinations. Cancer screening guidelines in older IBD patients have to account for unique considerations, such as life expectancy, functional performance status, multimorbidity, financial status, and patient desires. Additionally, providers need to be vigilant in screening for osteoporosis, ocular disease, depression, and adverse events arising from polypharmacy.

  18. Cannabis use amongst patients with inflammatory bowel disease.

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    Lal, Simon; Prasad, Neeraj; Ryan, Manijeh; Tangri, Sabrena; Silverberg, Mark S; Gordon, Allan; Steinhart, Hillary

    2011-10-01

    Experimental evidence suggests the endogenous cannabinoid system may protect against colonic inflammation, leading to the possibility that activation of this system may have a therapeutic role in inflammatory bowel disease (IBD). Medicinal use of cannabis for chronic pain and other symptoms has been reported in a number of medical conditions. We aimed to evaluate cannabis use in patients with IBD. One hundred patients with ulcerative colitis (UC) and 191 patients with Crohn's disease (CD) attending a tertiary-care outpatient clinic completed a questionnaire regarding current and previous cannabis use, socioeconomic factors, disease history and medication use, including complimentary alternative medicines. Quality of life was assessed using the short-inflammatory bowel disease questionnaire. A comparable proportion of UC and CD patients reported lifetime [48/95 (51%) UC vs. 91/189 (48%) CD] or current [11/95 (12%) UC vs. 30/189 (16%) CD] cannabis use. Of lifetime users, 14/43 (33%) UC and 40/80 (50%) CD patients have used it to relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite. Patients were more likely to use cannabis for symptom relief if they had a history of abdominal surgery [29/48 (60%) vs. 24/74 (32%); P=0.002], chronic analgesic use [29/41 (71%) vs. 25/81 (31%); Pmedicine use [36/66 (55%) vs. 18/56 (32%); P=0.01] and a lower short inflammatory bowel disease questionnaire score (45.1±2.1 vs. 50.3±1.5; P=0.03). Patients who had used cannabis [60/139 (43%)] were more likely than nonusers [13/133 (10%); Pcannabis for IBD. Cannabis use is common amongst patients with IBD for symptom relief, particularly amongst those with a history of abdominal surgery, chronic abdominal pain and/or a low quality of life index. The therapeutic benefits of cannabinoid derivatives in IBD may warrant further exploration.

  19. Social Media Use in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Guo, Ling; Reich, Jason; Groshek, Jacob; Farraye, Francis A

    2016-05-01

    Patients with chronic illnesses such as Inflammatory Bowel Disease (IBD) have been more keen to utilize the Internet and in particular, social media to obtain patient educational information in recent years. It is important for the gastroenterologist to be aware of these modalities and how they might affect information exchange and ultimately, disease management. This article addresses the current prevalence of social media use, advent of mobile health applications, social media usage in patients with chronic conditions, usage amongst providers, and most notably, the usage and preferences in IBD patients. Over the last decade there has been an increasing desire from patients to receive educational material about their disease through social media. We reviewed the medical literature on the quality of IBD-related information on social media. Given the disparity of information available on the Internet, we remark on the quality of this information and stress the need for further research to assess the validity of IBD information posted on social media.

  20. Hepatobiliary dysfunction in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    E.B.N Daryani

    2006-08-01

    Full Text Available A high percent of patients with inflammatory bowel diseases (IBD experience non intestinal symptoms. Many studies demonstrated that hepatobiliary disorders are the most common. Corresponding disorders consist of primary sclerosing cholangitis, non alcoholic steatohepatitis (NASH, biliary stones, pericholangitis, autoimmune hepatitis, liver amyloidosis, liver abscess, liver granuloma, hepatocellular carcinoma and primary biliary cirrhosis. However most studies concentrate on identifying primary sclerosing cholangitis, the most dreadful complication of IBD, other disorders like NASH and biliary stones are common and because of the similarity of symptoms to the primary disease may be ignored. In this article we review these disorders.

  1. Exercise in patients with inflammatory bowel diseases: current perspectives

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    Engels M

    2017-12-01

    Full Text Available Michael Engels,1 Raymond K Cross,1 Millie D Long2 1Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA, 2Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC, USA Abstract: Inflammatory bowel diseases (IBDs, including both Crohn’s disease (CD and ulcerative colitis (UC, are chronic autoimmune diseases. Both CD and UC have relapsing and remitting courses. Although effective medical treatments exist for these chronic conditions, some patients do not respond to these traditional therapies. Patients are often left frustrated with incomplete resolution of symptoms and seek alternative or complementary forms of therapy. Patients often search for modifiable factors that could improve their symptoms or help them to maintain periods of remission. In this review, we examine both the published evidence on the benefits of exercise clinically and the pathophysiological changes associated with exercise. We then describe data on exercise patterns in patients with IBDs, potential barriers to exercise in IBDs, and the role of exercise in the development and course of IBDs. While some data support physical activity as having a protective role in the development of IBDs, the findings have not been robust. Importantly, studies of exercise in patients with mild-to-moderate IBD activity show no danger of disease or symptom exacerbation. Exercise has theoretical benefits on the immune response, and the limited available data suggest that exercise may improve disease activity, quality of life, bone mineral density, and fatigue levels in patients with IBDs. Overall, exercise is safe and probably beneficial in patients with IBDs. Evidence supporting specific exercise recommendations, including aspects such as duration and heart rate targets, is needed in order to better counsel patients with IBDs. Keywords: inflammatory bowel

  2. Telemedicine in the treatment of patients with inflammatory bowel disease.

    Science.gov (United States)

    Aguas, Mariam; Del Hoyo, Javier; Faubel, Raquel; Valdivieso, Bernardo; Nos, Pilar

    2017-11-01

    Inflammatory bowel disease (IBD) is a chronic and relapsing disorder with significant medical, social and financial impacts. IBD patients require continuous follow-up, and healthcare resource use in this context increases over time. In the last decade, telemedicine has influenced the treatment of chronic diseases like IBD via the application of information and communication technologies to provide healthcare services remotely. Telemedicine and its various applications (telemanagement, teleconsulting and tele-education) enable closer follow-up and provide education resources that promote patient empowerment, encouraging treatment optimisation over the entire course of the disease. We describe the impact of using telemedicine on IBD health outcomes and discuss the limitations of implementing these systems in the real-life management of IBD patients. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  3. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease.

    Science.gov (United States)

    Pedersen, Natalia; Ankersen, Dorit Vedel; Felding, Maria; Wachmann, Henrik; Végh, Zsuzsanna; Molzen, Line; Burisch, Johan; Andersen, Jens Rikardt; Munkholm, Pia

    2017-05-14

    To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD). This was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates (at least 50-point reduction) in IBS-SSS at week 6 between groups; secondary end-point was the impact on quality of life. Eighty-nine patients, 67 (75%) women, median age 40, range 20-70 years were randomised: 44 to LFD group and 45 to ND, from which 78 patients completed the study period and were included in the final analysis (37 LFD and 41 ND). There was a significantly larger proportion of responders in the LFD group (n = 30, 81%) than in the ND group (n = 19, 46%); (OR = 5.30; 95%CI: 1.81-15.55, P FODMAP diet reduced IBS-like symptoms and increased quality of life in patients with IBD in remission.

  4. Management of patients with inflammatory bowel disease and spondyloarthritis.

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    Pouillon, Lieven; Bossuyt, Peter; Vanderstukken, Joke; Moulin, David; Netter, Patrick; Danese, Silvio; Jouzeau, Jean-Yves; Loeuille, Damien; Peyrin-Biroulet, Laurent

    2017-12-01

    More than half of the patients with inflammatory bowel disease (IBD) experience at least one extra-intestinal manifestation (EIM). The most common EIM in patients with IBD is spondyloarthritis (SpA). Microscopic intestinal inflammation is documented in almost 50% of the patients with SpA. Areas covered: We give an overview of the classification, the epidemiology and the diagnosis of IBD and SpA. The treatment goals, the pharmacologic management options and the available treatment guidelines in IBD patients with SpA are discussed. Expert commentary: The coexistence of IBD and SpA generates challenges and opportunities for both the gastroenterologist and the rheumatologist. The potential of drugs with a gut-specific mode of action in the treatment of IBD-related arthritis warrants further exploration.

  5. Increased risk of venous thromboembolism and arterial cardiovascular events in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper

    2012-01-01

    This focused review describes the current knowledge of the association between inflammatory bowel disease (IBD) and cardiovascular disease. Atherosclerosis is a chronic inflammatory disease, and as well as venous thromboembolism this disease shares inflammatory mechanisms with IBD. Patients...

  6. A Comparison of Self-Perceived Health Status in Inflammatory Bowel Disease and Irritable Bowel Syndrome Patients from a Canadian National Population Survey

    Directory of Open Access Journals (Sweden)

    Linda YL Tang

    2008-01-01

    Full Text Available OBJECTIVE: To determine whether differences exist in perceptions of physical health, mental health and stress levels between patients with inflammatory bowel disease (IBD and patients with irritable bowel syndrome (IBS.

  7. [Development of malignant tumors in patients with inflammatory bowel disease].

    Science.gov (United States)

    Meyer, Lital; Simian, Daniela; Kronberg, Udo; Estay, Camila; Lubascher, Jaime; Figueroa, Carolina; Quera, Rodrigo

    2015-07-01

    The chronic inflammation of the intestinal mucosa, the extra-intestinal manifestations of the disease and the immunosuppressive treatment of inflammatory bowel disease may increase cancer risk. To report the demographic and clinical features of patients with IBD who developed a malignant tumor. Retrospective analysis of an IBD patient registry of a private clinic, diagnosed between 1976 and 2014. 437 subjects were included, aged 15-88 years (58% women). Seventy two percent of patients had ulcerative colitis. The median time of follow up was 6 years. Ten patients (2.3%) developed a malignant tumor. In four, the tumor could be related to IBD (two colorectal cancers, one cholangiocarcinoma and one chronic myeloid leukemia (CML)). Two of 45 patients treated with biological therapy developed a tumor (CML and hypernephroma). Three of 170 patients on immunosuppressive treatment developed tumors. Only one had a tumor possibly related with the use of azathioprine (non-melanoma skin cancer). In only two patients, the treatment was changed at the time of their cancer diagnosis, from immunosuppressive medications to mesalamine. Only a small proportion of these patients with IBD developed a malignant tumor. The treatment of IBD has to be determined by the severity of the disease and not by the fear of developing a neoplasia. Following recommendations is fundamental to decrease the possibility of developing this complication.

  8. Marijuana use patterns among patients with inflammatory bowel disease.

    Science.gov (United States)

    Ravikoff Allegretti, Jessica; Courtwright, Andrew; Lucci, Matthew; Korzenik, Joshua R; Levine, Jonathan

    2013-12-01

    The prevalence and perceived effectiveness of marijuana use has not been well studied in inflammatory bowel disease (IBD) despite increasing legal permission for its use in Crohn's disease. Health care providers have little guidance about the IBD symptoms that may improve with marijuana use. The aim of this study was to assess the prevalence, sociodemographic characteristics, and perceived benefits of marijuana use among patients with IBD. Prospective cohort survey study of marijuana use patterns in patients with IBD at an academic medical center. A total of 292 patients completed the survey (response rate = 94%); 12.3% of patients were active marijuana users, 39.0% were past users, and 48.6% were never users. Among current and past users, 16.4% of patients used marijuana for disease symptoms, the majority of whom felt that marijuana was "very helpful" for relief of abdominal pain, nausea, and diarrhea. On multivariate analysis, age and chronic abdominal pain were associated with current marijuana use (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.89-0.97; P marijuana (OR, 0.93; 95% CI, 0.89-0.97; P marijuana for abdominal pain, were it legally available. A significant number of patients with IBD currently use marijuana. Most patients find it very helpful for symptom control, including patients with ulcerative colitis, who are currently excluded from medical marijuana laws. Clinical trials are needed to determine marijuana's potential as an IBD therapy and to guide prescribing decisions.

  9. Iron deficiency anemia in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Goldberg ND

    2013-06-01

    Full Text Available Neil D Goldberg Emeritus Chief of Gastroenterology, University of Maryland St. Joseph Medical Center, Towson, MD, USA Abstract: Iron deficiency anemia is the most common form of anemia worldwide, caused by poor iron intake, chronic blood loss, or impaired absorption. Patients with inflammatory bowel disease (IBD are increasingly likely to have iron deficiency anemia, with an estimated prevalence of 36%–76%. Detection of iron deficiency is problematic as outward signs and symptoms are not always present. Iron deficiency can have a significant impact on a patient's quality of life, necessitating prompt management and treatment. Effective treatment includes identifying and treating the underlying cause and initiating iron replacement therapy with either oral or intravenous iron. Numerous formulations for oral iron are available, with ferrous fumarate, sulfate, and gluconate being the most commonly prescribed. Available intravenous formulations include iron dextran, iron sucrose, ferric gluconate, and ferumoxytol. Low-molecular weight iron dextran and iron sucrose have been shown to be safe, efficacious, and effective in a host of gastrointestinal disorders. Ferumoxytol is the newest US Food and Drug Administration-approved intravenous iron therapy, indicated for iron deficiency anemia in adults with chronic kidney disease. Ferumoxytol is also being investigated in Phase 3 studies for the treatment of iron deficiency anemia in patients without chronic kidney disease, including subgroups with IBD. A review of the efficacy and safety of iron replacement in IBD, therapeutic considerations, and recommendations for the practicing gastroenterologist are presented. Keywords: anemia, inflammatory bowel disease, intravenous iron, iron deficiency, oral iron, therapy

  10. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review

    Science.gov (United States)

    Abreu, Cândida; Rocha-Pereira, Nuno; Sarmento, António; Magro, Fernando

    2015-01-01

    Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated. PMID:26074688

  11. [Pregnancy and inflammatory bowel disease: experience in 17 patients].

    Science.gov (United States)

    Vergara A, María Teresa; Rey G, Paula

    2011-11-01

    Inflammatory bowel disease (IBD) has a peak incidence between 15 and 25 years of age, thereby affecting women of reproductive age. Fertility rates with inactive IBD are similar to the general population, and drugs currently used, with the exception of methotrexate and thalidomide, have a good safety and efficacy profile during pregnancy. Starting a pregnancy with inactive IBD significantly reduces the potential maternal and fetal complications. To assess the evolution of pregnancy and the underlying disease in women with IBD. Retrospective and prospective study of female patients with IBD controlled in our hospital who became pregnant from January 1994 to February, 2011. We followed 17 patients with a total of 19 pregnancies. In two patients the onset of IBD occurred during pregnancy and from the remaining, 11 patients became pregnant during remission of IBD. Most of the patients continued the same treatment during pregnancy and the few flares that occurred were treated satisfactorily. Major complications occurred in three patients, all associated with IBD activity. Fifteen patients had full-term deliveries and the majority of the newborns had normal weight and Apgar score. None had malformations. Pregnancies among patients with an inactive IBD, have a good evolution. A multidisciplinary approach and patient education are invaluable to achieve these good results.

  12. Malignancy and mortality in pediatric patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    de Ridder, Lissy; Turner, Dan; Wilson, David C

    2014-01-01

    working group of ESPGHAN conducted a multinational-based survey of cancer and mortality in pediatric IBD. METHODS: A survey among pediatric gastroenterologists of 20 European countries and Israel on cancer and/or mortality in the pediatric patient population with IBD was undertaken. One representative...... from each country repeatedly contacted all pediatric gastroenterologists from each country for reporting retrospectively cancer and/or mortality of pediatric patients with IBD after IBD onset, during 2006-2011. RESULTS: We identified 18 cases of cancers and/or 31 deaths in 44 children (26 males) who......BACKGROUND: The combination of the severity of pediatric-onset inflammatory bowel disease (IBD) phenotypes and the need for intense medical treatment may increase the risk of malignancy and mortality, but evidence regarding the extent of the problem is scarce. Therefore, the Porto Pediatric IBD...

  13. Nutritional problems in inflammatory bowel disease: the patient perspective.

    Science.gov (United States)

    Prince, Alexis; Whelan, Kevin; Moosa, Arifa; Lomer, Miranda C E; Reidlinger, Dianne P

    2011-10-01

    Crohn's Disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD), which may result in nutrition problems that impact on patient health, nutritional status and quality of life. Subjective reports of how IBD patients experience these problems as part of their disease process, including comparisons between patient groups, or the need for tailored nutrition advice as perceived by these patients, have not been widely studied. This survey aimed to identify and explore nutritional problems that are important to CD and UC patients and to investigate their views on the IBD health services provided to help them with these. Eighty-seven IBD patients were invited to take part in a nutrition survey using face-to-face questionnaire interviews. The survey asked about food and nutrition problems that patients have experienced, identifying which were most significant and the extent to which they had been addressed by the clinical service. Seventy-two IBD patients completed the evaluation (47 CD, 25 UC). Of these, 45 (62.5%) felt that food and nutrition were either 'important' or 'extremely important' in their experience of IBD, and 59 (82%) reported problems with food and nutrition. Patients with CD and UC reported similar frequencies of most nutritional problems. However, 44 (94%) CD vs. 16 (64%) UC patients reported problems with weight (p=0.002). Less than half of patients had seen a dietitian for tailored nutritional advice to address these problems. Nutritional problems experienced and reported by IBD patients are numerous and varied. They are considered important by patients with CD and UC, both of whom would generally value specific dietary counselling, highlighting a need for further research in this area and adequate and equal provision of services for both groups. Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  14. Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease

    Science.gov (United States)

    Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

    2016-01-01

    Abstract In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease. We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index risk of nutrition-related problems (modified nutritional risk index nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses. The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P risk factors affecting the poor nutritional status of patients with Crohn disease after small bowel resection. PMID:27472702

  15. How patients view probiotics: findings from a multicenter study of patients with inflammatory bowel disease and irritable bowel syndrome.

    Science.gov (United States)

    Mercer, MaryBeth; Brinich, Margaret A; Geller, Gail; Harrison, Krista; Highland, Janelle; James, Katherine; Marshall, Patricia; McCormick, Jennifer B; Tilburt, Jon; Achkar, Jean-Paul; Farrell, Ruth M; Sharp, Richard R

    2012-02-01

    Patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) have access to a growing number of probiotic products marketed to improve digestive health. It is unclear how patients make decisions about probiotics and what role they expect their gastroenterologists to play as they consider using probiotics. Understanding patients' knowledge, attitudes and expectations of probiotics may help gastroenterologists engage patients in collaborative discussions about probiotics. Focus groups were conducted with patients with IBD and IBS at the Cleveland Clinic, Mayo Clinic, and Johns Hopkins University. Inductive analytic methods were used to identify common themes and draw interpretations from focus group narratives. One hundred thirty-six patients participated in 22 focus groups between March and August 2009. Patients viewed probiotics as an appealing alternative to pharmaceutical drugs and understood probiotics as a more "natural," low-risk therapeutic option. Many patients were hesitant to use them without consulting their gastroenterologists. Patients would weigh the risks and benefits of probiotics, their disease severity and satisfaction with current treatments when considering probiotic use. Patients are interested in probiotics but have many unanswered questions about their use. Our findings suggest that patients with IBD and IBS will look to gastroenterologists and other clinicians as trustworthy advisors regarding the utility of probiotics as an alternative or supplement to pharmaceutical drugs. Gastroenterologists and other clinicians who care for patients with these diseases should be prepared to discuss the potential benefits and risks of probiotics and assist patients in making informed decisions about their use.

  16. The metabolic activity of fecal microbiota from healthy individuals and patients with inflammatory bowel disease

    NARCIS (Netherlands)

    Nuenen, M.H.M.C. van; Venema, K.; Woude, J.C.J. van der; Kuipers, E.J.

    2004-01-01

    The hypothesis was studied that intestinal microbial metabolites play a role in the pathogenesis of inflammatory bowel disease. For that purpose, an in vitro model of the colon was inoculated with fresh feces of six healthy individuals and eight inflammatory bowel disease patients. Samples were

  17. [Follow-up of patients with inflammatory bowel disease].

    Science.gov (United States)

    García-López, Santiago

    2013-10-01

    Multiple data were presented on inflammatory bowel disease (IBD) in Digestive Disease Week (DDW). Of particular interest to gastroenterologists were those on novel treatments and information on safety. Other data, such as those relating to disease "follow-up", were possibly of lesser interest. However, the information reported this year was, in my opinion, highly important, because it could lead to significant changes in clinical practice. Thus, results presented strongly suggest that patients with asymptomatic IBD, specifically Crohn's disease (CD), often develop complications during their clinical course. Moreover, this is especially true in patients with CD and biological signs of inflammation, despite being asymptomatic. In addition, it seems clear that the absence of symptoms does not imply an absence of inflammation. These observations indicate a dual practical message: patients should be followed-up and objectively evaluated. Multiple data were presented on how to objectively evaluate disease activity in IBD. The prognostic value and objectivity of endoscopy has been reaffirmed, specifically with new data on the only validated index, the UCEIS, in ulcerative colitis. Together with endoscopy, the role of less invasive techniques such as imaging tests (magnetic resonance enterography, computed tomography enterography and even echography, with and without contrast agent) and fecal markers has been reaffirmed in several conditions and these techniques have a certain predictive value. Finally, many studies were reported that confirm the therapeutic activity of levels of anti-TNF and its antibodies in certain conditions and with some limitations. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Increased Risk of Pneumonia among Patients with Inflammatory Bowel Disease

    Science.gov (United States)

    Long, Millie D.; Martin, Christopher; Sandler, Robert S.; Kappelman, Michael D.

    2015-01-01

    Background & Aims Patients with inflammatory bowel disease (IBD) may be at increased risk for infectious complications. We aimed to determine the risk of pneumonia in IBD and how biologic and immunosuppressive medications affect this risk. Methods We performed a retrospective cohort and a nested case-control study using administrative data from IMS Health Inc, LifeLink™ Health Plan Claims Database. In the cohort, IBD patients were matched to 4 individuals without IBD. Pneumonia risk was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazards models. In the nested case-control analysis, 4856 IBD patients with pneumonia were matched to up to 4 IBD patients without pneumonia by incidence density sampling. Conditional logistic regression was used to determine associations between medications and pneumonia. Results The cohort included 50,932 patients with Crohn's disease (CD), 56,403 patients with ulcerative colitis (UC), and 1,269 with unspecified IBD; matched to 434,416 individuals without IBD. The IBD cohort had an increased pneumonia risk when compared to non-IBD (IRR 1.82, 95% CI 1.75-1.88). In adjusted Cox analysis, pneumonia risk remained increased for the IBD vs. non-IBD cohort (HR 1.54, 95% CI 1.49-1.60), with increased risk in both CD (HR 1.71, 95% CI 1.62-1.80) and UC (HR 1.41, 95% CI 1.34-1.48). In the nested case-control analysis, use of biologic medications (OR 1.28, 95% CI 1.08-1.52), corticosteroids (OR 3.62, 95% CI 3.30-3.98) and proton pump inhibitor (PPI) (OR 1.14, 95% CI 1.03-1.25) in the preceding 120 days were significantly associated with pneumonia. Conclusions Patients with IBD are at increased risk for pneumonia. Use of corticosteroids particularly increases pneumonia risk. PMID:23295276

  19. Celiac disease: Serologic prevalence in patients with irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Zobeiri Mehdi

    2012-01-01

    Full Text Available Background: The prevalence of irritable bowel syndrome (IBS in the community is 10%-20% and have symptom based diagnostic criteria. Many symptoms of celiac disease (CD with 1% prevalence in some communities can mimic IBS. Sensitive and specific serologic tests of CD can detect asymptomatic cases. The purpose of this study was to compare the level of anti-tissue-transglutaminase (tTG IgA in IBS patients and controls group. Materials and Methods: This case-control study was performed at a University hospital in which 107 patients with IBS who met the Rome II criteria for their diagnosis were compared with 126 healthy age and sex-matched controls. Both groups were investigated for CD by analysis of their serum tTG IgA antibody with human recombinant antigen. Titers were positive containing over 10u/ml and borderline if they were between 4 and 10 u/ml. Result: 86 percent of IBS patients were female. The mean antibody level was 0.837 u/ml in IBS group and 0.933 u/ml in control group without any significant difference. Discussion and Conclusion: Results of this study may intensify disagreement on the situation of CD in IBS patients.

  20. Is there a role for prophylactic colectomy in Lynch syndrome patients with inflammatory bowel disease?

    Science.gov (United States)

    McNamara, Kate L; Aronson, Melyssa D; Cohen, Zane

    2016-01-01

    Lynch syndrome and chronic inflammatory bowel disease are two important risk factors for colorectal cancer. It is unclear whether Lynch syndrome patients with inflammatory bowel disease are at sufficiently increased risk for colorectal cancer to warrant prophylactic colectomy. This study aims to identify all cases of Lynch syndrome and concurrent inflammatory bowel disease in a large familial gastrointestinal cancer registry, define incidence of colorectal cancer, and characterize mismatch repair protein gene mutation status and inflammatory bowel disease-associated colorectal cancer risk factors. We retrospectively identified and collected clinical data for all cases with confirmed diagnoses of Lynch syndrome and inflammatory bowel disease in the Familial Gastrointestinal Cancer Registry at Mount Sinai Hospital in Toronto, Canada. Twelve cases of confirmed Lynch syndrome, and concurrent inflammatory bowel disease were identified. Four cases developed colorectal cancer. An additional five cases had colectomy; one was performed for severe colitis, and four were performed for low-grade dysplasia. None of these surgical specimens contained malignancy or high-grade dysplasia. The presentation of Lynch syndrome with inflammatory bowel disease is uncommon and not well described in the literature. This small but important series of twelve cases is the largest reported to date. In this series, patients with Lynch syndrome and concurrent inflammatory bowel disease do not appear to have sufficiently increased risk for colorectal cancer to recommend prophylactic surgery. Therefore, the decision to surgery should continue to be guided by surgical indications for each disease. Further evaluation of this important area will require multi-institutional input.

  1. Treatment of the Pregnant Patient with Inflammatory Bowel Disease.

    Science.gov (United States)

    Winter, Rachel; Nørgård, Bente M; Friedman, Sonia

    2016-03-01

    Research regarding fertility, medication safety, and pregnancy outcomes is increasing, but there are still many knowledge gaps in these areas. Women with ulcerative colitis and Crohn's disease may have decreased fertility because of voluntary childlessness and inflammatory bowel disease (IBD) surgery, and women with Crohn's disease may also have decreased ovarian reserve. Initial studies show that in vitro fertilization is a viable option, and laparoscopic ileoanal pouch anastomosis surgery improves fertility rates. Additional research is needed on the effect of disease activity on fertility and on the rates of pregnancy loss and ectopic pregnancies. We do not know how to reliably measure disease activity during pregnancy or the effect of pregnancy on the microbiome. Although immunomodulators and anti-tumor necrosis factor medications are relatively safe during pregnancy, the long-term effects of these medications on the child are unknown. The recommended mode of delivery is still debated, especially for women after ileoanal pouch anastomosis. There are multiple studies on the relative safety of immunomodulators and anti-tumor necrosis factor medications during pregnancy, and we know how to safely treat a pregnant patient with a disease flare. The best way to manage women with IBD who are pregnant or contemplating pregnancy is a multidisciplinary approach. Team members often include a gastroenterologist, a high-risk obstetrician, an infertility specialist, a colorectal surgeon, and a pediatrician with experience in caring for children of mothers with IBD. By integrating expertise from these disciplines, women with even very complex IBD should be able to have a healthy pregnancy and delivery.

  2. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients.

    Science.gov (United States)

    Aberra, Faten N; Lewis, James D; Hass, David; Rombeau, John L; Osborne, Benjamin; Lichtenstein, Gary R

    2003-08-01

    Many patients with inflammatory bowel disease receive corticosteroids and 6-mercaptopurine/azathioprine during elective bowel surgery. We investigated the postoperative infection risk for patients undergoing elective bowel surgery who were receiving corticosteroids and/or 6-mercaptopurine/azathioprine before surgery compared with patients not receiving these medications. A retrospective cohort study was conducted on 159 patients with inflammatory bowel disease who underwent elective bowel surgery. There were 56 patients receiving corticosteroids alone, 52 patients receiving 6-mercaptopurine/azathioprine alone or with corticosteroids, and 51 patients receiving neither corticosteroids nor 6-mercaptopurine/azathioprine. Postoperative infectious complications to time of discharge were categorized into major and minor complications. Patients receiving corticosteroids had an adjusted odds ratio for any and major infectious complications of 3.69 (95% confidence interval [CI], 1.24-10.97) and 5.54 (95% CI, 1.12-27.26), respectively. The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively. Preoperative use of corticosteroids in patients with inflammatory bowel disease who are undergoing elective bowel surgery is associated with an increased risk of postoperative infectious complications. 6-Mercaptopurine/azathioprine alone and the addition of 6-mercaptopurine/azathioprine for patients receiving corticosteroids was not found to significantly increase the risk of postoperative infectious complications.

  3. Bacterial permeation in patients with chronic inflammatory bowel disease

    OpenAIRE

    Steenfatt, Nicole

    2012-01-01

    The present study was carried out to establish a method of bacterial permeation through human intestinal gut ex vivo. Assuming that the inflammed epithelial layer exhibits barrier defects in chronic inflammatory bowel disease, we accomplished our research. In the study under consideration, we demonstrated the bacterial permeation in human intestinal gut layer ex vivo for the first time. Concerning the lowely rate of permeation we examine the miscellaneous causes: A modification of...

  4. How Patients View Probiotics: Findings from a Multicenter Study of Patients with Inflammatory Bowel Disease and Irritable Bowel Syndrome

    Science.gov (United States)

    Mercer, MaryBeth; Brinich, Margaret A.; Geller, Gail; Harrison, Krista; Highland, Janelle; James, Katherine; Marshall, Patricia; McCormick, Jennifer B.; Tilburt, Jon; Achkar, Jean-Paul; Farrell, Ruth M.; Sharp, Richard R.

    2011-01-01

    Background Patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) have access to a growing number of probiotic products marketed to improve digestive health. It is unclear how patients make decisions about probiotics and what role they expect their gastroenterologists to play as they consider using probiotics. Understanding patients’ knowledge, attitudes and expectations of probiotics may help gastroenterologists engage patients in collaborative discussions about probiotics. Study Focus groups were conducted with patients with IBD and IBS at the Cleveland Clinic, Mayo Clinic and Johns Hopkins University. Inductive analytic methods were utilized to identify common themes and draw interpretations from focus group narratives. Results One hundred thirty-six patients participated in 22 focus groups between March and August 2009. Patients viewed probiotics as an appealing alternative to pharmaceutical drugs and understood probiotics as a more “natural,” low-risk therapeutic option. Many patients were hesitant to use them without consulting their gastroenterologists. Patients would weigh the risks and benefits of probiotics, their disease severity and satisfaction with current treatments when considering probiotic use. Conclusions Patients are interested in probiotics but have many unanswered questions about their use. Our findings suggest that patients with IBD and IBS will look to gastroenterologists and other clinicians as trustworthy advisors regarding the utility of probiotics as an alternative or supplement to pharmaceutical drugs. Gastroenterologists and other clinicians who care for patients with these diseases should be prepared to discuss the potential benefits and risks of probiotics and assist patients in making informed decisions about their use. PMID:21716123

  5. Clinical significance of the glucose breath test in patients with inflammatory bowel disease.

    Science.gov (United States)

    Lee, Ji Min; Lee, Kang-Moon; Chung, Yoon Yung; Lee, Yang Woon; Kim, Dae Bum; Sung, Hea Jung; Chung, Woo Chul; Paik, Chang-Nyol

    2015-06-01

    Small intestinal bacterial overgrowth which has recently been diagnosed with the glucose breath test is characterized by excessive colonic bacteria in the small bowel, and results in gastrointestinal symptoms that mimic symptoms of inflammatory bowel disease. This study aimed to estimate the positivity of the glucose breath test and investigate its clinical role in inflammatory bowel disease. Patients aged > 18 years with inflammatory bowel disease were enrolled. All patients completed symptom questionnaires. Fecal calprotectin level was measured to evaluate the disease activity. Thirty historical healthy controls were used to determine normal glucose breath test values. A total of 107 patients, 64 with ulcerative colitis and 43 with Crohn's disease, were included. Twenty-two patients (20.6%) were positive for the glucose breath test (30.2%, Crohn's disease; 14.1%, ulcerative colitis). Positive rate of the glucose breath test was significantly higher in patients with Crohn's disease than in healthy controls (30.2% vs 6.7%, P=0.014). Bloating, flatus, and satiety were higher in glucose breath test-positive patients than glucose breath test-negative patients (P=0.021, 0.014, and 0.049, respectively). The positivity was not correlated with the fecal calprotectin level. The positive rate of the glucose breath test was higher in patients with inflammatory bowel disease, especially Crohn's disease than in healthy controls; gastrointestinal symptoms of patients with inflammatory bowel disease were correlated with this positivity. Glucose breath test can be used to manage intestinal symptoms of patients with inflammatory bowel disease. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  6. Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, Marianne; Fonager, Kirsten; Sørensen, Henrik Toft

    1999-01-01

    ) and Crohn's disease (CD) among first-degree relatives of patients with these diseases. To give more precise risk estimates we conducted a nationwide study using population-based data from the Danish National Registry of Patients (NRP). METHODS: All patients from the entire Danish population (5.2 million......OBJECTIVE: The incidence of inflammatory bowel disease (IBD) varies among and within countries, but several studies have indicated that genetic factors may play an important role in the etiology of IBD. A Danish regional study has observed an almost 10-fold increased risk for ulcerative colitis (UC...

  7. Telomere dysfunction in peripheral blood lymphocytes from patients with primary sclerosing cholangitis and inflammatory bowel disease.

    Science.gov (United States)

    Laish, Ido; Katz, Hila; Stein, Assaf; Liberman, Meytal; Naftali, Timna; Kitay-Cohen, Yona; Biron-Shental, Tal; Konikoff, Fred M; Amiel, Aliza

    2015-09-01

    Primary sclerosing cholangitis and inflammatory bowel disease are two associated, chronic inflammatory, pre-malignant conditions. We hypothesized that patients with these disorders may harbour telomere dysfunction as a marker of chromosomal instability. The aim of our study was to compare parameters of the telomere-telomerase system in these cohorts. In this prospective study, peripheral blood was withdrawn from patients with primary sclerosing cholangitis (N=20), inflammatory bowel disease (N=20) and healthy controls (N=20), and lymphocytes were isolated. Telomere length was quantified as a function of the signal intensity and telomere number. Random aneuploidy and telomere capture were determined by fluorescence in situ hybridization technique with specific probes. Patients with inflammatory bowel disease had higher measures of intestinal disease activity than patients with primary sclerosing cholangitis. Despite this, shorter telomere length and telomere aggregates, especially the fusion of 2-5 telomeres, were observed at significantly higher rate in patients with primary sclerosing cholangitis relative to inflammatory bowel disease or healthy controls. Rates of aneuploidy and telomere capture were higher in the two probes in both diseases compared to controls (pprimary sclerosing cholangitis patients more than inflammatory bowel disease and healthy controls patients, which attests to genetic instability and immunosenescence. NCT02247622. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  8. Treatment of the Pregnant Patient with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Winter, Rachel; Nørgård, Bente M; Friedman, Sonia

    2016-01-01

    and on the rates of pregnancy loss and ectopic pregnancies. We do not know how to reliably measure disease activity during pregnancy or the effect of pregnancy on the microbiome. Although immunomodulators and anti-tumor necrosis factor medications are relatively safe during pregnancy, the long-term effects......Research regarding fertility, medication safety, and pregnancy outcomes is increasing, but there are still many knowledge gaps in these areas. Women with ulcerative colitis and Crohn's disease may have decreased fertility because of voluntary childlessness and inflammatory bowel disease (IBD...... of these medications on the child are unknown. The recommended mode of delivery is still debated, especially for women after ileoanal pouch anastomosis. There are multiple studies on the relative safety of immunomodulators and anti-tumor necrosis factor medications during pregnancy, and we know how to safely treat...

  9. Impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, and quality of life.

    Science.gov (United States)

    Schindlbeck, Katharina A; Becker, Janek; Berger, Felix; Mehl, Arne; Rewitzer, Charlotte; Geffe, Sarah; Koch, Peter M; Preiß, Jan C; Siegmund, Britta; Maul, Jochen; Marzinzik, Frank

    2017-01-01

    Inflammatory bowel disease has been associated with neurological symptoms including restless legs syndrome. Here, we investigated the impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, mood, cognition, and quality of life. Two groups of inflammatory bowel disease patients, with and without restless legs syndrome, were prospectively evaluated for sleep disorders, fatigue, daytime sleepiness, depression, anxiety, and health-related quality of life. Furthermore, global cognitive function, executive function, attention, and concentration were assessed in both groups. Disease activity and duration of inflammatory bowel disease as well as current medication were assessed by interview. Inflammatory bowel disease patients with and without restless legs syndrome were matched for age, education, severity, and duration of their inflammatory bowel disease. Patients with inflammatory bowel disease and clinically relevant restless leg syndrome suffered significantly more frequent from sleep disturbances including sleep latency and duration, more fatigue, and worse health-related quality of life as compared to inflammatory bowel disease patients without restless legs syndrome. Affect and cognitive function including cognitive flexibility, attention, and concentration showed no significant differences among groups, indicating to be not related to restless legs syndrome. Sleep disorders including longer sleep latency, shorter sleep duration, and fatigue are characteristic symptoms of restless legs syndrome in inflammatory bowel disease patients, resulting in worse health-related quality of life. Therefore, clinicians treating patients with inflammatory bowel disease should be alert for restless legs syndrome.

  10. [A consecutive study of patients with irritable bowel disease in two tertiary referral centers].

    Science.gov (United States)

    Porsch, U; Wanitschke, R; Linhart, P; Börner, N; Bassler, M; Galle, P; Hoffmann, S O

    2001-07-01

    We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS). A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD). The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB). We found that the rate of physician visits given in the course of the disease, is increased for those having irritable bowel disease (IBS). These patients are dissatisfied with the physicians and prone to psychophysiological complaint. In the daily routine and in occupation they are more impaired than those with inflammatory disease. This finding emphasizes in particular that patients with irritable bowel diseases (IBS) have experienced emotional deficiencies in childhood as an after effect of loss, divorce of the parents etc. Implications for doctor-patient relationship and the necessity for epidemiological studies in Germany are discussed.

  11. [Quality of life and physical activity of patients with inflammatory bowel diseases].

    Science.gov (United States)

    Nowak, Agata; Kucio, Cezary

    2015-01-01

    Estimation of the quality of life of patients with inflammatory bowel diseases and comparison these results with control group. A group of 16 patients with inflammatory bowel diseases and 13 healthy persons as a control group. In orderto estimate the quality of life, polish version of Inflammatory Bowel Disease Questionnaire (IBDQ) was used. The Second questionnaire that was used is WHOQOL-BREF (The World Health Organization Quality of Life). To assess the level of physical activity was applied the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ). All the results have been correlated to answer the question if there is any relationship between the quality of life and physical activity and if level of these parameters is different in control group. In the group of patients the lowest level of functioning were stated on bowel ailments field and emotional field. The most important roles in patients life are social relationship and sanity. The higher level of the caloric consumption was stated in the group of patients with inflammatory bowel diseases in comparison to control group. There was no significant difference in caloric consumption related with the recreation and house works. Because of the fact that all of the patients were in the remission period, it was impossible to verify if there is any relationship between quality of life and the stage of disease. The results of researches have not proved relationship between the level of physical activity and the quality of life among the patients as well as in the control group.

  12. Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive.

    Science.gov (United States)

    Sands, K; Jansen, R; Zaslau, S; Greenwald, D

    2015-05-01

    Many therapeutic drugs are used by patients with inflammatory bowel disease, often around the time of conception. The pregnancy outcomes of males and females exposed to these therapeutics needs to be examined and this information is necessary to counsel patients appropriately. To review the literature describing male infertility and inflammatory bowel disease to educate practitioners of the impact of inflammatory bowel disease on male reproduction and the impact of therapeutics on pregnancy outcomes. We performed a PubMed search using the search terms 'male infertility,' 'Crohn's disease,' 'inflammatory bowel disease,' 'ulcerative colitis,' 'ciprofloxacin AND infertility,' 'metronidazole AND infertility,' 'sulfasalazine AND infertility,' 'azathioprine AND infertility,' 'methotrexate AND infertility,' 'ciclosporin AND infertility,' 'corticosteroids AND infertility,' 'infliximab AND male fertility,' 'infliximab AND infertility,' 'infliximab AND foetus,' 'infliximab AND paternal exposure' and 'infliximab AND sperm.' References from selected papers were reviewed and used if relevant. Over half of male patients with IBD have some degree of infertility, compared to 8-17% of the general population. Semen parameters including total count, motility and morphology may be adversely affected by therapeutics. IBD medications in males do not increase foetal risk with the possible exception of azathioprine and mercaptopurine; however, increased foetal risk is seen in other drugs if taken by female patients. It is recognised that male infertility is often impacted with therapeutic drugs used to treat inflammatory bowel disease; however, the effects of the paternal drug exposure at the time of conception and exposure in utero should be considered to counsel patients appropriately. © 2015 John Wiley & Sons Ltd.

  13. Patient-reported Outcomes in a French Nationwide Survey of Inflammatory Bowel Disease Patients.

    Science.gov (United States)

    Williet, Nicolas; Sarter, Hélène; Gower-Rousseau, Corinne; Adrianjafy, Charlotte; Olympie, Alain; Buisson, Anne; Beaugerie, Laurent; Peyrin-Biroulet, Laurent

    2017-02-01

    Patient reported-outcomes [PROs] are a major therapeutic goal in inflammatory bowel disease [IBD]. Between January and June 2014, patients affiliated with the French national IBD association filled out six self-questionnaires: quality of life 9QoL, according to the Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and the Short-Form-36 Questionnaire [SF-36] v2); fatigue (the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]); work productivity (the Work Productivity and Activity Impairment [WPAI] questionnaire); disability [the I nflammatory Bowel Disease Disability Index]; and anxiety/depression (the Hospital Anxiety and Depression scale [HADS]). Associated factors were identified by univariate and multivariate logistic regression analyses. Datasets were obtained from 1185 IBD patients. Around half of patients reported poor QoL [SIBDQ 7: 49.4%]. One-third of the patients reported anxiety [HAD-A >7: 30.3%] and/or moderate [22.4%] or severe [11.9%] disability. About half of them reported presenteeism and moderate-to-severe loss of work productivity and loss of activity. Poor QoL, severe fatigue, severe disease-related disability, and/or high WPAI were all associated with female gender, unemployment, and disease activity. Poor QoL, severe fatigue, and high WPAI were also associated with the use of tumour necrosis factor antagonists. A history of surgery was associated with poor QoL, whereas age was associated with severe fatigue. Severe depression was associated with female gender and disease activity. The disease burden is very high in IBD, with poor QoL, fatigue, work impairment, and depression in half of patients. Marked disability and anxiety were reported by one-third of patients. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  14. Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases

    DEFF Research Database (Denmark)

    Halling, Morten L; Kjeldsen, Jens; Knudsen, Torben

    2017-01-01

    were significantly increased (P celiac disease, type 1 diabetes (T1D), sarcoidosis, asthma, iridocyclitis, psoriasis, pyoderma gangrenosum, rheumatoid arthritis, and ankylosing spondylitis. Restricted to UC (P ...AIM: To investigate whether immune mediated diseases (IMD) are more frequent in patients with inflammatory bowel disease (IBD). METHODS: In this population based registry study, a total of 47325 patients with IBD were alive and registered in the Danish National Patient Registry on December 16, 2013....... Controls were randomly selected from the Danish Civil Registration System (CRS) and matched for sex, age, and municipality. We used ICD 10 codes to identify the diagnoses of the included patients. The IBD population was divided into three subgroups: Ulcerative colitis (UC), Crohn's disease (CD) and Both...

  15. Prevalence of hepatobiliary dysfunction in a regional group of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Wewer, V; Gluud, C; Schlichting, P

    1991-01-01

    A regional group of outpatients with chronic inflammatory bowel disease (ulcerative colitis, n = 396, and Crohn's disease, n = 125) was biochemically screened to estimate the prevalence of hepatobiliary dysfunction. Among the 396 patients with ulcerative colitis, 69 (17%; 95% confidence limits, 1...... the criteria for further evaluation as described above. One patient appeared to have epithelioid granuloma in the liver and one patient had alcoholic liver disease, whereas one patient refused further examination.(ABSTRACT TRUNCATED AT 250 WORDS)...

  16. Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?

    NARCIS (Netherlands)

    Geboes, K.; Ectors, N.; D'Haens, G.; Rutgeerts, P.

    1998-01-01

    To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied

  17. The prevalence of inflammatory bowel diseases, microscopic colitis, and colorectal cancer in patients with irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Magdy El-Salhy

    2011-07-01

    Full Text Available The diagnosis of irritable bowel syndrome (IBS is symptom-based and experts have developed diagnostic criteria for IBS. Distinguishing inflammatory bowel diseases (IBD from IBS, especially with mild disease activity, can be difficult. Another concern is microscopic colitis (MC. MC and IBS have similar symptoms and a normal endoscopic appearance. Our study investigated the prevalence of patients with IBD, MC, and colorectal cancer among 968 patients that fulfill the Rome III criteria for IBS. Among these patients, four were found with IBD (0.4% and seven with MC (0.7%. Among the IBD patients, three suffered from Crohn’s disease, affecting the terminal ileum, and one with ulcerative rectosigmoiditis. Of the seven patients with MC, two had collagenous colitis and five had lymphocytic colitis. Two IBS diarrhea-predominant patients had adenocarcin­oma in the sigmoid colon. These patients were a female aged 58 years and a male aged 56 years. We concluded from our study and earl­ier studies that symptom-based diagnosis of IBS may lead to missing a number of other gastrointestinal disorders that require quite different management than that for IBS.

  18. Characteristics of the Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Harunobu Kawamura

    2013-01-01

    Full Text Available Obscure gastrointestinal bleeding (OGIB is one of the common complications in patients with chronic kidney disease (CKD, especially those who are on maintenance hemodialysis (HD. However, little is known about the characteristics of the small-bowel lesions in these patients, or of the factors that could predict the presence of such lesions. Therefore we enrolled a total of 42 CKD patients (including 19 HD patients and 23 non-HD patients, and compared the incidence of the small-bowel lesions among two groups. Furthermore, to identify predictive factors for the presence of small-bowel lesions, we performed multivariate logistic-regression-analyses. The incidence of small-bowel vascular lesions was significantly higher in CKD patients than in age-and-sex matched non-CKD patients (P<0.001. On the other hand, there was any significant difference of the incidence of small-bowel lesions between HD and non-HD patients. In CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10–29.1, P=0.04 was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13–31.9, P=0.04 was identified as that of erosive/ulcerated lesions. This indicated that proactive CE examination would be clinically meaningful for these patients.

  19. Prevalence and risk of inflammatory bowel disease in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Jemec, Gregor B E; Kimball, Alexa B

    2017-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease (IBD) has been associated with increased prevalence of HS, but data on the concurrence of IBD in patients with HS is limited. We therefore investigated the prevalence and risk of IBD...

  20. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis

    NARCIS (Netherlands)

    Weismueller, Tobias J.; Trivedi, Palak J; Bergquist, Annika; Imam, Mohamad; Lenzen, Henrike; Ponsioen, Cyriel Y.; Holm, Kristian; Gotthardt, Daniel; Faerkkilae, Martti A.; Marschall, Hanns-Ulrich; Thorburn, Douglas; Weersma, Rinse K.; Fevery, Johan; Mueller, Tobias; Chazouilleres, Olivier; Schulze, Kornelius; Lazaridis, Konstantinos N.; Almer, Sven; Pereira, Stephen P.; Levy, Cynthia; Mason, Andrew L.; Naess, Sigrid; Bowlus, Christopher L.; Floreani, Annarosa; Halilbasic, Emina; Yimam, Kidist K.; Milkiewicz, Piotr; Beuers, Ulrich; Huynh, Dep K.; Pares, Albert; Manser, Christine N.; Dalekos, George N.; Eksteen, Bertus; Invernizzi, Pietro; Berg, Christoph P.; Kirchner, Gabi I.; Sarrazin, Christoph; Zimmer, Vincent; Fabris, Luca; Braun, Felix; Marzioni, Marco; Juran, Brian D.; Said, Karouk; Rupp, Christian; Jokelainen, Kalle; de Valle, Maria Benito; Saffioti, Francesca; Cheung, Angela; Trauner, Michael; Schramm, Christoph; Chapman, Roger W.; Karlsen, Tom H.; Schrumpf, Erik; Strassburg, Christian P.; Manns, Michael P.; Lindor, Keith D; Hirschfield, Gideon M.; Hansen, Bettina E.; Boberg, Kirsten M.

    BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. METHODS: We

  1. Development of Inflammatory Bowel Disease in Patients with Juvenile Idiopathic Arthritis Treated with Etanercept

    NARCIS (Netherlands)

    van Dijken, Trudy D; Vastert, Sebastiaan J; Gerloni, Valeria M; Pontikaki, Irene; Linnemann, Kristina; Girschick, Hermann; Armbrust, Wineke; Minden, Kirsten; Prince, Femke H M; Kokke, Freddy T M; Nieuwenhuis, Edward E S; Horneff, Gerd; Wulffraat, Nico M

    OBJECTIVE: With the increasing use of etanercept for juvenile idiopathic arthritis (JIA) new possible adverse events are reported including new autoimmune diseases. Our purpose was to examine if the incidence of inflammatory bowel disease (IBD) in patients with JIA using etanercept is higher than in

  2. Patients' beliefs about medicine are associated with early thiopurine discontinuation in patients with inflammatory bowel diseases.

    Science.gov (United States)

    Broekman, Mark M T J; Coenen, Marieke J H; Wanten, Geert J; van Marrewijk, Corine J; Kievit, Wietske; Klungel, Olaf H; Verbeek, André L M; Wong, Dennis R; Hooymans, Piet M; Guchelaar, Henk-Jan; Scheffer, Hans; Derijks, Luc J J; Bouvy, Marcel L; de Jong, Dirk J

    2018-02-01

    Patients' beliefs about medicine may either reflect the necessity for treatment or concerns regarding the treatment. We explored the extent to which these beliefs have an effect on thiopurine metabolite levels and premature discontinuation in patients with inflammatory bowel disease (IBD). Patients enrolled in the 'Thiopurine response Optimization by Pharmacogenetic testing in Inflammatory Bowel Disease Clinics' (TOPIC) trial were asked to complete the Beliefs about Medicine Questionnaire (BMQ) 4 weeks after thiopurine initiation. The BMQ measures perceptions about treatment necessity and concerns. On the basis of the necessity and concern scores, patients can be categorized as accepting, ambivalent, indifferent, or skeptical. The thiopurine discontinuation rates for these belief subgroups were compared by Kaplan-Meier curves. Furthermore, clinical response and metabolite levels were compared between the belief subgroups. A total of 767 patients with IBD started thiopurine treatment, of whom 576 (75%) completed the BMQ. Patients could be classified as accepting (34%), indifferent (17%), ambivalent (34%), or skeptical (15%). Compared with patients in the accepting group (discontinuation rate 22%), patients with an indifferent (35%; P=0.02), ambivalent (37%; P<0.01), or skeptical belief (54%; P<0.01) had higher thiopurine discontinuation rates. No differences were observed in the steady-state thiopurine metabolite levels between the different belief subgroups. Patients with a low perceived treatment necessity or high concerns toward IBD treatment were more likely to discontinue thiopurine treatment prematurely. Extra attention toward these patients might prevent premature discontinuation.

  3. Vaccination and Health Maintenance Issues to Consider in Patients With Inflammatory Bowel Disease.

    Science.gov (United States)

    Reich, Jason; Wasan, Sharmeel K; Farraye, Francis A

    2017-12-01

    Patients with inflammatory bowel disease (IBD) do not receive routine preventive care at the same rate as the general population. IBD places patients at increased risk for developing vaccine-preventable illnesses. This risk is further exacerbated by immunosuppressive therapy. This article highlights the necessary vaccinations for IBD patients and the timing of vaccination for immunosuppressed patients, and discusses the health maintenance needs and preventive care issues related to heart disease, smoking, osteoporosis, mental health, cervical cancer, and skin cancer.

  4. Bowel Diseases and Kidneys

    Directory of Open Access Journals (Sweden)

    A.E. Dorofeiev

    2015-09-01

    Full Text Available This review of contemporary publications analyzes the prevalence of combinations of bowel and renal diseases. Special attention is paid to the problem of correlation between bowel diseases and urolithiasis. We consider the possible pathogenic mechanisms of lesions, such as genetically determined violations of intestinal absorption and secretion, changes in the intestinal microbiota, systemic inflammatory response, water and electrolyte disturbances.

  5. Mucormycosis in Patients with Inflammatory Bowel Disease: Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Maheen Z. Abidi

    2014-01-01

    Full Text Available Mucormycosis is a rare and often fatal invasive fungal infection mostly seen in immune-compromised individuals. A high index of clinical suspicion is necessary, so that effective preemptive therapy can be started, as timely intervention is crucial. In this series we present three cases of invasive mucormycosis in patients with underlying inflammatory bowel disease that had received therapy with immunomodulators prior to the infection. All three had varied clinical manifestations. We also review the literature of invasive mucormycosis in patients with inflammatory bowel disease.

  6. Family planning and inflammatory bowel disease: the patient and the practitioner.

    LENUS (Irish Health Repository)

    Toomey, Desmond

    2013-02-01

    Patients with inflammatory bowel disease (IBD) are commonly in their child-bearing years. Maintainance medication, as recommended by international guidelines, is an emotive topic and an anxiety source. This study measures the awareness of patients and primary practitioners of the issues involved.

  7. Adenomas in Patients with Inflammatory Bowel Disease Are Associated with an Increased Risk of Advanced Neoplasia

    NARCIS (Netherlands)

    van Schaik, Fiona D. M.; Mooiweer, Erik; van der Have, Mike; Belderbos, Tim D. G.; ten Kate, Fiebo J. W.; Offerhaus, G. Johan A.; Schipper, Marguerite E. I.; Dijkstra, Gerard; Pierik, Marieke; Stokkers, Pieter C. F.; Ponsioen, Cyriel; de Jong, Dirk J.; Hommes, Daniel W.; van Bodegraven, Ad A.; Siersema, Peter D.; van Oijen, Martijn G. H.; Oldenburg, Bas

    Background: It is still unclear whether inflammatory bowel disease (IBD) patients with adenomas have a higher risk of developing high-grade dysplasia (HGD) or colorectal cancer (CRC) than non-IBD patients with sporadic adenomas. We compared the risk of advanced neoplasia (AN, defined as HGD or CRC)

  8. Ferric carboxymaltose prevents recurrence of anemia in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Evstatiev, Rayko; Alexeeva, Olga; Bokemeyer, Bernd

    2013-01-01

    Iron-deficiency anemia is the most common systemic complication of inflammatory bowel diseases (IBD). Iron-deficiency anemia recurs frequently and rapidly after iron-replacement therapy in patients with IBD. We performed a randomized, placebo-controlled trial to determine if administration...... of ferric carboxymaltose (FCM) prevents anemia in patients with IBD and low levels of serum ferritin....

  9. Patient health communication mediating effects between gastrointestinal symptoms and gastrointestinal worry in pediatric inflammatory bowel disease

    Science.gov (United States)

    To investigate the effects of patient health communication regarding their inflammatory bowel disease (IBD) to their health care providers and significant others in their daily life as a mediator in the relationship between gastrointestinal symptoms and gastrointestinal worry in pediatric patients. ...

  10. Serological screening for celiac disease in adult Chinese patients with diarrhea predominant irritable bowel syndrome

    NARCIS (Netherlands)

    H. Wang (Hongling); G. Zhou (Guoying); L. Luo (Linjie); J.B.A. Crusius; A. Yuan (Anlong); J. Kou (Jiguang); G. Yang (Guifang); M. Wang (Min); J. Wu (Jing); B.M.E. von Blomberg (Mary); S.A. Morré (Servaas); A. Salvador Pena; B. Xia (Bing)

    2015-01-01

    textabstractCeliac disease (CD) is common in Caucasians, but thought to be rare in Asians. Our aim was to determine the prevalence of CD in Chinese patients with chronic diarrhea predominant irritable bowel syndrome (IBS-D). From July 2010 to August 2012, 395 adult patients with IBS-D and 363 age

  11. Employment status, difficulties at work and quality of life in inflammatory bowel disease patients

    NARCIS (Netherlands)

    De Boer, Angela G. E. M.; Evertsz', Floor Bennebroek; Stokkers, Pieter C.; Bockting, Claudia L.; Sanderman, Robbert; Hommes, Daniel W.; Sprangers, Mirjam A. G.; Frings-Dresen, Monique H. W.

    2016-01-01

    ObjectivesTo assess employment status, difficulties at work and sick leave in inflammatory bowel disease (IBD) patients and their relation with sociodemographic and clinical factors, quality of life (QoL), and anxiety and depression.Materials and methodsIBD patients attending an IBD outpatients'

  12. Do Inflammatory Bowel Disease patients with anxiety and depressive symptoms receive the care they need?

    NARCIS (Netherlands)

    Bennebroek Evertsz', F; Thijssens, N A M; Stokkers, P C F; Grootenhuis, M A; Bockting, C L H; Nieuwkerk, P T; Sprangers, M A G

    BACKGROUND AND AIMS: Inflammatory Bowel Disease (IBD) patients with anxiety and/or depressive symptoms may not receive the care they need. Provision of care requires insight into the factors affecting these psychiatric symptoms. The study was designed to examine the extent to which: (1) IBD patients

  13. Employment status, difficulties at work and quality of life in inflammatory bowel disease patients

    NARCIS (Netherlands)

    De Boer, A. G.; Bockting, C. L. H.; Bennebroek Evertsz', F.; Stokkers, P. C.; Sandeman, R.; Hommes, D. W.; Sprangers, M. A. G.; Frings-Dresen, M. H. W.

    2016-01-01

    OBJECTIVES: To assess employment status, difficulties at work and sick leave in inflammatory bowel disease (IBD) patients and their relation with sociodemographic and clinical factors, quality of life (QoL), and anxiety and depression. MATERIALS AND METHODS: IBD patients attending an IBD

  14. Drug Safety and Risk of Adverse Outcomes for Pregnant Patients With Inflammatory Bowel Disease.

    Science.gov (United States)

    Mahadevan, Uma; McConnell, Ryan A; Chambers, Christina D

    2017-02-01

    The management of the pregnant patient with inflammatory bowel disease is complicated by multiple providers, misinformation, and a disease entity that, particularly when active, can adversely affect pregnancy outcomes. This article seeks to frame the debate on medication safety in pregnancy and lactation using the US Food and Drug Administration's new Pregnancy and Lactation Labeling Rule and the most up-to-date safety information to discuss the risks and benefits of using each class of inflammatory bowel disease medication. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  15. Food avoidance in patients with inflammatory bowel disease: What, when and who?

    Science.gov (United States)

    Bergeron, Fanny; Bouin, Mickael; D'Aoust, Louise; Lemoyne, Michel; Presse, Nancy

    2017-03-15

    Patients with inflammatory bowel diseases avoid a variety of foods. However, it remains unclear how this behavior varies across patients. This cross-sectional study investigated how the food avoidance pattern in inflammatory bowel disease varies according to disease's activity, disease's subtype, Crohn's location, and prior history of bowel resection, strictures, and fistulae. Outpatients with Crohn's disease (n = 173) and ulcerative colitis (n = 72) reported which food they avoid when they perceive they are in remission or in active disease using a list of 82 food items classified in 10 categories. Medical charts were reviewed for patients' characteristics. Linear regression analyses were used to compare food exclusion rates between patients' subgroups and food categories. During remission, food exclusion rates varied from 1 to 39%. Most avoided foods were those with capsaicin, meat alternatives, and raw vegetables. Overall, food exclusion rates were 38% higher in Crohn's disease than ulcerative colitis (P < 0.001), and 50% higher in stricturing than non-stricturing Crohn's disease (P < 0.001). During active disease, food exclusion rates were 69% higher than in remission (P < 0.001). Similar differences between subgroups were again observed during active disease though less noticeable than in remission. No association was found with other disease characteristics. Avoided foods were very similar across patients except for alcoholic beverages and foods rich in dietary fibers/residue, which were avoided more specifically during active disease and in Crohn's disease, respectively. Food avoidance is common among patients with inflammatory bowel diseases, and most particularly in those with stricturing Crohn's disease. Specificities in avoidance pattern suggest that the clinical response to dietary restrictions may differ according to the disease's characteristics. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All

  16. Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases.

    Science.gov (United States)

    Rieder, Florian; Fiocchi, Claudio; Rogler, Gerhard

    2017-02-01

    In the last 10 years, we have learned much about the pathogenesis, diagnosis, and management of intestinal fibrosis in patients with inflammatory bowel diseases. Just a decade ago, intestinal strictures were considered to be an inevitable consequence of long-term inflammation in patients who did not respond to anti-inflammatory therapies. Inflammatory bowel diseases-associated fibrosis was seen as an irreversible process that frequently led to intestinal obstructions requiring surgical intervention. This paradigm has changed rapidly, due to the antifibrotic approaches that may become available. We review the mechanisms and diagnosis of this serious complication of inflammatory bowel diseases, as well as factors that predict its progression and management strategies. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  17. Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease.

    Science.gov (United States)

    Levenstein, S; Li, Z; Almer, S; Barbosa, A; Marquis, P; Moser, G; Sperber, A; Toner, B; Drossman, D A

    2001-06-01

    The aim of this work was to study cross-cultural variations in the impact of inflammatory bowel disease (IBD) on health-related quality of life by an international comparison of disease-related concerns. Item and factor scores on the Rating Form of Inflammatory Bowel Disease Patient Concerns and overall mean concern levels were compared by analysis of variance among 2002 IBD patients in eight countries. The overall level of concern varied from 51 out of 100 in Portugal to 19 in Sweden, with intermediate scores for Italy (43), Canada (40), United States (39), France (39), Austria (33), and Israel (25). Having surgery, an ostomy, the uncertain nature of the disease, and medication side effects were each rated among the first five in importance in six countries. Other items varied considerably. For example, concern regarding pain and suffering was high in Israel and low in Portugal, whereas concern over developing cancer was low in Italy. Concern over financial issues and access to high-quality health care were inversely associated with measures of national economic prosperity. 1) Cross-cultural comparisons of patient concerns related to IBD are feasible using translated scales. 2) Reporting tendencies vary greatly; within Europe, patients from southern countries report greater overall concern. 3) The complications and the variable evolution of disease elicit general concern, but the importance of specific issues varies among countries. 4) The reasons for national differences may have social, cultural, and/or economic determinants with relevance to the patient-physician relationship, patient education, and therapeutic decision making.

  18. Diagnosis and treatment of anemia in patients with inflammatory bowel disease

    OpenAIRE

    M?cke, Victoria; M?cke, Marcus M.; Raine, Tim; Bettenworth, Dominik

    2016-01-01

    Anemia represents one of the most frequent complications in inflammatory bowel disease (IBD) and severely impairs the quality of life of affected patients. The etiology of anemia in IBD patients can be multifactorial, often involving a combination of iron deficiency (ID) and anemia of chronic disease (ACD). Although current guidelines recommend screening for and treatment of anemia in IBD patients, current observational data suggest that it still remains underdiagnosed and undertreated. Besid...

  19. Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases.

    Science.gov (United States)

    Halling, Morten L; Kjeldsen, Jens; Knudsen, Torben; Nielsen, Jan; Hansen, Lars Koch

    2017-09-07

    To investigate whether immune mediated diseases (IMD) are more frequent in patients with inflammatory bowel disease (IBD). In this population based registry study, a total of 47325 patients with IBD were alive and registered in the Danish National Patient Registry on December 16, 2013. Controls were randomly selected from the Danish Civil Registration System (CRS) and matched for sex, age, and municipality. We used ICD 10 codes to identify the diagnoses of the included patients. The IBD population was divided into three subgroups: Ulcerative colitis (UC), Crohn's disease (CD) and Both the latter referring to those registered with both diagnoses. Subsequently, odds-ratios (OR) and 95%CI were obtained separately for each group and their respective controls. The use of Bonferoni post-test correction adjusted the significance level to P disease, type 1 diabetes (T1D), sarcoidosis, asthma, iridocyclitis, psoriasis, pyoderma gangrenosum, rheumatoid arthritis, and ankylosing spondylitis. Restricted to UC (P autoimmune hepatitis, primary biliary cholangitis, Grave's disease, polymyalgia rheumatica, temporal arteritis , and atrophic gastritis. Restricted to CD (P disease restricted to men (P diseases were significantly more frequent in patients with IBD. Our results strengthen the hypothesis that some IMDs and IBD may have overlapping pathogenic pathways.

  20. Critical Situations in Daily Life as Experienced by Patients With Inflammatory Bowel Disease.

    Science.gov (United States)

    Pihl Lesnovska, Katarina; Hollman Frisman, Gunilla; Hjortswang, Henrik; Börjeson, Sussanne

    2016-01-01

    Crohn disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), are chronic and have a fluctuating clinical course that impacts daily life. Daily life with a chronic disease involves thinking and worrying about the limitations that chronic disease causes. Knowledge about how patients who suffer from IBD manage critical incidents in daily life is lacking. The aim of the study was to describe how patients living with IBD experience critical incidents in daily life in relation to their disease and symptoms. Thirty adult patients were interviewed focusing on critical incidents in daily life. Data were analyzed using the critical incident technique. The study comprised 224 critical incidents and was grouped into 21 subcategories and 5 categories: losing bowel control, having a body that smells, being unable to meet own and others' expectations, not being believed or seen, and experiencing frustration due to side effects and ineffective treatment. These categories formed one main area describing the overall result "The bowels rule life." The uncertain nature of IBD created critical incidents in which the bowel ruled life, causing patients to avoid social interaction. It also placed considerable demands on the family and sometimes had a negative effect on the afflicted person's career.

  1. [Immunological profile of coeliac disease in a subgroup of patients with symptoms of irritable bowel syndrome].

    Science.gov (United States)

    Elloumi, Hela; El Assoued, Youssef; Ghédira, Ibtissem; Ben Abdelaziz, Ahmed; Yacoobi, Mohamed T; Ajmi, Salem

    2008-09-01

    The purpose of this study was to determine if authentic cases of irritable bowel syndrome could be secondary in a latent or potential coeliac disease. All new patients who consulted for irritable bowel syndrome fulfilling Rome II criteria between 01/04/2003 and 30/03/2004 were included. All patients had upper endoscopy with duodenal biopsy and colonoscopy or enema. Then they were investigated for celiac disease by analysis of serum IgA antigliadin, IgG antigliadin, and endomysial antibodies. One hundred patients with irritable bowel syndrome were included. They had an average age of 45,5 +/- 0,98 and they were 61 women. Clinical signs were dominated by abdominal pains associated to constipation (69% of the cases). Five patients had positive antigliadin antibody (IgG for 2 patients and IgA for 3 patients). None of them had endomysial antibodies nor abnormal duodenal biopsy. This study didn't provide a relation between celiac disease and irritable bowel syndrome when it is associated to constipation.

  2. Mycobacterium avium subspecies paratuberculosis causes Crohn's disease in some inflammatory bowel disease patients.

    Science.gov (United States)

    Naser, Saleh A; Sagramsingh, Sudesh R; Naser, Abed S; Thanigachalam, Saisathya

    2014-06-21

    Crohn's disease (CD) is a chronic inflammatory condition that plagues millions all over the world. This debilitating bowel disease can start in early childhood and continue into late adulthood. Signs and symptoms are usually many and multiple tests are often required for the diagnosis and confirmation of this disease. However, little is still understood about the cause(s) of CD. As a result, several theories have been proposed over the years. One theory in particular is that Mycobacterium avium subspecies paratuberculosis (MAP) is intimately linked to the etiology of CD. This fastidious bacterium also known to cause Johne's disease in cattle has infected the intestines of animals for years. It is believed that due to the thick, waxy cell wall of MAP it is able to survive the process of pasteurization as well as chemical processes seen in irrigation purification systems. Subsequently meat, dairy products and water serve as key vehicles in the transmission of MAP infection to humans (from farm to fork) who have a genetic predisposition, thus leading to the development of CD. The challenges faced in culturing this bacterium from CD are many. Examples include its extreme slow growth, lack of cell wall, low abundance, and its mycobactin dependency. In this review article, data from 60 studies showing the detection and isolation of MAP by PCR and culture techniques have been reviewed. Although this review may not be 100% comprehensive of all studies, clearly the majority of the studies overwhelmingly and definitively support the role of MAP in at least 30%-50% of CD patients. It is very possible that lack of detection of MAP from some CD patients may be due to the absence of MAP role in these patients. The latter statement is conditional on utilization of methodology appropriate for detection of human MAP strains. Ultimately, stratification of CD and inflammatory bowel disease patients for the presence or absence of MAP is necessary for appropriate and effective

  3. Colorectal cancer in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Halfvarson, Jonas; Vogel, Ulla Birgitte

    2012-01-01

    during 30 years of observation. The overall risk of CRC among patients with UC and CD was comparable with that of the general population. However, patients diagnosed with UC during childhood or as adolescents, patients with long duration of disease and those with concomitant primary sclerosing...... cholangitis were at increased risk. In this commentary, we discuss the mechanisms underlying carcinogenesis in IBD and current investigations of genetic susceptibility in IBD patients. Further advances will depend on the cooperative work by epidemiologist and molecular geneticists in order to identify genetic...

  4. Validation and results of a questionnaire for functional bowel disease in out-patients

    Directory of Open Access Journals (Sweden)

    Skordilis Panagiotis

    2002-05-01

    Full Text Available Abstract Background The aim was to evaluate and validate a bowel disease questionnaire in patients attending an out-patient gastroenterology clinic in Greece. Methods This was a prospective study. Diagnosis was based on detailed clinical and laboratory evaluation. The questionnaire was tested on a pilot group of patients. Interviewer-administration technique was used. One-hundred-and-forty consecutive patients attending the out-patient clinic for the first time and fifty healthy controls selected randomly participated in the study. Reliability (kappa statistics and validity of the questionnaire were tested. We used logistic regression models and binary recursive partitioning for assessing distinguishing ability among irritable bowel syndrome (IBS, functional dyspepsia and organic disease patients. Results Mean time for questionnaire completion was 18 min. In test-retest procedure a good agreement was obtained (kappa statistics 0.82. There were 55 patients diagnosed as having IBS, 18 with functional dyspepsia (Rome I criteria, 38 with organic disease. Location of pain was a significant distinguishing factor, patients with functional dyspepsia having no lower abdominal pain (p Conclusions This questionnaire for functional bowel disease is a valid and reliable instrument that can distinguish satisfactorily between organic and functional disease in an out-patient setting.

  5. Colorectal Cancer Risk in Patients With Lynch Syndrome and Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Derikx, L.A.A.P.; Smits, L.J.T.; Lent-van Vliet, S. van; Dekker, E.; Aalfs, C.M.; Kouwen, M.C.A. van; Nagengast, F.M.; Nagtegaal, I.D.; Hoogerbrugge, N.; Hoentjen, F.

    2017-01-01

    Lynch syndrome and inflammatory bowel diseases (IBD) are associated with an increased risk of colorectal cancer (CRC). However, it is not clear whether the risk of CRC is even higher for patients with a combination of Lynch syndrome and IBD. We investigated the risk for CRC in this subgroup by

  6. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease

    NARCIS (Netherlands)

    Jharap, B.; Boer, N.K. de; Stokkers, P.; Hommes, D.W.; Oldenburg, B.; Dijkstra, G.; Woude, C.J. van der; Jong, D.J. de; Mulder, C.J.; Elburg, R.M. van; Bodegraven, A.A. van

    2014-01-01

    OBJECTIVE: Several studies have demonstrated a favourable safety profile for thiopurine use for inflammatory bowel disease (IBD) during pregnancy. We performed a study in pregnant patients with IBD who were using thiopurines, in order to determine the influence of pregnancy on thiopurine metabolism

  7. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease

    NARCIS (Netherlands)

    Jharap, Bindia; de Boer, Nanne K. H.; Stokkers, Pieter; Hommes, Daniel W.; Oldenburg, Bas; Dijkstra, Gerard; van der Woude, C. Janneke; de Jong, Dirk J.; Mulder, Chris J. J.; van Elburg, Ruurd M.; van Bodegraven, Adriaan A.

    Objective Several studies have demonstrated a favourable safety profile for thiopurine use for inflammatory bowel disease (IBD) during pregnancy. We performed a study in pregnant patients with IBD who were using thiopurines, in order to determine the influence of pregnancy on thiopurine metabolism

  8. Inflammatory bowel disease and pregnancy.

    Science.gov (United States)

    Maliszewska, Anna Małgorzata; Warska, Aleksandra; Cendrowski, Krzysztof; Sawicki, Włodzimierz

    2017-01-01

    Inflammatory bowel disease (IBD) comprising Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) may appear at any age. As such, IBD commonly affects young patients in their reproductive age. Rate of voluntary childlessness among women with IBD far exceed that of the general population, as patients with IBD fear not only the effect of pregnancy on the course of inflammatory bowel disease, but also the increased risk of the offspring developing the disease, adverse pregnancy outcomes, the effect IBD treatment may have on the health and development of the infant or the risk of relapse during pregnancy and the influence of lactation on child development and disease course. This article aims at improving pre-conception counseling of patients with inflammatory bowel disease.

  9. Treatment of the Pregnant Patient with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Winter, Rachel; Nørgård, Bente M; Friedman, Sonia

    2016-01-01

    a pregnant patient with a disease flare. The best way to manage women with IBD who are pregnant or contemplating pregnancy is a multidisciplinary approach. Team members often include a gastroenterologist, a high-risk obstetrician, an infertility specialist, a colorectal surgeon, and a pediatrician...

  10. Inflammatory Bowel Disease (For Teens)

    Science.gov (United States)

    ... Protecting Your Online Identity and Reputation ADHD Medicines Inflammatory Bowel Disease KidsHealth > For Teens > Inflammatory Bowel Disease Print A ... en español Enfermedad inflamatoria del intestino What Is Inflammatory Bowel Disease? Inflammatory bowel disease (IBD) is a condition that ...

  11. Comparison of three commercial fecal calprotectin ELISA test kits used in patients with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Mirsepasi-Lauridsen, Hengameh Chloé; Bachmann Holmetoft, Ulla; Halkjær, Sofie Ingdam

    2016-01-01

    OBJECTIVE: Fecal calprotectin is a noninvasive marker of intestinal inflammation used to distinguish between functional and organic bowel diseases and to evaluate disease activity among patients with Inflammatory Bowel Disease (IBD). The goal of this study was to compare three different ELISA tests...... and 18 to 67 years, respectively. Disease activity in the patients was established using the following clinical activity indices: the Simple Clinical Colitis Activity Index (SCCAI), the Harvey Bradshaw Index (HBI) and the Modified Pouchitis Disease Activity Index (MPDAI). Three ELISA calprotectin tests...... (EK-CAL, CALPRO and HK325) were performed on fecal specimens and results compared. RESULTS: The CALPRO calprotectin ELISA test was shown to have the best specificity of 96% compared to the HK325 and the EK-CAL calprotectin ELISA tests with 28% specificity and 74% specificity, respectively...

  12. Risk factors for gallstones and kidney stones in a cohort of patients with inflammatory bowel diseases.

    Science.gov (United States)

    Fagagnini, Stefania; Heinrich, Henriette; Rossel, Jean-Benoît; Biedermann, Luc; Frei, Pascal; Zeitz, Jonas; Spalinger, Marianne; Battegay, Edouard; Zimmerli, Lukas; Vavricka, Stephan R; Rogler, Gerhard; Scharl, Michael; Misselwitz, Benjamin

    2017-01-01

    Gallstones and kidney stones are known complications of inflammatory bowel diseases (IBD). Risk factors have been insufficiently studied and explanatory studies date back up to 30 years. It remains unclear, whether improved treatment options also influenced risk factors for these complications. Identifying risk factors for gallstones and kidney stones in IBD patients. Using data from the Swiss Inflammatory Bowel Disease Cohort Study we assessed associations of diseases characteristics with gallstones and kidney stones in univariate and multivariate logistic regression analyses. Out of 2323 IBD patients, 104 (7.8%) Crohn's disease (CD) and 38 (3.8%) ulcerative colitis (UC) patients were diagnosed with gallstones. Significant risk factors for gallstones were diagnosis of CD, age at diagnosis, disease activity and duration, NSAID intake, extra-intestinal manifestations and intestinal surgery. Kidney stones were described in 61 (4.6%) CD and 30 (3.0%) UC patients. Male gender, disease activity, intestinal surgery, NSAID usage and reduced physical activity were significant risk factors. Hospitalization was associated with gallstones and kidney stones. The presence of gallstones increased the risk for kidney stones (OR 4.87, p<0.001). The diagnosis of CD, intestinal surgery, prolonged NSAID use, disease activity and duration and bowel stenosis were significantly associated with cholecystonephrolithiasis in IBD.

  13. QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: importance of clinical, demographic and psychosocial factors

    Directory of Open Access Journals (Sweden)

    Joana MAGALHÃES

    2014-09-01

    Full Text Available Context Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. Objectives To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Methods Ninety two patients with Crohn’s disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32 and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. Results IBDQ-32 scores were significantly lower in female patients (P<0.001, patients with an individual perception of a lower co-workers support (P<0.001 and career fulfillment (P<0.001, patients requiring psychological support (P = 0.010 and pharmacological treatment for anxiety or depression (P = 0.002. A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001 and the perception of a lower co-workers support (P = 0.025 and career fulfillment (P = 0.001. Conclusions The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

  14. Intestinal Inflammation Does Not Predict Nonalcoholic Fatty Liver Disease Severity in Inflammatory Bowel Disease Patients.

    Science.gov (United States)

    Carr, Rotonya M; Patel, Arpan; Bownik, Hillary; Oranu, Amanke; Kerner, Caroline; Praestgaard, Amy; Forde, Kimberly A; Reddy, K Rajender; Lichtenstein, Gary R

    2017-05-01

    Nonalcoholic fatty liver disease (NAFLD) is a common cause of hepatic steatosis in patients with inflammatory bowel disease (IBD). Both metabolic syndrome (MetS) and intestinal inflammation are implicated in NAFLD pathogenesis. We performed a retrospective cohort study of patients with IBD and NAFLD seen in our health system from January 1997 to December 2011 to examine associations between IBD severity and phenotype; MetS; and NAFLD fibrosis as estimated by the NAFLD Fibrosis Score (NFS). A total of 84 patients were included in our analysis (24 UC, 60 CD). 23% of patients had MetS. IBD patients with MetS were significantly older at the time of IBD diagnosis (44 vs. 33, p = 0.005) and NAFLD diagnosis (55 vs. 47, p = 0.018). IBD patients with MetS had higher ALT (54 vs. 38 U/L, p = 0.02) and AST (52 vs. 35 U/L, p = 0.004). Comparing MetS patients to non-MetS IBD patients, there was no significant difference between IBD medication use (i.e., steroids, anti-TNFs, and immunomodulators) or NAFLD medication use, other than statins. Both UC and CD patients with concomitant MetS had significantly higher NFS scores than non-MetS patients: UC (-0.4 vs. -2.5, p = 0.02) and CD (-0.8 vs. -2.3, p = 0.03). IBD disease severity, disease location, or IBD medication use was associated with NAFLD severity. To our knowledge, this is the first study to demonstrate that NAFLD severity in both UC and CD IBD patients is associated with the presence of MetS but not with the severity of IBD.

  15. Better disease specific patient knowledge is associated with greater anxiety in inflammatory bowel disease.

    Science.gov (United States)

    Selinger, Christian P; Lal, Simon; Eaden, Jayne; Jones, D Brian; Katelaris, Peter; Chapman, Grace; McDonald, Charles; Leong, Rupert W L; McLaughlin, John

    2013-07-01

    Inflammatory bowel disease (IBD)-related knowledge not only empowers patients, but may also engender anxiety. The study aimed to identify predictors of anxiety in IBD and examine the interplay between anxiety and disease-related patient knowledge. The effect of anxiety on quality of life was also explored. Ambulatory IBD patients provided data on demographics, their IBD and Crohn's Colitis Association (CCA) membership status. Disease-related knowledge was assessed using the validated Crohn's and Colitis Knowledge score (CCKnow) and disease related QOL using the short IBD questionnaire (SIBDQ). Anxiety and depression were assessed with the Hospital Anxiety and Depression Scores. Of the 258 patients 19.4% had a potential anxiety and a further 22.4% had a probable anxiety disorder. Females (P=0.003), tertiary care patients (P=0.014) and non-Caucasian patients (P=0.037) had significantly higher anxiety levels. CCA members had marginally higher levels of anxiety (P=0.07). Anxiety was associated with significantly better patient knowledge (P=0.016) and increased depression (Panxiety (Panxiety levels. The reason for this is unclear: educating patients about their disease might trigger anxiety, but, equally, anxious patients might seek out information and hence have better knowledge. It is thus noteworthy that an educational intervention may not necessarily reduce anxiety. Further work is needed to evaluate the association between anxiety and knowledge and to develop targeted interventions that will improve knowledge and simultaneously reduce anxiety. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  16. IMPORTANCE OF MEASURING LEVELS OF INFLIXIMAB IN PATIENTS TREATING INFLAMMATORY BOWEL DISEASE IN A BRAZILIAN COHORT

    Directory of Open Access Journals (Sweden)

    Katia Cristina KAMPA

    2017-09-01

    Full Text Available ABSTRACT BACKGROUND: Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases. In such pathologies, there is an increased production of alpha tumor necrosis factor (TNF-α. Patients, in whom the conventional immunosuppressant treatment fails, require the use of immunobiological therapy, such as anti-TNF-α, a monoclonal antibody. Infliximab is an anti-TNF-α drug, a chimerical immunoglobulin, with a murine component, which is responsible for the generation of immunogenicity against the drug and formation of anti-TNF-α antibodies. The presence of anti-drug antibodies may be responsible for adverse events and reduction of the drug’s effectiveness. Patients with inflammatory bowel diseases undergoing therapy with biological medication, such as infliximab, can relapse overtime and this may not be translated into clinical symptoms. Thus, there is a need for a method to evaluate the efficacy of the drug, through the measurement of serum infliximab levels, as well as antibodies research. OBJECTIVE: This study aimed to measure serum infliximab levels and anti-infliximab antibodies in patients with inflammatory bowel diseases post-induction phase and during maintenance therapy, and describe the therapeutic modifications that took place based on the serum levels results. METHODS: It was a retrospective study, that included forty-five patients, with a total of 63 samples of infliximab measurement. RESULTS: Twenty-one patients had an adequate infliximab serum level, 31 had subtherapeutic levels and 11 had supratherapeutic levels. Seven patients had their medication suspended due to therapeutic failure or high levels of antibodies to infliximab. CONCLUSION: In conclusion, only a third of the patients had adequate infliximab levels and 36% presented with subtherapeutic levels at the end of the induction phase. Therapy optimization occurred based in about 46% of the samples results, demonstrating the importance of having this tool to

  17. Quantification of disease activity in patients undergoing leucocyte scintigraphy for suspected inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Cheow, Heok K.; Voutnis, Demetrius D.; Evans, John W.; Szczepura, Katy R.; Swift, E. Anna; Bird, Nicholas J.; Ruparelia, Prina; Solanki, Chandra K.; Ballinger, James R.; Chilvers, Edwin R.; Peters, A. Michael [Addenbrooke' s Hospital, Department of Nuclear Medicine, Cambridge (United Kingdom); Middleton, Stephen J. [Addenbrooke' s Hospital, Department of Gastroenterology, Cambridge (United Kingdom)

    2005-03-01

    Whole-body gamma camera counting is an alternative to faecal {sup 111}In collection for quantifying disease activity in inflammatory bowel disease (IBD) but requires administration of imaging activities of {sup 111}In. The aim of this study was to explore a dedicated whole-body counter which requires 20-fold less activity than gamma camera counting. Thirty patients with known or suspected IBD received {sup 99m}Tc-granulocytes ({proportional_to}200 MBq) and {sup 111}In-granulocytes ({proportional_to}0.5 MBq). The {sup 99m}Tc-cells were injected 45 min after the {sup 111}In-cells and immediately after a baseline {sup 111}In whole-body count. The decay-corrected count at 120 h was expressed as a fraction of baseline to give whole-body {sup 111}In retention (WBR). One patient was excluded as the injected cells were non-viable. Median 45-min intravascular {sup 111}In recovery was 35% in patients compared with 43% in six normal volunteers (p<0.05). WBR in normals ranged from 91% to 93% and in 11 patients with negative {sup 99m}Tc imaging from 87% to 96%. Only one of 11 patients with negative imaging had WBR <90% while 11/12 patients with WBR <90% had abnormal imaging. Ten of 13 patients with Crohn's disease (CD) had abnormal imaging. The lowest WBR in these ten was 77% and six had values of >90%. There was a significant association between WBR and {sup 99m}Tc image grade (R{sub s}=0.73, p<0.002) in 16 patients without CD, but not in 13 patients with CD (R{sub s}=0.54, p>0.05). Dedicated whole-body counting is able to quantify disease activity in IBD but may give normal values in active CD. (orig.)

  18. Nutritional Assessment and Disease Activity for Patients with Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Thomas E Wasser

    1995-01-01

    Full Text Available Using the Harvard/Willett Semi-Quantitative Food Frequency Questionnaire (H/WSQFFQ, nutritional information was gathered on patients enrolled in an inflammatory bowel disease (IBD registry. The registry lists 320 patients positive for either ulcerative colitis (n=124 or Crohn’s disease (n=196. The sample was limited to those 19 to 84 years old (mean ± SD 48.57±14.98, and comprised 136 males and 184 females. Using a battery of indices, quality of life, disease activity and general well-being were also assessed. Nutritional intake values from the Harvard-Willett data were compared with recommended dietary allowances (RDA tables by sex and age group (19 to 24 years, 25 to 50, 51 and older to discover any intake deficiencies. Results showed that IBD patients were below RDA guidelines for vitamin E, calcium, magnesium, zinc, iodine and selenium. Females were below RDA guidelines for iron while men were below for vitamin B6. There were also some deficiencies according to age in males and two nutrient deficiencies were seen by age group in women. There were no deficiencies by sex or age for vitamins A, C, D and niacin. There were no observed nutrient intake differences between ulcerative colitis and Crohn’s disease groups. Patients receiving vitamin or mineral supplementation showed significant decreases in quality of life, regardless of diagnosis (Crohn’s disease or ulcerative colitis group. The H/WSQFFQ is a useful tool for assessment of the nutritional status of the IBD patient because it not only provides valuable measurement data to the clinician, but also adds to patient awareness about nutritional problems associated with IBD.

  19. [Follow-up of patients with inflammatory bowel disease: developments presented at Digestive Disease Week 2014].

    Science.gov (United States)

    García-López, Santiago

    2014-09-01

    A lot of data were reported about monitoring patients with inflammatory bowel disease, with varying degrees of practical applicability. Concerning the evaluation of disease activity, it was established that objective assessments are needed. Among the techniques that we use, although endoscopy is undoubtedly the reference standard, a lot of data were presented regarding less invasive techniques. The importance of MRIs, CTs and ultrasounds (with some variations) was thus reiterated. The importance of fecal calprotectin is also reiterated, not only for colon disease, but probably small intestine disease as well. Regarding treatment monitoring, a great deal was reported about anti-TNF therapy, demonstrating again its potential role when properly used. In addition to results with infliximab, results with adalimumab were reported as very consistent. For colon cancer prevention, it seems that the clinical guidelines are achieving their objective. It also seems clear that we must improve conventional endoscopic techniques. Finally, there are other aspects that need to be considered when monitoring our patients, such as adequate sleeping patterns, anxiety or depression. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  20. Inflammatory Bowel Disease (For Children)

    Science.gov (United States)

    ... Bowel Disease Print A A A en español Enfermedad inflamatoria del intestino What Is Inflammatory Bowel Disease? ... of IBD? There are two kinds of IBD: Crohn's disease and ulcerative colitis (say: UL-sur-uh- ...

  1. Using eHealth strategies in delivering dietary and other therapies in patients with irritable bowel syndrome and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Ankersen, Dorit Vedel; Carlsen, Katrine; Marker, Dorte

    2017-01-01

    for inflammation (fecal calprotectin) that the patients can measure independently using their smart phone, providing both patient and physician with an immediate disease status that they can react to instantaneously. Likewise, web applications for IBD patients, web applications for irritable bowel syndrome (IBS...

  2. Technical Quality of Delivered Care for Patients with Inflammatory Bowel Disease in Tabriz Care Centers

    Directory of Open Access Journals (Sweden)

    Mohammad Hosein Somi

    2015-08-01

    Full Text Available ​Background and objectives : Inflammatory Bowel Disease (IBD is a chronic disease and requires complex treatment. Due to the various treatment options and gradual understanding of specialists about the risks and benefits of different treatments of IBD, delivering care according to the treatment protocols and guidelines is essential. This study was conducted to assess delivered care from the perspective of patients with inflammatory bowel disease. Material and Methods : This cross-sectional study was conducted with 94 participants with IBD selected randomly in Emam Reza hospital and Golgasht clinic in Tabriz. Data were collected by an approved researcher-made questionnaire via interviewing patients. Chi-Squared Test was used to evaluate the relationship between demographic variables and accordance of delivered care with standards. SPSS17 was used for data analysis. Results : The results indicated that "visit by specialist" and "providing dietary recommendation by nutritionist" aspects had highest and lowest degree of accordance with standards, respectively. Furthermore, the aspects of “delivered care in exacerbation status of disease” and “delivered care by other specialists” had only 20 percent compliance with standards. Also, there was a significant relationship between age, job, education status, smoking and compliance with related standards in some care aspects (p Conclusion : The study results indicated that there is a deep gap between delivered cares for patients with inflammatory bowel disease and related standards. These deficiencies showed the parts that need improvement and require healthcare managers and policy makers’ attention.

  3. Comparative Readability Analysis of Online Patient Education Resources on Inflammatory Bowel Diseases

    OpenAIRE

    Rishabh Gulati; Mohammad Nawaz; Linh Lam; Pyrsopoulos,Nikolaos T

    2017-01-01

    Background. The National Institutes of Health recommend a readability grade level of less than 7th grade for patient directed information. In this study, we use validated readability metrics to analyze patient information from prominent websites pertaining to ulcerative colitis and Crohn’s disease. Methods. The terms “Crohn’s Disease,” “Ulcerative Colitis,” and “Inflammatory Bowel Disease” were queried on Google and Bing. Websites containing patient education material were saved as a text fil...

  4. From conception to delivery: managing the pregnant inflammatory bowel disease patient.

    Science.gov (United States)

    Huang, Vivian W; Habal, Flavio M

    2014-04-07

    Inflammatory bowel disease (IBD) typically affects patients during their adolescent and young adult years. As these are the reproductive years, patients and physicians often have concerns regarding the interaction between IBD, medications and surgery used to treat IBD, and reproduction, pregnancy outcomes, and neonatal outcomes. Studies have shown a lack of knowledge among both patients and physicians regarding reproductive issues in IBD. As the literature is constantly expanding regarding these very issues, with this review, we provide a comprehensive, updated overview of the literature on the management of the IBD patient from conception to delivery, and provide action tips to help guide the clinician in the management of the IBD patient during pregnancy.

  5. Asymptomatic urinary anomalies, hematuria and proteinuria, in patients with inflammatory bowel disease. Preliminary study.

    Science.gov (United States)

    Velciov, Silvia; Gluhovschi, Gh; Sporea, I; Trandafirescu, Virginia; Petrica, Ligia; Bozdog, Gh; Gluhovschi, Cristina; Bob, F; Gădălean, Florica; Buzaş, Roxana; Bobu, Maria; Voicu, L

    2011-01-01

    The study assesses the presence of asymptomatic urinary anomalies in patients with inflammatory bowel disease. Asymptomatic urinary anomalies are mainly due to glomerular nephritis, they being one of the forms of its manifestation, together with chronic nephrotic and nephritic syndromes. We identified urinary anomalies in 18 patients (20%) with bowel inflammatory disease that consisted of haematuria in 8 (9%) patients, isolated proteinuria in 5 (6%) patients and haematuria associated with proteinuria in 5 (6%) patients. Asymptomatic urinary anomalies were more frequent in patients with the Crohn disease than in those with ulcerative colitis. We identified RFG under 60ml/min in 4 patients with asymptomatic urinary anomalies. It is very easy to evaluate asymptomatic urinary anomalies with dipstick. This method is also required in current practice for patients with urinary anomalies for identifying the glomerular disease that might have caused them. One must take into consideration differential diagnosis with other diseases that can manifest themselves with proteinuria or isolated proteinuria. One must also take into account the fact that urinary anomalies may also be related to administration of 5-aminosalicylates.

  6. Customer Quality of Patients with Inflammatory Bowel Disease In Tabriz, 1391

    Directory of Open Access Journals (Sweden)

    Roya Hasanzadeh

    2015-08-01

    Full Text Available Background and objectives: Customer Quality is one of the most important dimensions of quality in health care which refers to service receiver's knowledge, attitude and skills that play effective role in treatment process. This study is aimed at assessing customer quality score in patients with Inflammatory Bowel Disease in Tabriz city in 2012. Material and Methods: This is a cross-sectional study which was conducted with the participation of 94 Inflammatory Bowel Disease patients who referred to Tabriz Imam Reza Hospital and Golgasht clinic. Customer Quality was measured using a questionnaire with 19 items which its validity was confirmed by 10 experts and its reliability was reviewed using Cronbach's alpha index (α =0.78.  Obtained data were analyzed using SPSS17.   Results: The results illustrated that average score of customer quality among patients with inflammatory bowel disease is 70.63 (±9.67. All the participants achieved stage 1 scores of Customer Quality in self-management but only 11.7% reported highest customer quality score and were able to continue their self-care in high pressure circumstances such as stress and financial problems. Also, there was a significant relation between customer quality score and patient’s education (P-value=0.05, so that by having higher education level, the customer quality score was increased as well. Conclusion: The results of this study indicate that customer quality status in assessed patients with Inflammatory Bowel Disease is partially acceptable, but major problems in some areas are evident and require more attention of health care managers and policy makers. ​

  7. ORAL MUCOSA LESIONS AND ORAL SYMPTOMS IN INFLAMMATORY BOWEL DISEASE PATIENTS

    Directory of Open Access Journals (Sweden)

    Nuno LARANJEIRA

    2015-06-01

    Full Text Available Background Inflammatory Bowel Disease is known for its extra intestinal manifestations, the oral cavity is no exception. Objectives The aim of this study was to evaluate the association between Inflammatory Bowel Disease and oral mucosa lesions and symptoms, and complementary to evaluate their possible relation with oral hygiene, smoking habits, drug therapy, duration and activity of the disease. Methods Patients were selected from the Gastroenterology Clinic of a Portuguese tertiary referral hospital. This sample consisted of 113 patients previously diagnosed with ulcerative colitis or Crohn’s disease along with a control group of 58 healthy individuals that were accompanying the study group patients to their appointments. Clinical interviews and clinical examinations were performed for data collection. Results The patients in the study group were more affected by oral symptoms (P=0.011, and showed a trend towards a higher incidence of oral mucosal lesions, even though statistical significance was not reached (8.8% versus 3.4% in the control group; P=0.159. Patients in active phase were the most affected. No differences were detected between Crohn’s disease and ulcerative colitis, or concerning smoking habits. The corticosteroid and immunosuppressant therapy seemed to increase the incidence of oral symptoms (P=0.052. The oral mucosa lesions increased and the oral symptoms decreased over the course of the disease, however without statistical significance. Conclusion Oral mucosa’s lesions and oral symptoms were positively associated with Inflammatory Bowel Disease, mainly during disease activity periods and conceivably, associated with corticosteroid and immunosuppressant therapy.

  8. Specific features of clostridium difficile colitis in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Mihai Catalina

    2015-01-01

    Full Text Available Through its specific biological, epidemiological, diagnostic and infection management features, Clostridium difficile infection (CDI can be considered a major health concern, especially in inflammatory bowel disease (IBD patients. In this particular infection, many IBD risk factors are triggered due to bowel inflammation, antibiotics use, microbiota changes, immunosuppressive therapy use and surgical intervention. Thus, each IBD and diarrhea patient must be tested for CDI. Clinical features show different initial infectious stages such as mild, fulminate and refractory. It has been shown that CDI presents recurrent episodes. CDI treatment consists of metronidazole, vancomycin or fidaxomicin, as well as prophylactic measures. It was recently shown that antibiotic doses must be gradually reduced in order to avoid CDI relapses. Fecal transplantation, effective in CDI management, remains controversial in CDI patients with concurrent IBD.

  9. Depression and anxiety levels in therapy-naïve patients with inflammatory bowel disease and cancer of the colon

    OpenAIRE

    Filipović, Branislav R; Filipović, Branka F; Kerkez, Mirko; Milinić, Nikola; Ranđelović, Tomislav

    2007-01-01

    AIM: To assess whether depression and anxiety are more expressed in patients with the first episode of inflammatory bowel disease (IBD) than in individuals with newly discovered cancer of the colon (CCa).

  10. Fecal Microbiota Transplantation Improves the Quality of Life in Patients with Inflammatory Bowel Disease

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    Yao Wei

    2015-01-01

    Full Text Available Introduction. To determine the effect of fecal microbiota transplantation (FMT on quality of life (QoL in patients with inflammatory bowel disease (IBD. Methods. Fourteen IBD patients, including 11 Ulcerative colitis (UC and 3 Crohn’s disease (CD, were treated with FMT via colonoscopy or nasojejunal tube infusion. QoL was measured by IBD Questionnaire (IBDQ. Disease activity and IBDQ were evaluated at enrollment and four weeks after treatment. Patients’ attitude concerning the treatment was also investigated. Results. One patient was excluded due to intolerance. All the other patients finished the study well. Mean Mayo score in UC patients decreased significantly (5.80 ± 1.87 versus 1.50 ± 1.35, P<0.01. Mean IBDQ scores of both UC and CD patients increased (135.50 ± 27.18 versus 177.30 ± 20.88, P=0.00063, and 107.33 ± 9.45 versus 149.00 ± 20.07, P=0.024 four weeks after fecal microbiota transplantation. There was no correlation between the IBDQ score and Mayo score before and after FMT. Patients refused to take FMT as treatment repeatedly in a short time. Conlusions. Fecal microbiota transplantation improves quality of life significantly in patients with inflammatory bowel disease.

  11. Intestinal and extraintestinal neoplasia in patients with inflammatory bowel disease in a tertiary care hospital.

    Science.gov (United States)

    Campos, Fábio Guilherme; Teixeira, Magaly Gemio; Scanavini, Arceu; Almeida, Maristela Gomes de; Nahas, Sergio Carlos; Cecconello, Ivan

    2013-04-01

    The development of neoplasia is an important concern associated with inflammatory bowel disease (IBD), especially colorectal cancer (CRC). Our aim was to determine the incidence of intestinal and extraintestinal neoplasias among patients with inflammatory bowel disease. There were retrieved information from 1607 patients regarding demographics, disease duration and extent, temporal relationship between IBD diagnosis and neoplasia, clinical outcomes and risk factors for neoplasia. Crohn's disease (CD) was more frequent among women (P=0.0018). The incidence of neoplasia was higher in ulcerative colitis (UC) when compared to CD (P=0.0003). Eight (0.99%) patients developed neoplasia among 804 with CD: 4 colorectal cancer, 2 lymphomas, 1 appendix carcinoid and 1 breast cancer. Thirty (3.7%) patients developed neoplasia among the 803 UC: 13 CRC, 2 lymphomas and 15 extraintestinal tumors. While CRC incidence was not different among UC and CD (1.7% vs 0.5%; P=0.2953), the incidence of extraintestinal neoplasias was higher among UC (2.1% vs 0.5%, P=0.0009). Ten (26.3%) patients out of 38 with neoplasia died. CRC incidence was low and similar in both diseases. There was a higher incidence of extraintestinal neoplasia in UC when compared to CD. Neoplasias in IBD developed at a younger age than expected for the general population. Mortality associated with malignancy is significant, affecting 1/4 of the patients with neoplasia.

  12. INTESTINAL AND EXTRAINTESTINAL NEOPLASIA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Fábio Guilherme CAMPOS

    2013-04-01

    Full Text Available Context The development of neoplasia is an important concern associated with inflammatory bowel disease (IBD, especially colorectal cancer (CRC. Objectives Our aim was to determine the incidence of intestinal and extraintestinal neoplasias among patients with inflammatory bowel disease. Methods There were retrieved information from 1607 patients regarding demographics, disease duration and extent, temporal relationship between IBD diagnosis and neoplasia, clinical outcomes and risk factors for neoplasia. Results Crohn's disease (CD was more frequent among women (P = 0.0018. The incidence of neoplasia was higher in ulcerative colitis (UC when compared to CD (P = 0.0003. Eight (0.99% patients developed neoplasia among 804 with CD: 4 colorectal cancer, 2 lymphomas, 1 appendix carcinoid and 1 breast cancer. Thirty (3.7% patients developed neoplasia among the 803 UC: 13 CRC, 2 lymphomas and 15 extraintestinal tumors. While CRC incidence was not different among UC and CD (1.7% vs 0.5%; P = 0.2953, the incidence of extraintestinal neoplasias was higher among UC (2.1% vs 0.5%, P = 0.0009. Ten (26.3% patients out of 38 with neoplasia died. Conclusions CRC incidence was low and similar in both diseases. There was a higher incidence of extraintestinal neoplasia in UC when compared to CD. Neoplasias in IBD developed at a younger age than expected for the general population. Mortality associated with malignancy is significant, affecting 1/4 of the patients with neoplasia.

  13. Inflammatory Bowel Disease in Primary Immunodeficiencies.

    Science.gov (United States)

    Kelsen, Judith R; Sullivan, Kathleen E

    2017-08-01

    Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease. The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis. This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

  14. Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Oppenheimer, D.A.; Jones, H.H.

    1982-12-01

    The case of a 14-year old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

  15. Inflammatory bowel disease epidemiology

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2013-01-01

    The occurrence of inflammatory bowel disease (IBD) is increasing worldwide, yet the reasons remain unknown. New therapeutic approaches have been introduced in medical IBD therapy, but their impact on the natural history of IBD remains uncertain. This review will summarize the recent findings...

  16. Anxiety in close relationships is higher and self-esteem lower in patients with irritable bowel syndrome compared to patients with inflammatory bowel disease.

    Science.gov (United States)

    Bengtsson, Mariette; Sjöberg, Klas; Candamio, Martina; Lerman, Annie; Ohlsson, Bodil

    2013-04-01

    Previous research has suggested an interaction between personality factors and inflammatory bowel disease (IBD) as well as irritable bowel syndrome (IBS). We therefore aimed to elucidate differences in psychological and coping functioning between patients with IBD and IBS, and to assess the relationship of disease activity with these functions. Seventy-four patients with IBD (mean age 43±17 years, range 18-82 years) and 81 patients with IBS (mean age 37±12 years, range 21-66 years) completed the questionnaires; Rosenberg Self-Esteem Scale, Toronto Alexithymia, Experiences in Close Relationships, and Sense of Coherence. Disease activity was evaluated either by the Harvey-Bradshaw index, the Simple Clinical Colitis Activity Index, or the Visual Analogue Scale for Irritable Bowel Syndrome. The study revealed that patients with IBS had higher degree of anxiety in close relationships than patients with IBD (p=0.003), and lower self-esteem (p=0.001). No other statistical differences between the whole groups IBS and IBD or between subgroups were seen. The fact that patients with IBS seem to have higher levels of anxiety in relationships and lower self-esteem could influence the way the patient deal with the disease and how the communication with health care professionals works out. A higher awareness of the importance of past negative life events should be taken into consideration. Whether the disease or the personal traits are the primary event should be addressed in future research. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  17. Evaluation of lactose and milk intolerance, and bone mineral density in Indian patients with inflammatory bowel disease.

    Science.gov (United States)

    Gupta, Richa; Makharia, Govind; Khadgawat, Rajesh; Yadav, Raj Kumar

    2012-01-01

    A misconception that milk and lactose intolerance increases disease activity in inflammatory bowel disease leads to the exclusion of dietary dairy products, and patients are at an increased risk of low bone mineral density. Patients with inflammatory bowel disease (n=45, 19 men and 26 women) and healthy controls were included in this prospective open-label study. As part of exploratory dietary intervention, patients were advised to exclude milk and milk products from diet for the first 7 days and reintroduce at least 250 ml of milk for the next 21 days. Milk and lactose intolerance was assessed in patients and healthy subjects using clinical symptoms and lactose hydrogen breath test, respectively; bone mineral density was assessed in patients using a Hologic QDR 4500A DXA machine. Milk and lactose intolerance was statistically comparable in patients with inflammatory bowel disease (31% and 44%, respectively) and healthy subjects (22% and 27%, respectively). Most of the patients (40%) had excluded dairy products from their diet, and 53% had dietary intake of calcium Milk and lactose intolerance in patients with inflammatory bowel disease was not different from that in healthy subjects. The proportion of patients with osteoporosis and osteopenia was high in this population. Hence, patients with inflammatory bowel disease in remission phase may be encouraged to add dairy products in their diet, unless otherwise indicated. Copyright 2012, NMJI.

  18. The relationship between different information sources and disease-related patient knowledge and anxiety in patients with inflammatory bowel disease.

    Science.gov (United States)

    Selinger, C P; Carbery, I; Warren, V; Rehman, A F; Williams, C J; Mumtaz, S; Bholah, H; Sood, R; Gracie, D J; Hamlin, P J; Ford, A C

    2017-01-01

    Patient education forms a cornerstone of management of inflammatory bowel disease (IBD). The Internet has opened new avenues for information gathering. To determine the relationship between different information sources and patient knowledge and anxiety in patients with IBD. The use of information sources in patients with IBD was examined via questionnaire. Anxiety was assessed with the hospital anxiety and depression scale and disease-related patient knowledge with the Crohn's and colitis knowledge score questionnaires. Associations between these outcomes and demographics, disease-related factors, and use of different information sources were analysed using linear regression analysis. Of 307 patients (165 Crohn's disease, 142 ulcerative colitis) 60.6% were female. Participants used the hospital IBD team (82.3%), official leaflets (59.5%), and official websites (53.5%) most frequently in contrast to alternative health websites (9%). University education (P anxiety. Different patient information sources are associated with better knowledge or worse anxiety levels. Face-to-face education and written information materials remain the first line of patient education. Patients should be guided towards official information websites and warned about the association between the use of alternative health websites or random links and anxiety. © 2016 John Wiley & Sons Ltd.

  19. Abdominal MRI without Enteral Contrast Accurately Detects Intestinal Fibrostenosis in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Fisher, Jeremy G; Kalb, Bobby; Martin, Diego; Dhere, Tanvi; Perez, Sebastian D; Srinivasan, Jahnavi K

    2015-11-01

    Patients with inflammatory bowel disease (IBD) presenting for surgical evaluation require thorough small bowel surveillance as it improves accuracy of diagnosis (ulcerative colitis versus Crohn's) and differentiates those who may respond to nonoperative therapy, preserving bowel length. MRI has not been validated conclusively against histopathology in IBD. Most protocols require enteral contrast. This study aimed to 1) evaluate the accuracy of MRI for inflammation, fibrosis, and extraluminal complications and 2) compare MRI without enteral contrast to standard magnetic resonance enterography. Adults with Crohn's disease or ulcerative colitis who underwent abdominal MRI and surgery were retrospectively reviewed. Of 65 patients evaluated, 55 met inclusion criteria. Overall sensitivity and specificity of MRI for disease involvement localized by segment were 93 per cent (95% confidence interval = 89.4-95.0) and 95 per cent (95% confidence interval = 92.3-97.0), respectively (positive predictive value was 86%, negative predictive value was 98%). Sensitivity and specificity between MRI with and without oral and rectal contrast were similar (96% vs 91% and 99% vs 94%, P > 0.10). As were positive predictive value and negative predictive value (85% vs 96%, P = 0.16; 97% vs 99%, P = 0.42). Magnetic resonance is highly sensitive and specific for localized disease involvement and extraluminal abdominal sequelae of IBD. It accurately differentiates patients who have chronic transmural (fibrotic) disease and thus may require an operation from those with acute inflammation, whose symptoms may improve with aggressive medical therapy alone. MRI without contrast had comparable diagnostic yield to standard magnetic resonance enterography.

  20. Ferrokinetic Parameters and Regulation of Iron Metabolism in Patients with Chronic Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    T.Y. Boiko

    2014-11-01

    Full Text Available Article presents parameters of iron metabolism and cytokines (IL-6 and TNF-α in patients with chronic inflammatory bowel diseases (CIBD. The material for the study was the blood of 69 patients with CIBD and anemia and 26 — without anemia. We have studied the features of main ferrokinetic parameters — iron, total iron-binding capacity of serum, transferrin saturation, ferritin, transferrin receptor, erythropoietin, hepcidin depending on hemoglobin level and the type of anemia. The relationship of iron metabolism disorders with the level of proinflammatory cytokines (IL-6 and TNF-α is shown.

  1. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Riis, L; Vind, Ida; Politi, P

    2006-01-01

    BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) often affects patients in their fertile age. The aim of this study was to describe pregnancy outcome in a European cohort of IBD patients. As data are limited regarding the effect of pregnancy on disease course, our second objective was to inv......BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) often affects patients in their fertile age. The aim of this study was to describe pregnancy outcome in a European cohort of IBD patients. As data are limited regarding the effect of pregnancy on disease course, our second objective...... was to investigate whether pregnancy influences disease course and phenotype in IBD patients. METHODS: In a European cohort of IBD patients, a 10-yr follow-up was performed by scrutinizing patient files and approaching the patients with a questionnaire. The cohort comprised 1,125 patients, of whom 543 were women....... Data from 173 female ulcerative colitis (UC) and 93 Crohn's disease (CD) patients form the basis for the present study. RESULTS: In all, 580 pregnancies, 403 occurring before and 177 after IBD was diagnosed, were reported. The rate of spontaneous abortion increased after IBD was diagnosed (6.5% vs. 13...

  2. Keratoconus in Inflammatory Bowel Disease Patients: A Cross-sectional Study.

    Science.gov (United States)

    Tréchot, Fanny; Angioi, Karine; Latarche, Clothilde; Conroy, Guillaume; Beaujeux, Pauline; Andrianjafy, Charlotte; Portier, Mathilde; Batta, Benjamine; Conart, Jean-Baptiste; Cloché, Véronique; Peyrin-Biroulet, Laurent

    2015-12-01

    Increasing evidence suggests that keratoconus may have an inflammatory component. The possible association of keratoconus with inflammatory bowel disease (IBD) has yet to be determined. The aim of this study was to determine the prevalence of keratoconus and suspect keratoconus in patients with IBD. All consecutive adult IBD patients seen in the Department of Gastroenterology, Nancy, University Hospital, France, between March 2014 and June 2014 were included. Pregnant women, rigid lens wearers, patients with a family history of keratoconus and patients with a history of refractive surgery were excluded. A control group of healthy subjects was included. All included patients underwent a corneal topography (OPD-Scan III, Nidek) to detect keratoconus or suspect keratoconus. Rabinowitz videokeratographic indices were the basis of corneal topography interpretation. Two hundred and one IBD patients were included, 150 with Crohn's disease and 51 with ulcerative colitis. Mean age was 38.7 years and 121 were women. Mean disease duration was 10.8 years. Two IBD patients were diagnosed with keratoconus (1%) and 38 with suspect keratoconus (18.9%). Overall prevalence of keratoconus and suspect keratoconus was 19.9% (95% confidence interval [CI] 17.5-22.0). None of the 100 healthy subjects had keratoconus, while three were diagnosed with suspect keratoconus (p = 0.0002 versus IBD patients). Only smoking was identified as a risk factor (p = 0.029), especially in Crohn's disease. Inflammatory bowel disease patients may carry an increased risk of keratoconus and suspect keratoconus, smoking further increasing this risk. This supports the hypothesis of an inflammatory origin of keratoconus. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  3. Food Elimination Diet and Nutritional Deficiency in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Lim, Hee-Sook; Kim, Soon-Kyung; Hong, Su-Jin

    2018-01-01

    Certain types of foods are common trigger for bowel symptoms such as abdominal discomfort or pain in patients with inflammatory bowel disease (IBD). But indiscriminate food exclusions from their diet can lead extensive nutritional deficiencies. The aim of this study was to investigate nutritional status, food restriction and nutrient intake status in IBD patients. A total 104 patients (food exclusion group: n = 49; food non-exclusion group: n = 55) participated in the survey. The contents were examined by 3 categories: 1) anthropometric and nutritional status; 2) diet beliefs and food restriction; and 3) nutrient intake. The malnutrition rate was significantly higher in the food exclusion group (p = 0.007) compared to food non-exclusion group. Fifty-nine percent of patients in the food exclusion group held dietary beliefs and reported modifying their intake according to their dietary belief. The most common restricted food was milk, dairy products (32.7%), raw fish (24.5%), deep-spicy foods (22.4%), and ramen (18.4%). The mean daily intake of calcium (p = 0.002), vitamin A (p food exclusion group. Considering malnutrition in IBD patients, nutrition education by trained dietitians is necessary for the patients to acquire disease-related knowledge and overall balanced nutrition as part of strategies in treating and preventing nutrition deficiencies.

  4. Inflammatory Bowel Disease and Pregnancy: Evidence, Uncertainty and Patient Decision-Making

    Directory of Open Access Journals (Sweden)

    Flavio M Habal

    2009-01-01

    Full Text Available Inflammatory bowel disease (IBD often affects women during their child-bearing years. Management of a pregnant IBD patient, or a patient contemplating pregnancy, poses unique challenges and can be quite daunting. Knowledge of the basic interplay among disease, normal host physiology and pregnancy is vital to managing these patients. One of the most important advances in the management of IBD over the past decade has been the finding that normal pregnancy outcomes can be achieved when a woman enters the pregnancy in remission. New insights into the safety of a wider spectrum of drugs in these patients has allowed for increased success in IBD management. The evidence supporting medical interventions including biological therapy such as antibodies to tumour necrosis factor agents is reviewed. Once the treating physician understands this complex relationship, management of the pregnant IBD patient can often become a rewarding experience.

  5. Assessment of selected psychological factors in patients with inflammatory bowel disease.

    Science.gov (United States)

    Morys, Joanna M; Kaczówka, Anna; Jeżewska, Maria

    2016-01-01

    In the majority of patients with inflammatory bowel diseases (IBD) mental health problems are demonstrated in the form of excessive anxiety and unstable emotional reactions. Emotional instability affects the wellbeing of these patients, and also their attitude towards the disease and the course of treatment. The objective of the study is to evaluate psychological factors in patients with IBD, and to compare patients with ulcerative colitis (UC) and patients suffering from Crohn's disease (CD) with respect to intensity of these factors. The study included 108 patients with IBD. NEO-FFI and type-D Scale were used to evaluate personality traits. Anxiety level was measured with STAI. CECS was used to measure the patients' tendency to suppress negative emotions. In the patients with CD 45% of subjects presented type D personality. In the group of patients with UC, type D personality was found in 38%. The higher levels of neuroticism and extraversion were observed in patients with UC, whereas the patients with CD exhibited a higher level of openness to experience and agreeableness. In patients with CD the levels of state anxiety were elevated, whereas in patients with UC higher scores were both for state and trait anxiety. There were no statistically significant differences in terms of personality factors in a group of patients with CD and UC. It was found that the majority of patients with IBD suffer elevated or high sense of anxiety.

  6. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Riis, L; Vind, Ida; Politi, P

    2006-01-01

    BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) often affects patients in their fertile age. The aim of this study was to describe pregnancy outcome in a European cohort of IBD patients. As data are limited regarding the effect of pregnancy on disease course, our second objective...... was to investigate whether pregnancy influences disease course and phenotype in IBD patients. METHODS: In a European cohort of IBD patients, a 10-yr follow-up was performed by scrutinizing patient files and approaching the patients with a questionnaire. The cohort comprised 1,125 patients, of whom 543 were women....... Data from 173 female ulcerative colitis (UC) and 93 Crohn's disease (CD) patients form the basis for the present study. RESULTS: In all, 580 pregnancies, 403 occurring before and 177 after IBD was diagnosed, were reported. The rate of spontaneous abortion increased after IBD was diagnosed (6.5% vs. 13...

  7. Correlation between serological biomarkers and endoscopic activity in patients with inflammatory bowel disease.

    Science.gov (United States)

    Miranda-García, Pablo; Chaparro, María; Gisbert, Javier P

    2016-10-01

    Endoscopy is the gold standard for assessing disease severity in inflammatory bowel disease (IBD), although it is an invasive procedure. Biological markers have been routinely used as a non-invasive means of determining disease activity. The aim of this study was to determine the correlation between common biological markers and endoscopic activity in IBD. Consecutive patients with IBD were included. Serum concentrations of different biomarkers (C-reactive protein [CRP], orosomucoid [ORM], erythrocyte sedimentation rate [ESR], fibrinogen, platelets, leukocytes, neutrophils and hemoglobin [Hb]) were measured, and their accuracy in detecting endoscopic activity was determined. Eighty patients were included (mean age 46 years, 53% Crohn's disease), 70% with endoscopic activity. Among Crohn's disease patients, 24% had mild endoscopic activity, 12% moderate activity and 39% severe activity. Among ulcerative colitis patients, 35% had an endoscopic Mayo score of 0-1 points, 30% 2 points and 35% 3 points. None of the biomarkers included had a good correlation with endoscopic activity (Area Under the ROC curve [AUC]Crohn's disease (AUC: 0.80-0.085). A sub-analysis in postoperative Crohn's disease patients found no correlation between endoscopic recurrence and biomarkers (AUCCrohn's disease. ORM, fibrinogen and platelets have the best accuracy to detect endoscopic activity in Crohn's disease. Copyright © 2016 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

  8. Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease: retrospective analysis of 9095 patients.

    Science.gov (United States)

    De Felice, K M; Novotna, M; Enders, F T; Faubion, W A; Tremaine, W J; Kantarci, O H; Raffals, L E

    2015-01-01

    Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn's disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The per cent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15% and 0.18% (RR = 0.83, 95% CI: 0.28-2.42; P = 0.729); CD: 0.19% and 0.22% (RR = 0.89, 95% CI: 0.24-3.31; P = 0.863); UC: 0.07% and 0.15% (RR = 0.49, 95% CI: 0.06-4.22; P = 0.510). Anti-TNFα biologics do not appear to impact the risk of developing clinical idiopathic inflammatory demyelinating disease in patients with inflammatory bowel disease. © 2014 John Wiley & Sons Ltd.

  9. Worries and Concerns among Inflammatory Bowel Disease Patients Followed Prospectively over One Year

    Directory of Open Access Journals (Sweden)

    Lars-Petter Jelsness-Jørgensen

    2011-01-01

    Full Text Available Disease-related worries are frequently reported in inflammatory bowel disease (IBD, but longitudinal assessments of these worries are scarce. In the present study, patients completed the rating form of IBD patient concerns (RFIPC at three occasions during one year. One-way analysis of variance (ANO VA, t-tests, bivariate correlation, and linear regression analyses were used to analyse data. The validity and reliability of the Norwegian RFIPC was tested. A total of 140 patients were included (V1, ulcerative colitis (UC n = 92, Crohn's disease (CD n = 48, mean age 46.9 and 40.0-year old, respectively. The highest rated worries included having an ostomy bag, loss of bowel control, and reduced energy levels. Symptoms were positively associated with more worries. A pattern of IBD-related worries was consistent over a period of one year. Worries about undergoing surgery or having an ostomy bag seemed to persist even when symptoms improved. The Norwegian RFIPC is valid and reliable.

  10. Semi-automatic bowel wall thickness measurements on MR enterography in patients with Crohn's disease.

    Science.gov (United States)

    Naziroglu, Robiel E; Puylaert, Carl A J; Tielbeek, Jeroen A W; Makanyanga, Jesica; Menys, Alex; Ponsioen, Cyriel Y; Hatzakis, Haralambos; Taylor, Stuart A; Stoker, Jaap; van Vliet, Lucas J; Vos, Frans M

    2017-06-01

    To evaluate a semi-automatic method for delineation of the bowel wall and measurement of the wall thickness in patients with Crohn's disease. 53 patients with suspected or proven Crohn's disease were selected. Two radiologists independently supervised the delineation of regions with active Crohn's disease on MRI, yielding manual annotations (Ano1, Ano2). Three observers manually measured the maximal bowel wall thickness of each annotated segment. An active contour segmentation approach semi-automatically delineated the bowel wall. For each active region, two segmentations (Seg1, Seg2) were obtained by independent observers, in which the maximum wall thickness was automatically determined. The overlap between (Seg1, Seg2) was compared with the overlap of (Ano1, Ano2) using Wilcoxon's signed rank test. The corresponding variances were compared using the Brown-Forsythe test. The variance of the semi-automatic thickness measurements was compared with the overall variance of manual measurements through an F-test. Furthermore, the intraclass correlation coefficient (ICC) of semi-automatic thickness measurements was compared with the ICC of manual measurements through a likelihood-ratio test. Patient demographics: median age, 30 years; interquartile range, 25-38 years; 33 females. The median overlap of the semi-automatic segmentations (Seg1 vs Seg2: 0.89) was significantly larger than the median overlap of the manual annotations (Ano1 vs Ano2: 0.72); p = 1.4 × 10-5. The variance in overlap of the semi-automatic segmentations was significantly smaller than the variance in overlap of the manual annotations (p = 1.1 × 10-9). The variance of the semi-automated measurements (0.46 mm2) was significantly smaller than the variance of the manual measurements (2.90 mm2, p = 1.1 × 10-7). The ICC of semi-automatic measurement (0.88) was significantly higher than the ICC of manual measurement (0.45); p = 0.005. The semi-automatic technique

  11. Cogan's Syndrome in Patients With Inflammatory Bowel Disease--A Case Series.

    Science.gov (United States)

    Vavricka, Stephan R; Greuter, Thomas; Scharl, Michael; Mantzaris, Gerassimos; Shitrit, Ariella B; Filip, Rafal; Karmiris, Konstantinos; Thoeringer, Christoph K; Boldys, Hubert; Wewer, Anne V; Yanai, Henit; Flores, Cristina; Schmidt, Carsten; Kariv, Revital; Rogler, Gerhard; Rahier, Jean-François

    2015-10-01

    Cogan's syndrome (CSy) is a very rare autoimmune disorder, mainly affecting the inner ear and the eye, and is associated with inflammatory bowel disease (IBD). This was a European Crohn's and Colitis Organisation (ECCO) retrospective observational study, performed as part of the CONFER project. A call to all ECCO members was made to report concomitant CSy and inflammatory bowel disease (IBD) cases. Clinical data were recorded in a standardized questionnaire. This international case series reports on 22 concomitant CSy-IBD cases from 14 large medical centres. Mean duration of IBD until diagnosis of CSy was 8.7 years (range 0.0-38.0) and mean age at CSy diagnosis was 44.6 years (range 9.0-67.0). Six patients had underlying ulcerative colitis (UC) and 16 had Crohn's disease. Eleven patients (50%) had active disease at CSy diagnosis. Sixteen patients were under IBD treatment at the time of CSy diagnosis, of whom 6 (37.5%) were on anti-tumour necrosis factor (TNF). Seven out of 10 patients, who were treated for CSy with immunomodulators (mostly with corticosteroids), demonstrated at least partial response. This is the largest CSy-IBD case series so far. Although CSy is considered to be an autoimmune disease and is associated with IBD, immunomodulatory IBD maintenance treatment and even anti-TNF therapy do not seem to prevent disease onset. Moreover, IBD disease activity does not seem to trigger CSy. However, vigilance may prompt early diagnosis and directed intervention with corticosteroids at inception may potentially hinder audiovestibular deterioration. Finally, vigilance and awareness may also offer a better setting to study the pathophysiological mechanisms of this rare but debilitating phenomenon. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  12. Cancer risk in patients with inflammatory bowel disease: a population-based study.

    Science.gov (United States)

    Bernstein, C N; Blanchard, J F; Kliewer, E; Wajda, A

    2001-02-15

    The objective of the current study was to determine the incidence of cancer among persons with inflammatory bowel disease (IBD) and to compare these incidence rates with those of the non-IBD population using population-based data from the administrative claims data of Manitoba's universal provincial insurance plan (Manitoba Health). IBD patients were matched 1:10 to randomly selected members of the population without IBD based on year, age, gender, and postal area of residence. The incidence of cancer was determined by linking records from the IBD and non-IBD cohorts with the comprehensive Cancer Care Manitoba registry. Incidence rates and rate ratios (IRR) were calculated based on person-years of follow-up (Crohn's disease = 21,340 person-years and ulcerative colitis [UC] = 19,665 person-years) for 1984-1997. There was an increased IRR of colon carcinoma for both Crohn disease patients (2.64; 95% confidence interval [95% CI], 1.69-4.12) and UC patients (2.75; 95% CI, 1.91-3.97). There was an increased IRR of rectal carcinoma only among patients with UC (1.90; 95% CI, 1.05-3.43) and an increased IRR of carcinoma of the small intestine only in Crohn disease patients (17.4; 95% CI, 4.16-72.9). An increased IRR of extraintestinal tumors was observed only for the liver and biliary tract in both Crohn disease patients (5.22; 95% CI, 0.96-28.5) and UC patients (3.96; 95% CI, 1.05-14.9). There was an increased IRR of lymphoma for males with Crohn disease only (3.63; 95% CI, 1.53-8.62), and this finding did not appear to be related to use of immunomodulatory therapy. Compared with controls, Crohn's disease was associated with an increased risk of cancer overall, but UC was not. There appear to be similar increased risks for developing colon carcinoma and hepatobiliary carcinoma among patients with Crohn disease and UC. There is an increased risk of developing rectal carcinoma in UC patients, an increased risk of developing carcinoma of the small bowel in Crohn disease

  13. Prevalence of Anxiety and Depression in Patients with Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Glynis Byrne

    2017-01-01

    Full Text Available Background. Inflammatory bowel disease (IBD patients are not routinely screened for depression and anxiety despite knowledge of an increased prevalence in people with chronic disease and negative effects on quality of life. Methods. Prevalence of anxiety and depression was assessed in IBD outpatients through retrospective chart review. The presence of anxiety and/or depression was determined using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 self-report questionnaires or by diagnosis through psychiatric interview. Patient demographics, disease characteristics, and medication information were also collected. Multivariable analysis was used to determine associations between patient factors and depression and anxiety. Results. 327 patient charts were reviewed. Rates of depression and anxiety were found to be 25.8% and 21.2%, with 30.3% of patients suffering from depression and/or anxiety. Disease activity was found to be significantly associated with depression and/or anxiety (p=0.01. Females were more likely to have anxiety (p=0.01. Conclusion. A significant proportion of IBD patients suffer from depression and/or anxiety. The rates of these mental illnesses would justify screening and referral for psychiatric treatment in clinics treating this population. Patients with active disease are particularly at risk for anxiety and depression.

  14. From conception to delivery: Managing the pregnant inflammatory bowel disease patient

    Science.gov (United States)

    Huang, Vivian W; Habal, Flavio M

    2014-01-01

    Inflammatory bowel disease (IBD) typically affects patients during their adolescent and young adult years. As these are the reproductive years, patients and physicians often have concerns regarding the interaction between IBD, medications and surgery used to treat IBD, and reproduction, pregnancy outcomes, and neonatal outcomes. Studies have shown a lack of knowledge among both patients and physicians regarding reproductive issues in IBD. As the literature is constantly expanding regarding these very issues, with this review, we provide a comprehensive, updated overview of the literature on the management of the IBD patient from conception to delivery, and provide action tips to help guide the clinician in the management of the IBD patient during pregnancy. PMID:24707132

  15. Factors Associated with Anxiety and Depression in Korean Patients with Inactive Inflammatory Bowel Disease.

    Science.gov (United States)

    Kim, Min Chul; Jung, Yoon Suk; Song, Young Seok; Lee, Jung In; Park, Jung Ho; Sohn, Chong Il; Choi, Kyu Yong; Park, Dong Il

    2016-05-23

    Psychological distress is highly prevalent in patients with inflammatory bowel disease (IBD). We evaluated the disease characteristics and socioeconomic factors associated with anxiety and depression in Korean patients with quiescent IBD. In total, 142 IBD patients (67 with Crohn's disease [CD] and 75 with ulcerative colitis [UC]) completed self-report questionnaires, including the Hospital Anxiety and Depression Score, the Modified Morisky Adherence Scale-8, the socioeconomic deprivation score, and the Crohn's and Colitis Knowledge Score questionnaires. In the CD group, 30 patients (44%) were anxious, and 10 patients (15%) were depressed; in the UC group, 31 patients (41%) were anxious, and 18 patients (24%) were depressed. Using multivariate analysis, in the CD group, socioeconomic deprivation was associated with anxiety (p=0.03), whereas disease duration (p=0.04) and socioeconomic deprivation (p=0.013) were associated with depression. In the UC group, there was no significant independent predictor of anxiety and/or depression; however, low income tended to be associated with depression (p=0.096). Despite clinical remission, a significant number of IBD patients present with anxiety and depression. IBD patients in remission, particularly those who are socioeconomically deprived, should be provided with appropriate psychological support.

  16. Biomarkers in inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bennike, Tue; Birkelund, Svend; Stensballe, Allan

    2014-01-01

    Unambiguous diagnosis of the two main forms of inflammatory bowel diseases (IBD): Ulcerative colitis (UC) and Crohn's disease (CD), represents a challenge in the early stages of the diseases. The diagnosis may be established several years after the debut of symptoms. Hence, protein biomarkers...... for early and accurate diagnostic could help clinicians improve treatment of the individual patients. Moreover, the biomarkers could aid physicians to predict disease courses and in this way, identify patients in need of intensive treatment. Patients with low risk of disease flares may avoid treatment...... with medications with the concomitant risk of adverse events. In addition, identification of disease and course specific biomarker profiles can be used to identify biological pathways involved in the disease development and treatment. Knowledge of disease mechanisms in general can lead to improved future...

  17. Characterization of Inflammatory Bowel Disease in Elderly Patients: A Review of Epidemiology, Current Practices and Outcomes of Current Management Strategies

    OpenAIRE

    Peter Stepaniuk; Bernstein, Charles N; Targownik, Laura E; Harminder Singh

    2015-01-01

    The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients.Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, i...

  18. Magnetic resonance imaging of the perineum in pediatric patients with inflammatory bowel disease.

    Science.gov (United States)

    Jamieson, Douglas H; Shipman, Peter; Jacobson, Kevan

    2013-08-01

    Magnetic resonance imaging (MRI) has profoundly changed and improved the investigation of abdominal and pelvic inflammatory bowel disease (IBD) in pediatrics. Using an imaging modality without ionizing radiation is of particular advantage because the pediatric IBD population is young and often requires repeat evaluation. MRI of the pelvis has become the imaging gold standard for detecting and monitoring perianal disease while bowel-directed imaging techniques (eg, enterography, enteroclysis and colonography) can accurately evaluate bowel inflammation in IBD. With recent technological innovations leading to faster and higher resolution, the role of MRI in IBD will likely continue to expand. The present article focuses on MRI of the perineum in pediatric IBD.

  19. Patient-reported Anxiety: A Possible Predictor of Pediatric Inflammatory Bowel Disease Health Care Use.

    Science.gov (United States)

    Reigada, Laura C; Satpute, Ankita; Hoogendoorn, Claire J; Cohen, Barry H; Lai, Joanne; Bao, Ruijun; Dubinsky, Marla C; Benkov, Keith J

    2016-09-01

    Anxiety is linked with adverse health-related outcomes and increased health-seeking behaviors among patients with chronic illness. Yet, this relationship has received little attention in pediatric inflammatory bowel disease. The aim of this study was to examine whether anxiety symptoms predicted youth at increased risk for repeated disease relapse and greater gastrointestinal health care use over the subsequent 12 months. Eighty-six pediatric patients aged 11 to 18 years (M = 14.7, SD = 2.0), and their caregivers completed a validated anxiety questionnaire during a gastrointestinal specialty appointment (baseline). Medical records were reviewed for the subsequent year to record the number of disease relapses and gastrointestinal health care services and generate disease activity scores at baseline and 12 months. Analysis of variance was used to examine anxiety levels between those who experienced ≤1 versus ≥2 disease relapses. Poisson regressions were used to model the relationship between child- and caregiver-reported anxiety and health care use, controlling for disease activity. The sample was predominantly white (81%) and male (56%). Patients with higher anxiety at baseline (M = 19.6; SD = 13.7) had more frequent (≥2) disease relapses compared with those with lower anxiety at baseline (M = 12.6; SD = 10.3). Higher anxiety, irrespective of reporter, also predicted greater total gastrointestinal health care use (P anxiety may be one mechanism by which to identify those youth who are most vulnerable for disease exacerbation and costly interventions in the near future.

  20. Severe infusion reactions to infliximab: aetiology, immunogenicity and risk factors in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Svenson, M; Bendtzen, K

    2011-01-01

    BACKGROUND: Infliximab (IFX) elicits acute severe infusion reactions in about 5% of patients with inflammatory bowel disease (IBD). AIM: To investigate the role of anti-IFX antibodies (Ab) and other risk factors. METHODS: The study included all IBD patients treated with IFX at a Danish university...... hospital until 2010 either continuously (IFX every 4-12 weeks) or episodically (reinitiation after >12 weeks). Anti-IFX Ab were measured using radioimmunoassay. RESULTS: Twenty-five (8%) of 315 patients experienced acute severe infusion reactions. Univariate analysis showed that patients who reacted were...... younger at the time of diagnosis (19 vs. 26 years, P=0.013) and at first IFX infusion (28 vs. 35 years, P=0.012). Furthermore, they more often received episodic therapy (72% vs. 31%, Preactions (OR 5 [2-13]; P

  1. Restriction of dairy products; a reality in inflammatory bowel disease patients.

    Science.gov (United States)

    Brasil Lopes, Mirella; Rocha, Raquel; Castro Lyra, André; Rosa Oliveira, Vanessa; Gomes Coqueiro, Fernanda; Silveira Almeida, Naiade; Santos Valois, Sandra; Oliveira Santana, Genoile

    2014-03-01

    Calcium deficiency is considered a risk factor for the development of osteoporosis in inflammatory bowel disease (IBD) patients. Various dietary restrictions, including milk products are reported by these patients. To evaluate dairy product and dietary calcium intake by IBD patients. This cross-sectional study enrolled 65 outpatients with IBD recruited from one reference center for IBD. A semi-structured questionnaire (to collect demographic, socioeconomic and clinical data) and a quantitative food frequency questionnaire were administered. With regard to clinical data, we evaluated the anthropometric nutritional status, the disease classification, the disease activity index and the presence of gastrointestinal symptoms. Self-reported modifications in the use of dairy products were evaluated. The IBD patients' ages ranged from 20-75 years and 67.0% were diagnosed with ulcerative colitis. The majority (64.7%) reported restricting dairy products. The frequency of gastrointestinal symptoms was higher among the Crohn's disease patients who restricted dairy products than among those with no restrictions (100% vs 42.9%; p = 0.013); this result was not observed among the UC (ulcerative colitis) patients. Disease activity was also more frequent in the IBD patients who restricted dairy products than in those with no restrictions (23.8% vs 4.5%; p = 0.031), and among the UC patients, extensive disease was more common in the patients who restricted dairy products than in those with no restrictions (42.9% vs 20.0%; p = 0.03). Restricting dairy products is common among IBD patients, possibly due to disease activity, the presence of gastrointestinal symptoms and the extension of the disease. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  2. Musculoskeletal Manifestations in Inflammatory Bowel Disease

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    Giovanni Fornaciari

    2001-01-01

    Full Text Available Muscoloskeletal manifestations are the most common extraintestinal complications of inflammatory bowel disease. Wide ranges in prevalence have been reported, depending on the criteria used to define spondylarthropathy. In 1991, the European Spondylarthropathy Study Group developed classification criteria that included previously neglected cases of undifferentiated spondylarthropathies, which had been ignored in most of the oldest epidemiological studies on inflammatory bowel disease. The spectrum of muscoloskeletal manifestations in inflammatory bowel disease patients includes all of the clinical features of spondylarthropathies: peripheral arthritis, inflammatory spinal pain, dactylitis, enthesitis (Achilles tendinitis and plantar fasciitis, buttock pain and anterior chest wall pain. Radiological evidence of sacroiliitis is common but not obligatory. The articular manifestations begin either concomitantly or subsequent to the bowel disease; however, the onset of spinal disease often precedes the diagnosis of inflammatory bowel disease. The prevalence of the different muscoloskeletal manifestations is similar in ulcerative colitis and Crohn's disease. Symptoms usually disappear after proctocolectomy. The pathogenetic mechanisms that produce the muscoloskeletal manifestations in inflammatory bowel disease are unclear. Several arguments favour an important role of the intestinal mucosa in the development of spondylarthropathy. The natural history is characterized by periods of flares and remission; therefore, the efficacy of treatment is difficult to establish. Most patients respond to rest, physical therapy and nonsteroidal anti-inflammatory drugs, but these drugs may activate bowel disease. Sulphasalazine may be recommended in some patients. There is no indication for the systemic use of steroids.

  3. Low Risk of Unemployment, Sick Leave, and Work Disability Among Patients with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Vester-Andersen, Marianne K; Prosberg, Michelle V; Vind, Ida

    2015-01-01

    BACKGROUND: To assess the occurrence and risk of unemployment (UE), sick leave (SL), and work disability (WD) in incident patients with inflammatory bowel disease (IBD) after 7 years of follow-up compared with the background population and to determine outcome predictors. METHODS: The study...... subset of the general population (n = 1435) were matched with IBD cases based on sex, age, and residency. The cumulative probabilities of UE, SL, and WD were calculated. A Cox proportional hazard regression was performed to identify possible outcome predictors. RESULTS: There was no difference in UE...... than 55 years. The rate of WD in CD (5.8%) was markedly lowered compared with previous studies. Within the IBD population, sex, educational level, disease behavior, smoking status, and surgery were predictors of UE, SL, and WD. CONCLUSIONS: The observed increased risk of SL and WD in patients with IBD...

  4. Impact of Environmental and Familial Factors in a Cohort of Pediatric Patients With Inflammatory Bowel Disease.

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    Strisciuglio, Caterina; Giugliano, Francesca; Martinelli, Massimo; Cenni, Sabrina; Greco, Luigi; Staiano, Annamaria; Miele, Erasmo

    2017-04-01

    The primary role of environment on inflammatory bowel disease (IBD) onset has been recently stressed. We aimed to investigate the effect of environmental factors in an IBD pediatric cohort. A total of 467 subjects (264 IBD and 203 controls) were enrolled. All patients underwent a questionnaire including 5 different groups of environmental risk factors: family history of IBD and autoimmune diseases, perinatal period, home amenities and domestic hygiene, childhood diseases and vaccinations, and diet. In a multivariate model, mother's degree (odds ratio [OR]: 5.5; 2.5-11.6), duration of breast feeding >3rd month (OR: 4.3; 1.6-10.5), father's employment (OR: 3.7; 1.2-8.7), gluten introduction environmental factors are closely linked to IBD onset and may partly explain IBD rise in developed countries.

  5. Prevalence and Determinants of Job Stress in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Schreiner, Philipp; Biedermann, Luc; Rossel, Jean-Benoit; Rogler, Gerhard; Pittet, Valérie; von Känel, Roland

    2017-02-01

    Psychosocial factors have been shown to predict a poor disease course in patients with inflammatory bowel disease (IBD), but whether this applies to job stress is currently unknown. We assessed the prevalence of job stress and its correlates in a large cohort of patients with IBD. We included all adult, professionally active patients enrolled between 2006 and 2015 in the Swiss IBD Cohort. Job stress was measured through the self-report effort-reward imbalance ratio and overcommitment (OC) to work questionnaires. We used multiple linear regressions to assess association with sociodemographic, lifestyle, psychosocial, and disease-related factors. Altogether 1656 patients completed the questionnaires (905 Crohn's disease and 751 ulcerative colitis/IBD unclassified). Only 91 (5.7%) of patients had an effort-reward imbalance ratio >1. Effort-reward imbalance and OC scores were higher in full-time versus part-time employees (coef = 0.050, P = 0.002; coef = 0.906, P job stress seems to be remarkably low in patients with IBD from Switzerland. The clinician should turn attention especially to women, full-time employees with a high level of education, and patients with extraintestinal manifestations to identify those with the most vulnerability to suffer from job stress.

  6. Cytomegalovirus colitis in hospitalized inflammatory bowel disease patients in Taiwan: a referral center study.

    Science.gov (United States)

    Weng, Meng-Tzu; Tung, Chien-Chih; Lee, Yi-Shuan; Leong, Yew-Loong; Shieh, Ming-Jium; Shun, Chia-Tung; Wang, Cheng-Yi; Wong, Jau-Min; Wei, Shu-Chen

    2017-02-13

    Colitis is exacerbated in patients with concurrent cytomegalovirus (CMV) infection and inflammatory bowel disease (IBD). We assessed the prevalence and clinical features of CMV colitis in hospitalized IBD patients. A retrospective study reviewed the data from January 1, 1998 through December 31, 2013 compiled at the National Taiwan University Hospital. The CMV colitis patients' demographic data, clinical information, treatment regimens, pathologic findings, and outcome were analyzed. A total of 673 IBD patients were hospitalized during the study period. There were 312 patients diagnosed with Crohn's disease (CD) and 361 with ulcerative colitis (UC). CMV colitis was diagnosed as having positive inclusion bodies in colonic tissue. Six of the 312 CD patients (1.9%) and five of the 361 UC patients (1.4%) were diagnosed with CMV colitis. Compared to CD patients without CMV colitis, patients with CMV colitis were more often older (p colitis flare-ups after the index admission. The prevalence of CMV colitis in hospitalized IBD inpatients was 1.6% in Taiwan. Two associated factors for CMV colitis in hospitalized IBD patients were that they were elderly in CD and were on higher doses of steroids. Routine histopathology studies and/or PCR for refractory colitis patients are suggested to diagnose CMV colitis. Once the diagnosis is made, antiviral treatment is recommended to decrease the colitis relapse rate.

  7. Results of home parenteral nutrition in patients with severe inflammatory bowel disease - an alternative for surgery of malnourished patients.

    Science.gov (United States)

    Turkot, Maryla; Sobocki, Jacek

    2017-10-31

    In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition. The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications. A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn's disease or ulcerative colitis. Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work. Home parenteral nutrition positively affects patient's general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate.

  8. Measurement and clinical implications of choroidal thickness in patients with inflammatory bowel disease

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    Ibrahim Koral Onal

    2015-10-01

    Full Text Available ABSTRACTPurpose:Ocular inflammation is a frequent extraintestinal manifestation of inflammatory bowel disease (IBD and may parallel disease activity. In this study, we evaluated the utility of a choroidal thickness measurement in assessing IBD activity.Methods:A total of 62 eyes of 31 patients with IBD [Crohn's disease (CD, n=10 and ulcerative colitis (UC, n=21] and 104 eyes of 52 healthy blood donors were included in this study. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. The Crohn's disease activity index (CDAI and the modified Truelove Witts score were used to assess disease activity in CD and UC, respectively.Results:No significant differences in mean subfoveal, nasal 3000 μm, or temporal 3000 μm choroidal thickness measurements (P>0.05 for all were observed between IBD patients and healthy controls. Age, smoking, CD site of involvement (ileal and ileocolonic involvement, CDAI, CD activity, and UC endoscopic activity index were all found to be significantly correlated with choroidal thickness by univariate analysis (P<0.05. Smoking (P<0.05 and the CD site of involvement (P<0.01 were the only independent parameters associated with increased choroidal thickness at all measurement locations.Conclusions:Choroidal thickness is not a useful marker of disease activity in patients with IBD but may be an indicator of ileal involvement in patients with CD.

  9. Inflammatory bowel disease: A descriptive study of 716 local Chilean patients.

    Science.gov (United States)

    Simian, Daniela; Fluxá, Daniela; Flores, Lilian; Lubascher, Jaime; Ibáñez, Patricio; Figueroa, Carolina; Kronberg, Udo; Acuña, Raúl; Moreno, Mauricio; Quera, Rodrigo

    2016-06-14

    To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group. A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile (C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed. The study included 716 patients with IBD: 508 patients (71%) were diagnosed with ulcerative colitis (UC), 196 patients (27%) were diagnosed with Crohn's disease (CD) and 12 patients (2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years (range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years (range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis (50%) and colonic involvement (44%) predominated in the patients with UC and CD, respectively. In CD patients, non-stricturing/non-penetrating behavior was more frequent (80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive and biological therapies

  10. Unsuspected Small-Bowel Crohn’s Disease in Elderly Patients Diagnosed by Video Capsule Endoscopy

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    Che-Yung Chao

    2018-01-01

    Full Text Available Background. Video capsule endoscopy (VCE is increasingly performed among the elderly for obscure bleeding. Our aim was to report on the utility of VCE to uncover unsuspected Crohn’s disease (CD in elderly patients. Methods. Retrospective review of VCE performed in elderly patients (≥70 y at a tertiary hospital (2010–2015. All underwent prior negative bidirectional endoscopies. CD diagnosis was based on consistent endoscopic findings, exclusion of other causes, and a Lewis endoscopic score (LS > 790 (moderate-to-severe inflammation. Those with lower LS (350–790 required histological confirmation. Known IBD cases were excluded. Results. 197 VCE were performed (mean age 78; range 70–93. Main indications were iron deficiency anemia (IDA, occult GI bleeding (OGIB, chronic abdominal pain, or diarrhea. Eight (4.1% were diagnosed as CD based on the aforementioned criteria. Fecal calprotectin (FCP was elevated in 7/8 (mean 580 μg/g. Mean LS was 1824. Small-bowel CD detected by VCE led to a change in management in 4/8. One patient had capsule retention secondary to NSAID induced stricture, requiring surgical retrieval. Conclusions. VCE can be safely performed in the elderly. A proportion of cases may have unsuspected small-bowel CD despite negative endoscopies. FCP was the best screening test. Diagnosis frequently changed management.

  11. Inflammatory bowel disease and cerebrovascular arterial and venous thromboembolic events in 4 pediatric patients: a case series and review of the literature.

    Science.gov (United States)

    Standridge, Shannon; de los Reyes, Emily

    2008-01-01

    Inflammatory bowel disease has been linked to cerebrovascular lesions, but the mechanisms of these vascular complications and their frequency among children with inflammatory bowel disease are unclear. We present 4 children with inflammatory bowel disease who developed ischemic or hemorrhagic stroke or cerebral sinovenous thrombosis. All 4 patients were female; 3 had Crohn's disease and 1 had indeterminate colitis. All of the patients had additional risk factors for thrombosis including thrombocytosis, severe dehydration attributable to an inflammatory bowel disease exacerbation, and, in 2 instances, genetically mediated coagulation defects. It is believed that the occurrence of thrombotic complications in individuals with inflammatory bowel disease is attributable to multifactorial causes. The current literature on cerebrovascular complications and treatment in the setting of pediatric inflammatory bowel disease is reviewed.

  12. Health care and patients' education in a European inflammatory bowel disease inception cohort

    DEFF Research Database (Denmark)

    Burisch, J; Vegh, Z; Pedersen, Natalia

    2014-01-01

    care and education of patients with inflammatory bowel disease (IBD). METHODS: A quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access...... was the Internet (92% vs. 88% p=0.23). In Western Europe, significantly more patients were educated by nurses (19% vs. 1%, p... items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden...

  13. Colonic neoplasia in young patients with inflammatory bowel disease and primary sclerosing cholangitis.

    Science.gov (United States)

    Imam, M H; Thackeray, E W; Lindor, K D

    2013-02-01

    Current guidelines recommend annual surveillance for colorectal cancer (CRC) in all patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). The aim of our study was to validate the need for annual surveillance for colon neoplasia in patients ≤45 of age with a combined diagnosis of PSC and IBD. We identified patients, ≤45 years of age with a combined diagnosis of PSC and IBD, who were seen at the Mayo Clinic between 1995 and 2010. We then reviewed the medical records of the patients who developed colonic neoplasia defined as cancer, high-grade dysplasia (HGD) or dysplasia-associated lesion or mass (DALM).  In the population of 784 patients ≤45 years of age with a combined diagnosis of PSC and IBD, 10 (1.3%) of 784 developed colonic neoplasia during the follow-up period. Seven patients had colon cancer, one had HGD and two had a DALM. Colonic neoplasia is uncommon in young patients (≤45 years of age) with a combined diagnosis of PSC and IBD. We suggest delaying surveillance in young patients and propose that studies should be carried out to clarify the cost-effectiveness of annual or biannual surveillance colonoscopies according to patient age. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  14. Patients' knowledge and fear of colorectal cancer risk in inflammatory bowel disease.

    Science.gov (United States)

    Lopez, Anthony; Collet-Fenetrier, Benjamin; Belle, Arthur; Peyrin-Biroulet, Laurent

    2016-06-01

    To investigate knowledge and fear of colorectal cancer (CRC) risk in inflammatory bowel disease (IBD) patients. A 12-item self-administered questionnaire, developed after a careful literature review, was administered to all consecutive IBD patients treated with infliximab who were followed up at Nancy University Hospital (Vandoeuvre-lès-Nancy, France) between February and May 2012. Altogether 100 patients including 72 with Crohn's disease (CD) were included. Only 7.0% of patients spontaneously mentioned CRC risk as a main feature of IBD and 37.0% as a potential IBD complication. CRC was the most feared complication by 26 patients [ulcerative colitis (UC) 46.4% vs CD 18.1%, P fear of having ostomy bags. Only one-quarter of UC patients were aware of the chemopreventive effect of 5-aminosalicylates on CRC risk. Two-thirds of IBD patients are aware of the risk of CRC. UC patients have a better knowledge of this risk and are more afraid of this complication. Our results underscore the need for therapeutic education about CRC in IBD patients. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  15. The concerns of Spanish patients with inflammatory bowel disease as measured by the RFIPC questionnaire

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    E. del Berroa-de-la-Rosa

    Full Text Available Background and objectives: Concerns impact the quality of life for patients with inflammatory bowel disease (IBD. We attempted to identify the concerns of IBD patients in our practice, and to assess the applicability of the Rating Form of IBD Patients Concerns (RFIPC questionnaire to Spanish patients. Patients and methods: One hundred and thirty-one patients seen in our practice filled out the Spanish version of RFIPC. The questionnaire's reliability, validity, and discriminating power were analyzed. Results: The total score was 46.93, with a standard deviation (SD of 21.475. Primary concerns included: "having an ostomy bag", "effects of medication", "developing cancer", "energy level", and "uncertain nature of disease". Female patients scored higher on total RFIPC and on most items. Cronbach's alpha was 0.924. A good correlation was seen between two consecutive answers for 37 patients; the Spearman's coefficient was 0.842 (p < 0.001, and the intraclass correlation coefficient (ICC was 0.775 (p < 0.001. Correlation was also found between RFIPC and both the IBDQ-32 emotional domain (0.413, p < 0.001 and anxiety scale (0.543, p < 0.001. Conclusions: The RFIPC questionnaire may be administered to Spanish patients.

  16. Campylobacter infection in 682 bulgarian patients with acute enterocolitis, inflammatory bowel disease, and other chronic intestinal diseases.

    Science.gov (United States)

    Boyanova, Lyudmila; Gergova, Galina; Spassova, Zoya; Koumanova, Radka; Yaneva, Penka; Mitov, Ivan; Derejian, Sirigan; Krastev, Zacharii

    2004-05-01

    The aim of the study was to assess Campylobacter infections in 309 patients with acute enterocolitis, 272 patients with relapses of chronic enterocolitis, 70 patients with inflammatory bowel disease (involving Crohn's disease and ulcerative colitis) and 31 patients with other chronic intestinal illnesses. Isolation and identification were performed conventionally. Limited agar dilution method was used for susceptibility testing of the strains. Campylobacter species were isolated in patients with acute enterocolitis (7.8%), chronic enterocolitis (6.2%), Crohn's disease (6.2%), ulcerative colitis (3.7%), and irritable bowel syndrome (8.3%). Hippurate-positive Campylobacter jejuni isolates accounted for 62.2% of Campylobacter strains. One tetracycline resistant Campylobacter upsaliensis isolate was detected from a girl with acute enterocolitis. Resistance rates to erythromycin (31.1%) and clarithromycin (22.2%) were high, whereas those to amoxicillin/clavulanate (4.4%), ampicillin/sulbactam (13.3%), tetracycline (24.4%) and ciprofloxacin (22.2%) were relatively low. Resistance to erythromycin and either tetracycline or ciprofloxacin was detected in 8.9% and 6.7%. The involvement of Campylobacter infection in relapses of chronic intestinal disorders and the susceptibility patterns of the strains strongly emphasize the role of Campylobacter as a cause of infection in this group of patients.

  17. Impaired coronary microvascular and left ventricular diastolic function in patients with inflammatory bowel disease.

    Science.gov (United States)

    Caliskan, Zuhal; Gokturk, Huseyin Savas; Caliskan, Mustafa; Gullu, Hakan; Ciftci, Ozgur; Ozgur, Gülsüm Teke; Guven, Aytekin; Selcuk, Haldun

    2015-01-01

    Increased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. Seventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove-Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. Compared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1±3.9 vs. 22. 4±2.9, pcoronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP. Copyright © 2014. Published by Elsevier Inc.

  18. Pregnancy related issues in inflammatory bowel disease: evidence base and patients' perspective.

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    Selinger, Christian P; Leong, Rupert Wl; Lal, Simon

    2012-06-07

    Inflammatory bowel disease (IBD) affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Women with IBD need to consider the possible course of disease during pregnancy, the benefits and risks associated with medications required for disease management during pregnancy and breastfeeding and the effects of mode of delivery on their disease. When indicated, aminosalicylates and thiopurines can be safely used during pregnancy. Infliximab and Adalimumab are considered probably safe during the first two trimesters. During the third trimester the placenta can be crossed and caution should be applied. Methotrexate is associated with severe teratogenicity due to its folate antagonism and is strictly contraindicated. Women with IBD tend to deliver earlier than healthy women, but can have a vaginal delivery in most cases. Caesarean sections are generally recommended for women with active perianal disease or after ileo-anal pouch surgery.While the impact of disease activity and medication has been addressed in several studies, there are minimal studies evaluating patients' perspective on these issues. Women's attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients' views on this subject.

  19. Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Carlsen, Katrine; Houen, Gunnar; Jakobsen, Christian

    2017-01-01

    BACKGROUND: To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program. METHODS: Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after...

  20. Impact of pregnancy on health-related quality of life of patients with inflammatory bowel disease.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N; Zadvornova, Yelena; Naik, Amar S; Issa, Mazen; Perera, Lilani P

    2012-09-01

    To examine the impact of pregnancy on health-related quality of life (HRQoL) of women with inflammatory bowel disease (IBD). This was a retrospective study in a tertiary referral center and included women with ≥2 short inflammatory bowel disease questionnaire (SIBDQ) scores obtained during their pregnancy. Regression models were used to identify independent factors influencing SIBDQ scores and changes of SIBDQ scores at different time points. A total of 32 women (23 CD, 9 UC) with a mean age at pregnancy of 29.4 years and a mean disease duration of 7.8 years were included in the study. The mean pre-pregnancy SIBDQ score in our cohort was 49, which was significantly lower than the values during (55, P pregnancy (53, P = 0.01). The score during pregnancy directly correlated with the pre-pregnancy SIBDQ score (correlation co-efficient 0.50, P = 0.003). Half of the patients had a ≥7-point increase in SIBDQ scores during pregnancy. Change in SIBDQ scores during pregnancy was inversely related to the pre-pregnancy score (-0.47, 95% CI -0.75 to -0.20) and changes in disease activity during pregnancy (-1.80, 95% CI -0.75 to -0.20). Half of the pregnant women with IBD in our cohort experienced improvement in their HRQoL. Pre-pregnancy HRQoL is predictive of HRQoL during pregnancy, supporting the need for optimizing disease activity prior to conception. © 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  1. Cross-sectional analysis of patient phone calls to an inflammatory bowel disease clinic

    Science.gov (United States)

    Corral, Juan E.; Yarur, Andres J.; Diaz, Liege; Simmons, Okeefe L.; Sussman, Daniel A.

    2015-01-01

    Background Patients with inflammatory bowel disease (IBD) require close follow up and frequently utilize healthcare services. We aimed to identify the main reasons that prompted patient calls to gastroenterology providers and further characterize the “frequent callers”. Methods This retrospective cross-sectional study included all phone calls registered in medical records of IBD patients during 2012. Predictive variables included demographics, psychiatric history, IBD phenotype, disease complications and medical therapies. Primary outcome was the reason for call (symptoms, medication refill, procedures and appointment issues). Secondary outcome was the frequency of changes in management prompted by the call. Results 209 patients participated in 526 calls. The mean number of calls per patient was 2.5 (range 0-27); 49 (23.4%) patients met the criterion of “frequent caller”. Frequent callers made or received 75.9% of all calls. Crohn’s disease, anxiety, extra-intestinal manifestations and high sedimentation rate were significantly associated with higher call volume. 85.7% of frequent callers had at least one call that prompted a therapeutic intervention, compared to 18.9% of non-frequent callers (Pchange in management may improve healthcare delivery. PMID:26126710

  2. Impact of Obesity on the Management and Clinical Course of Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Seminerio, Jennifer L; Koutroubakis, Ioannis E; Ramos-Rivers, Claudia; Hashash, Jana G; Dudekula, Anwar; Regueiro, Miguel; Baidoo, Leonard; Barrie, Arthur; Swoger, Jason; Schwartz, Marc; Weyant, Katherine; Dunn, Michael A; Binion, David G

    2015-12-01

    Obesity has been linked with a proinflammatory state and the development of inflammatory diseases. Data on the clinical course and treatment of obese patients with inflammatory bowel disease (IBD) are limited. We used an institutional IBD registry to investigate the impact of obesity on IBD severity and treatment. This was a retrospective analysis of prospectively collected data for 3 years (2009-2011). Patients with IBD were categorized by body mass index (BMI). IBD-related quality of life, biochemical markers of inflammation, comorbidities, health care utilization, and treatment were characterized. Obesity was defined as a BMI ≥30 (type I: 30-34.9, type II: 35-39.9, and type III ≥40). Among 1494 patients with IBD, 71.9% were above their ideal BMI and 31.5% were obese. Obesity was more common in ulcerative colitis compared with patients with Crohn's disease (P = 0.04). Obese class II and class III patients were predominantly female. Obesity in IBD was associated with female gender (P obesity. There was no association between increasing BMI and annual prednisone use, emergency department visits, hospitalization, and surgery. Obesity was associated with lower milligrams per kilogram doses of purine analogs and biologics. Obesity in IBD is not associated with increased health care utilization and IBD-related surgeries. Optimal regimens for drug dosing in obese patients with IBD have yet to be defined.

  3. [Pregnancy and inflammatory bowel disease].

    Science.gov (United States)

    Walldorf, J; Zwirnmann, K; Seufferlein, T

    2011-01-01

    Medical advice regarding the desire to have children and pregnancy in patients with inflammatory bowel disease (IBD) is often requested. The influence of IBD on pregnancy and--vice versa--of pregnancy on the activity of IBD is discussed. Based on three clinical cases the chances and limitations of medical treatment of CED during pregnancy are reviewed. Generally it is important to balance the therapy between the patients desire to be treated most effectively and to deliver a healthy child after an uncomplicated pregnancy. An interdisciplinary treatment is always advisable in patients with IBD and a desire to have children.

  4. Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Antonio Ramos-Martínez

    2015-01-01

    Full Text Available Background: Despite the growing incidence of Clostridium difficile diarrhea (CCD in patients with inflammatory bowel disease (IBD, little is known about the associated risk factors. Method: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. Results: Three cases (20 % with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22. Ten cases (67 % received treatment with proton pump inhibitors (PPIs versus 2 (13 % in the control group (IBD without CCD, p = 0.001. Seven cases underwent colonoscopy and pseudomembranes were seen in one (14 %. Fourteen (93 % patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years, a higher degree of community-acquired infection (13 patients, 87 %, immunosuppressive treatment (7 patients, 47 % and less patients had received previous antibiotic treatment (3 patients, 20 % than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66 % and 80 %, respectively p = 0.266. Conclusions: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.

  5. Are adipocytokines inflammatory or metabolic mediators in patients with inflammatory bowel disease?

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    Kahraman R

    2017-09-01

    Full Text Available Resul Kahraman,1 Turan Calhan,1 Abdurrahman Sahin,1 Kamil Ozdil,1 Zuhal Caliskan,1 Elif Sinem Bireller,2 Bedia Cakmakoglu3 1Department of Gastroenterology, Umraniye Education and Training Hospital, Health Sciences University, 2Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul Yeni Yuzyil University, 3Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey Abstract: This study examined the adiponectin and leptin levels and insulin resistance (IR in patients with inflammatory bowel disease (IBD and the associations between these factors and IBD characteristics. Fasting serum leptin, adiponectin, glucose, and insulin levels, as well as inflammatory parameters, were measured in 105 patients with IBD (49 patients with Crohn’s disease [CD], 56 patients with ulcerative colitis [UC] and 98 healthy controls [HC]. IR was evaluated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR. Disease activity and severity in patients with UC were evaluated using the Truelove–Witts index, and patients with CD were evaluated using the Crohn’s Disease Activity Index. Serum adiponectin levels were found to be significantly lower in patients with CD and UC (p<0.001. Serum leptin levels were also found to be significantly higher in both the UC and CD groups (p<0.001. When HOMA-IR levels were compared, no significant difference was detected for either the CD or UC groups compared with the controls. In conclusion, it was shown that leptin levels increased and adiponectin levels decreased in patients with IBD, which is thought to be related to chronic inflammation. The effects of adipocytokines in patients with IBD with inflammatory and metabolic processes need to be investigated in further broader studies. Keywords: ulcerative colitis, Crohn’s disease, insulin resistance, adiponectin, leptin

  6. Inflammatory bowel disease patient's satisfaction with healthcare services received. Physicians' and nurses' perceptions.

    Science.gov (United States)

    Casellas, Francesc; Vera, Isabel; Ginard, Daniel; Torrejón, Antonio

    2013-08-01

    patient satisfaction with healthcare services provided for inflammatory bowel diseases (IBD) is essential due to high resources use. the study aimed to describe patient satisfaction with healthcare services using the CACHE questionnaire and to assess gastroenterologist and nurse perception on patients' satisfaction. observational multicentric prospective study in 35 Spanish hospitals. Patients included had Crohn's disease or ulcerative colitis. The study was approved by the Hospital Universitari Vall d'Hebron Ethics Committee. Scheduled study visits: baseline (patient sociodemographics and clinical data were collected), 2-4 and 6-months. Patient satisfaction with healthcare was assessed by CACHE questionnaire at each visit; it scores from 0-least satisfaction to 100-highest satisfaction.Gastroenterologists and nurses answered once an adapted questionnaire. participating 290 patients (54.2 % males, 41.3 years old), 62 gastroenterologists and 47 nurses. At baseline mean (SD) CACHE score was 81.7 (10.9); satisfaction with clinician care was the highest, patient information the lowest. Scores did not change across study. Gastroenterologist global score was 72.5 (9.8); Staff Care satisfaction was the highest, patient information the lowest. All scores were significantly lower than patients'. Nurses' global score was 82.2 (8.5), clinician care satisfaction was the highest, centre facilities the lowest. Scores on satisfaction with clinician care, centre facilities, and patient information scored statistically lower than patients'. No relationship was found between patients' satisfaction and patients characteristics. conclusions: IBD patients are satisfied with healthcare services provided, even though the information may be improved. Nurses' perception is similar to that of patients, physicians have a lower perception.

  7. Epidemiologic Characteristics of Patients with Inflammatory Bowel Disease in Kermanshah, Iran.

    Science.gov (United States)

    Zobeiri, Mehdi; Bashiri, Homayoon; Askari, Lotfollah; Keshavars, Ali Asghar; Tavvafzadeh, Ramin; Fatahi, Kiomars; Najafi, Farid

    2017-07-01

    BACKGROUND This study was done to define some epidemiological aspects of inflammatory bowel disease (IBD), and to describe its characteristics in west of Iran. METHODS In this descriptive study all patient with the diagnosis of IBD who were visited in universityaffiliated medical centers, between 2014 and 2015 were recruited. Their demographic characteristics, disease-related manifestations, complications, disease course and their chief complaints were analyzed. RESULTS Of 156 referred individuals, 153 patients had ulcerative colitis (UC) and 3 patients had Crohn's diseases (CD). The mean age of the patients at diagnosis was 35.69±12.35 (range: 17-80) years with the most common age group of 25-35 years and slight female predominance (51.9%). More urban patients were registered (90.4%) and 57% had high school or upper education. Positive family history of the disease was in 25.6% and 66.6% had four or more family members. Furthermore, 51.9% had left sided colitis and 40.4% had pancolitis with bloody diarrhea (79.5%) and abdominal pain (68.6%) as the most common manifestations. 36.5% had other autoimmune diseases. Multiple flare was seen in 47.4%, most commonly due to drug discontinuation (26.28%). Hospital admission was reported in 34.6%. History of contraceptive pill use was in 38.8% of the female patients. CONCLUSION The demographic and clinical manifestations of IBD are usually the same as other developing countries; however, the rarity of CD is eminent. Although the accurate epidemiological characteristic of IBD in Iran is still obscure, it is not a rare disease as previously thought and it seems that gradual reception of a western lifestyle may be linked to the ongoing rise in IBD.

  8. Sexual function and patients' perceptions in inflammatory bowel disease: a case-control survey.

    Science.gov (United States)

    Marín, Laura; Mañosa, Míriam; Garcia-Planella, Esther; Gordillo, Jordi; Zabana, Yamile; Cabré, Eduard; Domènech, Eugeni

    2013-06-01

    Sexuality is important when assessing quality of life (QoL), which is often disturbed in inflammatory bowel disease (IBD). However, sexuality is not addressed in most QoL questionnaires. To evaluate the prevalence and predisposing factors of sexual dysfunction among IBD patients, and their own perception. A postal survey was conducted in IBD patients 25-65 years of age from two tertiary centres. Patients were asked to provide a control of the same gender and age without IBD. The questionnaire assessed patient perception of the impact of IBD on their sexuality, and also allowed calculation of the Erectile Function International Index or the Female Sexual Function Index. A total of 355 patients and 200 controls were available for the final analysis. Both groups were comparable except for a higher proportion of individuals who had been treated for depression among patients. Half of the female and one-third of the male patients considered that both sexual desire and satisfaction worsened after IBD diagnosis. As compared to controls, both men and women with IBD showed significantly lower scores in sexual function indexes, but a higher prevalence of sexual dysfunction was only noticed among women. Independent predictors of sexual dysfunction among IBD patients were the use of corticosteroids in women, and the use of biological agents, depression and diabetes in men. Sexuality is often disturbed in IBD patients, particularly among women. Many factors seem to contribute to worsened intimacy. Sexuality should be considered when QoL is assessed in these patients.

  9. Better survival of renal cell carcinoma in patients with inflammatory bowel disease.

    Science.gov (United States)

    Derikx, Lauranne A A P; Nissen, Loes H C; Drenth, Joost P H; van Herpen, Carla M; Kievit, Wietske; Verhoeven, Rob H A; Mulders, Peter F A; Hulsbergen-van de Kaa, Christina A; Boers-Sonderen, Marye J; van den Heuvel, Tim R A; Pierik, Marieke; Nagtegaal, Iris D; Hoentjen, Frank

    2015-11-10

    Immunosuppressive therapy may impact cancer risk in inflammatory bowel disease (IBD). Cancer specific data regarding risk and outcome are scarce and data for renal cell carcinoma (RCC) are lacking. We aimed(1) to identify risk factors for RCC development in IBD patients (2) to compare RCC characteristics, outcome and survival between IBD patients and the general population. A PALGA (Dutch Pathology Registry) search was performed to establish a case group consisting of all IBD patients with incident RCC in The Netherlands (1991-2013). Cases were compared with two separate control groups: (A) with a population-based IBD cohort for identification of risk factors (B) with a RCC cohort from the general population to compare RCC characteristics and outcomes. 180 IBD patients with RCC were identified. Pancolitis (OR 1.8-2.5), penetrating Crohn's disease (OR 2.8), IBD related surgery (OR 3.7-4.5), male gender (OR 3.2-5.0) and older age at IBD onset (OR 1.0-1.1) were identified as independent risk factors for RCC development. IBD patients had a significantly lower age at RCC diagnosis (p disease stage compared to the general population. This translates into a better survival independent of immunosuppressive or anti-TNFα therapy.

  10. Leven met Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Duijvendijk J. van, [No Value

    2004-01-01

    Leven met Inflammatory Bowel Disease Inflammatory bowel disease (IBD) is de verzamelnaam voor Colitis ulcerosa en de ziekte van Crohn. Het zijn chronische darmontstekingen, waarvan de ziekteactiviteit wisselt en zich niet laat voorspellen. Door de lichamelijke klachten en het onvoorspelbare karakter

  11. Inflammatory bowel disease: A descriptive study of 716 local Chilean patients

    Science.gov (United States)

    Simian, Daniela; Fluxá, Daniela; Flores, Lilian; Lubascher, Jaime; Ibáñez, Patricio; Figueroa, Carolina; Kronberg, Udo; Acuña, Raúl; Moreno, Mauricio; Quera, Rodrigo

    2016-01-01

    AIM: To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group. METHODS: A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile (C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed. RESULTS: The study included 716 patients with IBD: 508 patients (71%) were diagnosed with ulcerative colitis (UC), 196 patients (27%) were diagnosed with Crohn’s disease (CD) and 12 patients (2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years (range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years (range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis (50%) and colonic involvement (44%) predominated in the patients with UC and CD, respectively. In CD patients, non-stricturing/non-penetrating behavior was more frequent (80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive

  12. Serological markers for inflammatory bowel disease in AIDS patients with evidence of microbial translocation.

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    Anupa Kamat

    Full Text Available BACKGROUND: Breakdown of the gut mucosal barrier during chronic HIV infection allows translocation of bacterial products such as lipopolysaccharides (LPS from the gut into the circulation. Microbial translocation also occurs in inflammatory bowel disease (IBD. IBD serological markers are useful in the diagnosis of IBD and to differentiate between Crohn's disease (CD and ulcerative colitis (UC. Here, we evaluate detection of IBD serological markers in HIV-infected patients with advanced disease and their relationship to HIV disease markers. METHODS: IBD serological markers (ASCA, pANCA, anti-OmpC, and anti-CBir1 were measured by ELISA in plasma from AIDS patients (n = 26 with low CD4 counts (<300 cells/µl and high plasma LPS levels, and results correlated with clinical data. For meta-analysis, relevant data were abstracted from 20 articles. RESULTS: IBD serological markers were detected in approximately 65% of AIDS patients with evidence of microbial translocation. An antibody pattern consistent with IBD was detected in 46%; of these, 75% had a CD-like pattern. Meta-analysis of data from 20 published studies on IBD serological markers in CD, UC, and non-IBD control subjects indicated that IBD serological markers are detected more frequently in AIDS patients than in non-IBD disease controls and healthy controls, but less frequently than in CD patients. There was no association between IBD serological markers and HIV disease markers (plasma viral load and CD4 counts in the study cohort. CONCLUSIONS: IBD serological markers may provide a non-invasive approach to monitor HIV-related inflammatory gut disease. Further studies to investigate their clinical significance in HIV-infected individuals are warranted.

  13. Listeria monocytogenes infection in inflammatory bowel disease patients: case series and review of the literature.

    Science.gov (United States)

    Miranda-Bautista, José; Padilla-Suárez, Camilo; Bouza, Emilio; Muñoz, Patricia; Menchén, Luis; Marín-Jiménez, Ignacio

    2014-11-01

    Listeria monocytogenes (LM) is a gram-positive intracellular bacillus that in immunodeficient patients, children, geriatric patients, pregnant women, and even in healthy individuals can cause central nervous system infection, bacteremia, and other clinical manifestations, becoming a relevant pathogen. From the Microbiology Service data of 'Gregorio Marañón' Hospital, we selected all positive biological sample cultures for LM from inflammatory bowel disease (IBD) patients, from January 1986 until January 2011. These cases were included in an SPSS database, analyzing several basal clinical characteristics and factors related to the infection. Three patients diagnosed with IBD had positive cultures for LM during this period. All of them were male, and also all of them had a diagnosis of Crohn's disease. Every patient had a corticosteroid cumulated dose of more than 400 mg (equivalency in methylprednisolone doses), adding anti-tumor necrosis factor-α treatment (certolizumab) in one patient. Prior colonoscopy with biopsy was performed in two patients. Clinical presentation of the infection was bacteremia in two patients, accompanied by central nervous system infection in one patient. One patient had isolated meningoencephalitis. Despite correct empiric treatment, one patient died from a cause related to the infection, that is, rombencephalitis. Increased incidence of LM bacteremia was found in IBD patients, compared with the general population (12.2 bacteremias/100 000 IBD patient-years, compared with 1.6 bacteremias/100 000 person-years), with an odds ratio of 7.4. IBD patients may be at risk for more frequent and serious LM infection compared with the general population.

  14. Diagnostic and vaccine strategies to prevent infections in patients with inflammatory bowel disease.

    Science.gov (United States)

    Mazzola, Giovanni; Macaluso, Fabio Salvatore; Adamoli, Lucia; Renna, Sara; Cascio, Antonio; Orlando, Ambrogio

    2017-05-01

    The treatment of inflammatory bowel disease (IBD) has been revolutionized by the use of immunomodulatory agents. Although these potent drugs are effective in controlling disease activity, they also cause an increased risk of new infections or reactivation of latent infections. On these premises, we aimed to provide guidance on the definitions of immunocompromised patients, opportunistic infections and the risk factors associated with their occurrence in an IBD context, and to suggest the proper screening tests for infectious diseases and the vaccination schedules to perform before and/or during therapy with immunomodulators. All the most recent evidences - filtered by the combined work of gastroenterologists and infectious disease experts - were summarized with the aim to provide a practical standpoint for the physician. A systematic screening of all infections which may arise during therapy with immunomodulator drugs is necessary in all patients with IBD. The ideal timing to perform screening tests and vaccinations is at the diagnosis of the disease, regardless of its severity at onset, because the course of IBD and its treatment may vary over time, and an immunocompromised status may hamper efficacy and/or possibility to perform all necessary vaccines. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  15. Do Inflammatory Bowel Disease patients with anxiety and depressive symptoms receive the care they need?

    Science.gov (United States)

    Bennebroek Evertsz', F; Thijssens, N A M; Stokkers, P C F; Grootenhuis, M A; Bockting, C L H; Nieuwkerk, P T; Sprangers, M A G

    2012-02-01

    Inflammatory Bowel Disease (IBD) patients with anxiety and/or depressive symptoms may not receive the care they need. Provision of care requires insight into the factors affecting these psychiatric symptoms. The study was designed to examine the extent to which: (1) IBD patients with anxiety and/or depressive symptoms receive mental treatment and (2) clinical and socio-demographic variables are associated with these symptoms. 231 adult IBD patients (79% response rate), attending a tertiary care center, completed standardized measures on anxiety and depressive symptoms (HADS), quality of life (SF-12) and mental health care use (TIC-P). Diagnosis and disease activity were determined by the gastroenterologist. 43% had high levels of anxiety and/or depressive symptoms, indicative of a psychiatric disorder (HADS ≥ 8), of whom 18% received psychological treatment and 21% used psychotropic medication. In multivariate analysis, high disease activity was associated with anxiety (OR=2.72 | panxiety (OR=2.60 | panxiety and depressive symptoms and poor quality of life, psychiatric complaints in IBD patients were undertreated. Screening for and treatment of psychiatric symptoms should become an integral part of IBD medical care. Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  16. Low bone mineral density in Greek patients with inflammatory bowel disease: prevalence and risk factors

    Science.gov (United States)

    Koutroubakis, Ioannis E.; Zavos, Christos; Damilakis, John; Papadakis, Georgios Z.; Neratzoulakis, John; Karkavitsas, Nikolaos; Kouroumalis, Elias A.

    2011-01-01

    Background A high prevalence of osteopenia and osteoporosis is observed in patients with inflammatory bowel disease (IBD). Various risk factors of bone loss have been suggested in IBD. The aim of the present study was to investigate the prevalence of low bone mineral density (BMD) and to identify related risk factors in Greek patients with IBD. Methods One hundred and eighteen consecutive IBD patients were included. All patients underwent bone densitometry by dual energy X-ray absorptiometry at the femoral neck and lumbar spine levels. Serum levels of 25 hydroxyvitamin D (25 OH D), 1.25 dihydroxyvitamin D (1.25 OH 2D), osteocalcin, calcitonin and homocysteine were measured in all participants. Results Forty (33.9%) patients were normal, 55 (46.6%) were osteopenic, and 23 (19.5%) were osteoporotic. No significant differences between IBD patients with osteopenia or osteoporosis and those with normal BMD concerning the use of steroids and the examined biochemical markers were found. Statistically significant differences among the three groups were found for body mass index (BMI), age and disease duration (P=0.002, P<0.0001 and P=0.03 respectively). Multivariate analysis revealed that the most significant factors associated with BMD were age and BMI (P<0.0001). A weak but statistically significant correlation was also found for disease duration (P=0.04). Conclusions There is a high prevalence of osteopenia and osteoporosis in Greek patients with IBD. Low BMI, age and disease duration are the most important independent risk factors for osteoporosis in Greek IBD patients. PMID:24714255

  17. Gender differences in inflammatory bowel disease: Explaining body image dissatisfaction.

    Science.gov (United States)

    Trindade, Inês A; Ferreira, Cláudia; Duarte, Cristiana; Pinto-Gouveia, José

    2017-12-01

    The aim of this study was to examine the role of body image problems in the context of inflammatory bowel disease and to explore gender differences in these associations. A sample of inflammatory bowel disease patients (60 males and 140 females) was collected. Findings from a multi-group analysis show that inflammatory bowel disease symptomatology may impact on body image in both male and female patients through the effect of body-image-related cognitive fusion. Body image difficulties in the context of inflammatory bowel disease should not be a neglected dimension in research aiming at understanding the psychosocial effects of inflammatory bowel disease and by health professionals working with these patients.

  18. Cogan's Syndrome in Patients With Inflammatory Bowel Disease--A Case Series

    DEFF Research Database (Denmark)

    Vavricka, Stephan R; Greuter, Thomas; Scharl, Michael

    2015-01-01

    of the CONFER project. A call to all ECCO members was made to report concomitant CSy and inflammatory bowel disease (IBD) cases. Clinical data were recorded in a standardized questionnaire. RESULTS: This international case series reports on 22 concomitant CSy-IBD cases from 14 large medical centres. Mean...... treatment at the time of CSy diagnosis, of whom 6 (37.5%) were on anti-tumour necrosis factor (TNF). Seven out of 10 patients, who were treated for CSy with immunomodulators (mostly with corticosteroids), demonstrated at least partial response. CONCLUSION: This is the largest CSy-IBD case series so far...... and directed intervention with corticosteroids at inception may potentially hinder audiovestibular deterioration. Finally, vigilance and awareness may also offer a better setting to study the pathophysiological mechanisms of this rare but debilitating phenomenon....

  19. PET/CT in the diagnosis of inflammatory bowel disease in pediatric patients: a review

    DEFF Research Database (Denmark)

    Knudsen, Mikkel Malham; Hess, S.; Nielsen, R. G.

    2014-01-01

    studies dealt with both stand-alone FDG-PET and FDG-PET/CT, while three were about stand-alone FDG-PET only. No studies could be found that focused on FDG-PET/CT only. The five studies comprised analysis of a total 181 pediatric patients (0-18 years of age). They unanimously indicated that FDG......The literature on positron emission tomography and computed tomography using 18fluoro-deoxyglusose (FDG-PET/CT) in the diagnosis of pediatric inflammatory bowel disease (IBD) is presented. Only five papers representing independent studies were identified and included in this review. Of these, two......-PET/CT is a versatile method with a diagnostic high sensitivity ranging from 70% to 97%. In conclusion, the pediatric literature on FGD-PET/CT’s role in the diagnosis of IBD is very limited. Prospective studies of well characterized populations are needed in order to validate this novel imaging modality in pediatric...

  20. PET/CT in the diagnosis of inflammatory bowel disease in pediatric patients

    DEFF Research Database (Denmark)

    Malham, Mikkel; Hess, Søren; Nielsen, Rasmus G

    2014-01-01

    studies dealt with both stand-alone FDG-PET and FDG-PET/CT, while three were about stand-alone FDG-PET only. No studies could be found that focused on FDG-PET/CT only. The five studies comprised analysis of a total 181 pediatric patients (0-18 years of age). They unanimously indicated that FDG......The literature on positron emission tomography and computed tomography using (18)fluoro-deoxyglusose (FDG-PET/CT) in the diagnosis of pediatric inflammatory bowel disease (IBD) is presented. Only five papers representing independent studies were identified and included in this review. Of these, two......-PET/CT is a versatile method with a diagnostic high sensitivity ranging from 70% to 97%. In conclusion, the pediatric literature on FGD-PET/CT's role in the diagnosis of IBD is very limited. Prospective studies of well characterized populations are needed in order to validate this novel imaging modality in pediatric...

  1. Update on inflammatory bowel disease in patients with primary sclerosing cholangitis

    Science.gov (United States)

    Tsaitas, Christos; Semertzidou, Anysia; Sinakos, Emmanouil

    2014-01-01

    Patients with primary sclerosing cholangitis (PSC) complicated by inflammatory bowel disease (IBD) represent a distinct subset of patients with unique characteristics, which have serious clinical implications. The aim of this literature review was to shed light to the obscure clinical and molecular aspects of the two diseases combined utilizing current data available and putting issues of diagnosis and treatment into perspective. The prevalence of IBD, mainly ulcerative colitis in PSC patients is estimated to be 21%-80%, dependent on screening programs and nationality. PSC-associated colitis is likely to be extensive, characterized by rectal sparing, backwash ileitis, and generally mild symptoms. It is also more likely to progress to colorectal malignancy, making it imperative for clinicians to maintain a high level of suspicion when tackling PSC patients. There is no optimal surveillance strategy but current guidelines advocate that colonoscopy is necessary at the time of PSC diagnosis with annual endoscopic follow-up. Random biopsies have been criticized and a shift towards targeted biopsies using chromoendoscopy, laser endomicroscopy and narrow-band imaging has been noted. Techniques directed towards genetic mutations instead of histological abnormalities hold promise for easier, more accurate diagnosis of dysplastic lesions. Chemopreventive measures against colorectal cancer have been sought in these patients. Ursodeoxycholic acid seemed promising at first but subsequent studies yielded conflicting results showing anticarcinogenic effects in low doses (8-15 mg/kg per day) and carcinogenic properties in high doses (15-30 mg/kg per day). PMID:24799986

  2. Proinflammatory cytokines and IL-10 in inflammatory bowel disease and colorectal cancer patients.

    Science.gov (United States)

    Szkaradkiewicz, Andrzej; Marciniak, Ryszard; Chudzicka-Strugała, Izabela; Wasilewska, Agnieszka; Drews, Michał; Majewski, Przemysław; Karpiński, Tomasz; Zwoździak, Barbara

    2009-01-01

    The aim of the study was to describe the levels of circulating monocyte/macrophage pro-inflammatory cytokines (TNF-alpha, IL-1beta IL-6, and IL-8) and an anti-inflammatory cytokine (IL-10) in inflammatory bowel disease (IBD) and colorectal cancer (CRC) patients and healthy controls. The study was conducted on 15 healthy individuals, 20 patients with ulcerative colitis (UC), 12 with Crohn's disease (CD), and 15 with CRC (Dukes' stage B). Blood serum cytokine levels were measured by ELISA. The patients with UC had significantly higher levels of the pro-inflammatory cytokines and of circulating IL-10 than the healthy controls. The patients with CD and CRC had the same specific pattern of serum cytokines of significantly elevated levels of the pro-inflammatory cytokines, but the IL-10 levels were within the range found in the healthy individuals. Thus our results demonstrate that both IBD and CRC are linked with an intensified production of a wide array of monocyte/macrophage pro-inflammatory cytokines which is not accompanied by elevated levels of circulating IL-10, except for its insufficiently inhibitory elevation in UC patients.

  3. Fatigue in patients with inflammatory bowel disease is associated with distinct differences in immune parameters

    Directory of Open Access Journals (Sweden)

    Vogelaar L

    2017-05-01

    Full Text Available Lauran Vogelaar, 1,* Colin de Haar,2,* Bas RJ Aerts,1 Maikel P Peppelenbosch,1 Reinier Timman,3 Bettina E Hanssen,1 C Janneke van der Woude1 1Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, 2Applied Tumor Immunology, Laboratory of Translational Immunology, UMC Utrecht, Utrecht, 3Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands *These authors contributed equally to this work Background: Although it is well recognized that fatigue is an important problem in many of the quiescent inflammatory bowel disease (IBD patients, it is unknown whether the immune status is different in fatigued versus non-fatigued patients. In this study, we contrasted various characteristics of the immune system in fatigued against non-fatigued patients with IBD in clinical remission.Patients and methods: Patients with IBD in clinical remission were phenotyped according to the Montreal classification, and the checklist individual strength-fatigue (CIS-fatigue was used to assess fatigue (CIS-fatigue ≥ 35. Flow cytometry on peripheral blood samples was used to investigate differences in leukocyte subsets. The expression of various cytokines was determined in stimulated whole blood and serum samples using enzyme-linked immunosorbent assay. Differences between fatigued and non-fatigued patients with IBD were assessed.Results: In total, 55 patients were included in the fatigue group (FG and 29 patients in the non-fatigue group (NFG. No differences in demographic and clinical characteristics were observed between the groups. Flow cytometry data showed a significantly lower percentage of monocytes (p = 0.011 and a higher percentage of memory T-cells (p = 0.005 and neutrophils (p = 0.033 in the FG compared with the NFG. Whole blood stimulation showed increased TNF-α (p = 0.022 and IFN-γ (p = 0.047 in the FG. The median serum level was significantly higher for IL-12 (p < 0.001 and IL-10 (p

  4. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review.

    Science.gov (United States)

    Neuendorf, Rachel; Harding, Aubrey; Stello, Noelle; Hanes, Douglas; Wahbeh, Helané

    2016-08-01

    An increasing number of studies have been conducted to look at anxiety and depression in IBD; however, there is no clear consensus on the prevalence of anxiety and depression in this population. The objective of this systematic review was to compile the existing data on the prevalence of all mood and anxiety disorders in Inflammatory Bowel Disease patients. A series of comprehensive literature searches of Medline, Cochrane Library, PsycINFO, CINAHL, Embase, AMED, and ProQuest Dissertations were performed through March 2014. Inclusion criteria included peer-reviewed, published scientific articles that reported a measurement of mood or anxiety among IBD patients. Only studies with adults (≥18years old) and with more than 10 patients were included. Methodological quality was assessed for all included studies. 171 articles were identified with a total of 158,371 participants. Pooled prevalence estimate for anxiety disorders was 20.5% [4.9%, 36.5%] and 35.1% [30.5, 39.7%] for symptoms of anxiety. IBD patients in active disease had higher prevalence of anxiety of 75.6% [65.5%, 85.7%] compared to disease remission. Pooled prevalence of depression disorders was 15.2% [9.9%, 20.5%] and was 21.6% [18.7%, 24.3%] for symptoms of depression. The prevalence of depressive symptoms was higher in Crohn's disease (25.3% [20.7%, 30.0%]) compared to UC, and higher with active disease (40.7% [31.1%, 50.3%]) compared to IBD patients in remission. Results from this systematic review indicate that patients with IBD have about a 20% prevalence rate of anxiety and a 15% prevalence rate of depression. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Review article: the association of diet with onset and relapse in patients with inflammatory bowel disease

    NARCIS (Netherlands)

    Spooren, C.E.G.M.; Pierik, M.; Zeegers, M.P.A.; Feskens, E.J.M.; Masclee, A.A.M.

    2013-01-01

    Background The role of diet in inflammatory bowel disease (IBD) is supported by migration studies and increasing incidences in line with Westernisation. Aim To give a complete overview of studies associating habitual diet with the onset or relapses in ulcerative colitis (UC) or Crohn's disease (CD).

  6. Neutralizing antibodies against adeno-associated viruses in inflammatory bowel disease patients: implications for gene therapy

    NARCIS (Netherlands)

    van der Marel, Sander; Comijn, Elisabeth M.; Verspaget, Hein W.; van Deventer, Sander; van den Brink, Gijs R.; Petry, Harald; Hommes, Daniel W.; Ferreira, Valerie

    2011-01-01

    Inflammatory bowel diseases (IBDs) are comprised of two major disorders: Crohn's disease (CD) and ulcerative colitis (UC). No curative treatment options are available, but gene therapy may offer an alternative therapeutic approach. For this a safe and reliable vector is needed. The adeno-associated

  7. Survey of Immunization Practices in Patients With Inflammatory Bowel Disease Among Pediatric Gastroenterologists.

    Science.gov (United States)

    Lester, Rachael; Lu, Ying; Tung, Jeanne

    2015-07-01

    We aimed to determine vaccination practices of pediatric gastroenterologists, as well as barriers to following immunization guidelines in patients with inflammatory bowel disease. Institutions listed in the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition clinical research registry and/or ImproveCareNow were contacted. A total of 657 physicians from 129 institutions were asked to complete a 16-question electronic survey. A total of 178 physicians (27.1%) responded, of whom 55% were male and 83.1% practiced in an academic setting. A total of 11 physicians (6.2%) do not routinely assess vaccination status, whereas 63.5% assess at the time of diagnosis, 29.8% at "well" visits, and 44.4% before initiating immunosuppression. At diagnosis, 51.1% verbally inquire about immunization status, 30.9% obtain records, and 9.0% obtain serology.The influenza (78%), hepatitis B (84%), and varicella (82%) vaccines were most frequently assessed. Fewer than 55.5% of physicians reviewed other vaccines. Physicians using a reminder mechanism were more likely to review immunizations at established visits (41.1% vs 20.8%), and before transfer to an adult gastroenterologist (14.4% vs 2.6%). Lack of coordination of care with primary care practitioners (41%), poor access to immunization records (36%), and inability to offer vaccinations in their immediate area (55%) are barriers to vaccination. Only 28% believed that primary care practitioners were solely responsible for immunizations. There is practice variation among pediatric gastroenterologists in assessment of immunizations in patients with inflammatory bowel disease, including the specific vaccines assessed, and timing and method of assessment. Inability to coordinate care, access immunization records, and offer vaccines through their medical practice are barriers to adhering to immunization guidelines.

  8. Fecundity, pregnancy outcomes, and breastfeeding in patients with inflammatory bowel disease: a large cohort survey.

    Science.gov (United States)

    Mañosa, Míriam; Navarro-Llavat, Mercè; Marín, Laura; Zabana, Yamile; Cabré, Eduard; Domènech, Eugeni

    2013-04-01

    The aim was to assess the impact of inflammatory bowel disease (IBD) and its treatment on fertility, pregnancy outcomes, and breastfeeding. IBD is a chronic inflammatory condition that is usually diagnosed in young adulthood. Patients are often concerned about fertility and pregnancy outcomes. A structured questionnaire was posted to 850 adults with IBD followed-up on in a single center. A total of 503 patients (59%) with a median age of 40 years and equally distributed for gender and type of IBD returned the questionnaire. Overall, 71% of the patients had a total of 659 children, 36% of whom were born after the diagnosis. A total of 132 miscarriages were registered, 46% after the diagnosis of IBD. Most childless patients stated that having no children was a personal decision, and only 6% of them were evaluated and diagnosed with infertility. Pregnancies after diagnosis of IBD had a higher probability of caesarean section and preterm delivery. IBD-related drug therapy was discontinued in 16% of the pregnancies, mainly as a result of medical advice. Babies born after the diagnosis of IBD were less often breastfed. The infertility rate among IBD patients seems to be similar to that seen in the general population. However, a large proportion of patients chose to remain childless. Vaginal delivery and breastfeeding are less likely to occur in babies born after the diagnosis. Suitable information for patients to avoid unwarranted concerns about adverse reproductive outcomes, as well as improved obstetrical and perinatal management, still seems to be necessary.

  9. Genetic Markers Associated with Clinical Outcomes in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Yamamoto-Furusho, Jesús K; Fonseca-Camarillo, Gabriela

    2015-11-01

    Genetic factors play a significant role in determining inflammatory bowel disease (IBD) susceptibility. Epidemiologic data support genetic contribution to the pathogenesis of IBD, which include familial aggregation, twin studies, and racial and ethnic differences in disease prevalence. Recently, several new genes have been identified to be involved in the genetic susceptibility to IBD. The characterization of novel genes potentially will lead to the identification of therapeutic agents and clinical assessment of phenotype and prognosis in patients with IBD. The development of genetic markers associated with clinical outcomes in patients with IBD will be very important in the future. The progress of molecular biology tools (microarrays, proteomics, and epigenetics) have progressed the field of the genetic markers discovery. The advances in bioinformatics coupled with cross-disciplinary collaborations have greatly enhanced our ability to retrieve, characterize, and analyze large amounts of data generated by the technological advances. The techniques available for markers development are genomics (single nucleotide polymorphism genotyping, pharmacogenetics, and gene expression analyses) and proteomics. This could be a potential great benefit in predicting the course of disease in individual patients and in guiding appropriate medical therapy.

  10. Colorectal Cancer Risk in Patients With Lynch Syndrome and Inflammatory Bowel Disease.

    Science.gov (United States)

    Derikx, Lauranne A A P; Smits, Lisa J T; van Vliet, Shannon; Dekker, Evelien; Aalfs, Cora M; van Kouwen, Mariëtte C A; Nagengast, Fokko M; Nagtegaal, Iris D; Hoogerbrugge, Nicoline; Hoentjen, Frank

    2017-03-01

    Lynch syndrome and inflammatory bowel diseases (IBD) are associated with an increased risk of colorectal cancer (CRC). However, it is not clear whether the risk of CRC is even higher for patients with a combination of Lynch syndrome and IBD. We investigated the risk for CRC in this subgroup by establishing a Lynch syndrome cohort from the Radboud University Medical Center (Nijmegen, The Netherlands) and the Academic Medical Center (Amsterdam, The Netherlands). Patients with heterozygous germline mutations in MLH1, MSH2 (and EPCAM deletion-mediated MSH2 methylation), MSH6, or PMS2 who were tested and/or treated from 1998 through 2014 were included. Patients who developed IBD were identified by linkage of this cohort to the Dutch nationwide Pathology Registry (PALGA). Subsequently, we compared the risk of CRC between Lynch syndrome patients with IBD and without IBD. Of 1046 patients with Lynch syndrome, 15 developed IBD (1.4%). Patients with Lynch syndrome and IBD were significantly younger (median age, 38.0 y) than patients with Lynch syndrome without IBD (median age, 52.0 y; P = .001). Nevertheless, a similar proportion of patients in each group developed CRC: 4 of the 15 patients (26.7%) with Lynch syndrome and IBD compared with 311 of the 1031 patients (30.2%) with Lynch syndrome without IBD. Patients with Lynch syndrome and IBD developed CRC at a younger age (median age, 36.0 y) than patients with Lynch syndrome without IBD (median age, 46.0 y; P = .045). However, the cumulative incidence of CRC was similar between groups (P = .121). All patients with Lynch syndrome and IBD who developed CRC had ulcerative colitis, producing a higher cumulative incidence of CRC for this IBD subgroup (P Lynch syndrome and IBD develop CRC risk at a younger age than patients without IBD; patients with ulcerative colitis are at especially high risk. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  11. Targeted screening for Coeliac Disease among irritable bowel syndrome patients: analysis of cost-effectiveness and value of information

    NARCIS (Netherlands)

    Mohseninejad, L.; Feenstra, T.; van der Horst, H.E.; Woutersen-Koch, H.; Buskens, E.

    2013-01-01

    Objectives: A high prevalence of Coeliac Disease (CD) is found among patients with a clinical diagnosis of irritable bowel syndrome (IBS) compared to the general population. Symptoms of CD are quite similar to IBS, but its treatment is different. The aim of this study was to evaluate the

  12. Targeted screening for Coeliac Disease among irritable bowel syndrome patients : analysis of cost-effectiveness and value of information

    NARCIS (Netherlands)

    Mohseninejad, Leyla; Feenstra, Talitha; van der Horst, Henriette E.; Woutersen-Koch, Helen; Buskens, Erik

    2013-01-01

    A high prevalence of Coeliac Disease (CD) is found among patients with a clinical diagnosis of irritable bowel syndrome (IBS) compared to the general population. Symptoms of CD are quite similar to IBS, but its treatment is different. The aim of this study was to evaluate the cost-effectiveness of

  13. Prior Colorectal Neoplasia Is Associated With Increased Risk of Ileoanal Pouch Neoplasia in Patients With Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Derikx, Lauranne A. A. P.; Kievit, Wietske; Drenth, Joost P. H.; de Jong, Dirk J.; Ponsioen, Cyriel Y.; Oldenburg, Bas; van der Meulen-de Jong, Andrea E.; Dijkstra, Gerard; Grubben, Marina J. A. L.; van Laarhoven, Cornelis J. H. M.; Nagtegaal, Iris D.; Hoentjen, Frank

    BACKGROUND & AIMS: Although restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) substantially reduces the risk of colorectal cancer in patients with inflammatory bowel disease (IBD), subsequent pouch neoplasia can develop. There are few data on the incidence of and risk factors for

  14. Serum YKL-40, a potential new marker of disease activity in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Vind, Ida; Johansen, J S; Price, P A

    2003-01-01

    BACKGROUND: YKL-40 is secreted by macrophages and neutrophils and is a growth factor for vascular endothelial cells and fibroblasts. Elevated serum concentrations of YKL-40 are found in patients with diseases characterized by inflammation or ongoing fibrosis. The aim of this study was to seek...... were used to assess disease activity. Serum YKL-40 (determined by ELISA) was related to C-reactive protein (CRP) and disease activity. RESULTS: In patients with UC, the median serum YKL-40 rose with increasing disease activity, and patients with severe active disease had higher serum YKL-40 (median 59...

  15. Liver Function Test Abnormalities in Patients with Inflammatory Bowel Diseases: A Hospital-based Survey

    Directory of Open Access Journals (Sweden)

    Maria Cappello

    2014-07-01

    Full Text Available Background and Aims Inflammatory bowel diseases (IBD are frequently associated with altered liver function tests (LFTs. The causal relationship between abnormal LFTs and IBD is unclear. The aim of our study was to evaluate the prevalence and etiology of LFTs abnormalities and their association with clinical variables in a cohort of IBD patients followed up in a single center. Materials and Methods A retrospective review was undertaken of all consecutive IBD in- and outpatients routinely followed up at a single referral center. Clinical and demographic parameters were recorded. Subjects were excluded if they had a previous diagnosis of chronic liver disease. LFT abnormality was defined as an increase in aspartate aminotransferase, (AST, alanine aminotransferase (ALT, alkaline phosphatase (ALP, gamma-glutamyl transpeptidase (GGT, or total bilirubin. Results A cohort of 335 patients (179 males, mean age 46.0 ± 15.6 years was analyzed. Abnormal LFTs were detected in 70 patients (20.9%. In most cases, the alterations were mild and spontaneously returned to normal values in about 60% of patients. Patients with abnormal LFTs were less frequently on treatment with aminosalicylates (22.8 vs. 36.6%, P = 0.04. The most frequent cause for transient abnormal LFTs was drug-induced cholestasis (34.1%, whereas fatty liver was the most frequent cause of persistent liver damage (65.4%. A cholestatic pattern was found in 60.0% of patients and was mainly related to older age, longer duration of disease, and hypertension. Conclusions The prevalence of LFT abnormalities is relatively high in IBD patients, but the development of severe liver injury is exceptional. Moreover, most alterations of LFTs are mild and spontaneously return to normal values. Drug-induced hepatotoxicity and fatty liver are the most relevant causes of abnormal LFTs in patients with IBD.

  16. Switching Between Infliximab Originator and Biosimilar in Paediatric Patients with Inflammatory Bowel Disease. Preliminary Observations.

    Science.gov (United States)

    Sieczkowska, J; Jarzębicka, D; Banaszkiewicz, A; Plocek, A; Gawronska, A; Toporowska-Kowalska, E; Oracz, G; Meglicka, M; Kierkus, J

    2016-02-01

    The growing incidence of inflammatory bowel disease (IBD) in children necessitates the use of biological treatments. Recently, an infliximab biosimilar was authorized in the European Union, which may result in switching patients. We present our preliminary experiences with such switches. The prospective study included 32 paediatric patients diagnosed with Crohn's disease (CD) and 7 children with ulcerative colitis (UC) at 3 academic hospitals, who were switched from infliximab originator to its biosimilar (Remsima). Patient characteristics, disease severity, laboratory parameters and adverse events were recorded. Means, medians and ranges were calculated. Mean age at diagnosis of CD and UC was 11.1 (2.7-15.3) and 12.3 years (8.5-14.8), respectively. Mean number of infliximab originator infusions before switching to the biosimilar was 9.9 (median 8, range 4-29) and 5.1 (5, 1-12) for the CD and UC group, respectively. Evaluation efficacy of last biosimilar doses of all patients revealed rates of clinical remission of 88 and 57% for CD and UC patients, respectively. Last follow-up assessment of patients who continued with biosimilar therapy showed that 16/20 (80%) CD patients and all 4 UC individuals were in remission. One infusion reaction to infliximab biosimilar was observed in a CD patient, which led to treatment discontinuation. The incidence of sporadic mild adverse events prior to and after switching did not differ significantly and was consistent with the safety profile of the infliximab molecule. Switching from infliximab originator to its biosimilar seems to be a safe option in children with CD. After the switch the biosimilar was just as effective as the originator. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  17. Patients' perceptions on the impact of coffee consumption in inflammatory bowel disease: friend or foe?--a patient survey.

    Science.gov (United States)

    Barthel, Christiane; Wiegand, Sandra; Scharl, Sylvie; Scharl, Michael; Frei, Pascal; Vavricka, Stephan R; Fried, Michael; Sulz, Michael Christian; Wiegand, Nico; Rogler, Gerhard; Biedermann, Luc

    2015-08-12

    Environmental factors are an integral component in the pathogenesis of inflammatory bowel disease (IBD). There is an increasing interest in nutritive components. While the potential disease-modifying role of coffee has been intensively investigated in a variety of gastrointestinal diseases, the data on the potential impact on IBD is very limited. We aimed to determine the patients' perspective on coffee consumption in IBD. We conducted a questionnaire among IBD patients in Switzerland, assessing key questions regarding coffee consumption. Descriptive statistics including chi square testing were used for analysis of questionnaire data. Among a total of 442 patients 73% regularly consume coffee. 96% of patients attributing a positive and 91% of patients attributing no impact of coffee intake on IBD regularly drink coffee and surprisingly even 49% of those patients that assign a negative impact on disease symptoms. Among those patients refraining from regular coffee intake 62% are convinced that coffee adversely influences intestinal symptoms, significantly more in Crohn's disease (CD) than in ulcerative colitis (UC) (76% vs. 44%, p = 0.002). In total, 38% of all study subjects suppose that coffee has an effect on their symptoms of disease, significantly more in CD (54%) compared to UC patients (22%, p coffee has a detrimental influence, only 20% of UC patients share this impression (p coffee. More than twice as many CD compared to UC patients attribute a symptom-modifying effect of coffee consumption, the majority a detrimental one. However, this negative perception does not result in abstinence from coffee consumption.

  18. Prevalence of irritable bowel syndrome in caregivers of patients with chronic diseases.

    Science.gov (United States)

    Remes-Troche, J M; Torres-Aguilera, M; Montes-Martínez, V; Jiménez-García, V A; Roesch-Dietlen, F

    2015-06-01

    Caregivers are an at-risk population for psychic and physical diseases such as irritable bowel syndrome (IBS). However, it is not known whether providing care for the chronically ill patient can be considered a risk factor for developing IBS. In this study, our aim was to evaluate the prevalence of IBS according to the Rome II criteria in a group of caregivers. A cross-sectional study was conducted through an evaluation of caregivers of chronically ill patients. Subjects completed questionnaires including the Rome II Modular Questionnaire, the Hospital Anxiety and Depression Scale, the Zarit Caregiver Burden Interview (ZCBI) (an instrument for evaluating the burden experienced by caregivers), and the irritable bowel syndrome quality of life (IBS-QoL) questionnaire. Ninety-six primary caregivers (mean age was 43.6 ± 13.7 years and 87% were women) were evaluated. The mean length of time providing care was 37.6 months (3-288 months). Forty-seven caregivers (49%) presented with IBS. The caregivers with IBS had higher scores in the global ZCBI score (47 ± 8 vs 28 ± 8, p = 0.001) and on the anxiety and depression scale (p = 0.001) than those that did not have IBS. A total of 72% were diagnosed with caregiver stress syndrome; 42 of them had IBS according to the Rome II questionnaire (60% vs 18%, p = 0.001, relative risk 3.28, 95% CI: 1.4-7.4). Caregivers of chronically ill patients have a high prevalence of IBS, which is associated with depression, anxiety, and poor QoL. © 2015 John Wiley & Sons Ltd.

  19. Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator.

    OpenAIRE

    Pittet, V.; Vaucher, C.; F. Froehlich; B. Burnand; Michetti, P.; Maillard, M. H.

    2017-01-01

    Patient-reported disease perceptions are important components to be considered within a holistic model of quality of care. Gender may have an influence on these perceptions. We aimed to explore gender-specific concerns of patients included in a national bilingual inflammatory bowel disease cohort. Following a qualitative study, we built a questionnaire comprising 37 items of concern. Answers were collected on a visual analog scale ranging from 0 to 100. Principal axis factor analysis was u...

  20. Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator

    OpenAIRE

    Pittet, Val?rie; Vaucher, Carla; Froehlich, Florian; Burnand, Bernard; Michetti, Pierre; Maillard, Michel H.

    2017-01-01

    Background Patient-reported disease perceptions are important components to be considered within a holistic model of quality of care. Gender may have an influence on these perceptions. We aimed to explore gender-specific concerns of patients included in a national bilingual inflammatory bowel disease cohort. Methods Following a qualitative study, we built a questionnaire comprising 37 items of concern. Answers were collected on a visual analog scale ranging from 0 to 100. Principal axis facto...

  1. Immunogenecity of hepatitis A and B vaccination in pediatric patients with inflammatory bowel disease.

    Science.gov (United States)

    Urganci, Nafiye; Kalyoncu, Derya

    2013-04-01

    Aim of the study was to evaluate the response to hepatitis A and B vaccination in pediatric patients with inflammatory bowel disease (IBD). A total of 47 patients with IBD (25 ulcerative colitis, 14 Crohn's disease, and 8 indeterminate colitis) ages 3 to 17 years were compared with 50 healthy age- and sex-matched controls. Screening for hepatitis A and B serology was carried out before vaccination. Susceptible cases received 20 mg of recombinant DNA vaccine for hepatitis B (0, 1, and 6 months)and 720 milliELISA units of inactivated hepatitis A virus vaccine (HAV) (0 and 6 months). Postvaccination serologic evaluation was performed 1 month after the last dose of primary vaccination, 1 month after the booster dose, and once every year during follow-up. A total of 23 patients and 35 controls received HAV and protective anti-HAV antibodies were developed in all of the patients and controls (P =1.00). Forty-seven patients and 50 controls received hepatitis B vaccine and 70.2% of the patients versus 90% of the controls achieved seroprotection(anti-HBs titers 10 mIU/mL) 1 month after primary vaccination (95% confidence interval 0.71–0.87, P = 0.02). The overall seroprotection rates were 96% in controls and 85.1% in patients after the whole hepatitis B vaccination series (95% confidence interval 0.83–0.95, P = 0.08). No significant reduction was observed in antibody response among patients and controls during the follow-up period. The rate of seroconversion to the hepatitis B vaccine was lower in pediatric patients with IBD than in healthy controls and hepatitis A vaccine was highly immunogenic among patients with IBD.

  2. Idiopathic portal hypertension regarding thiopurine treatment in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Cristina Suárez-Ferrer

    2016-02-01

    Full Text Available Introduction: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. Material and methods: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH and its relationship with thiopurine treatment. Results: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%. A total of 4 patients with IBD type Crohn's disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000. Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3. Conclusion: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.

  3. Internet and electronic resources for inflammatory bowel disease: a primer for providers and patients.

    Science.gov (United States)

    Fortinsky, Kyle J; Fournier, Marc R; Benchimol, Eric I

    2012-06-01

    Patients with inflammatory bowel disease (IBD) are increasingly turning to the Internet to research their condition and engage in discourse on their experiences. This has resulted in new dynamics in the relationship between providers and their patients, with misinformation and advertising potentially presenting barriers to the cooperative patient-provider partnership. This article addresses important issues of online IBD-related health information and social media activity, such as quality, reliability, objectivity, and privacy. We reviewed the medical literature on the quality of online information provided to IBD patients, and summarized the most commonly accessed Websites related to IBD. We also assessed the activity on popular social media sites (such as Facebook, Twitter, and YouTube), and evaluated currently available applications for use by IBD patients and providers on mobile phones and tablets. Through our review of the literature and currently available resources, we developed a list of recommended online resources to strengthen patient participation in their care by providing reliable, comprehensive educational material. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

  4. Enfermedad inflamatoria intestinal en pacientes celíacos Inflammatory bowel disease in celiac patients

    Directory of Open Access Journals (Sweden)

    M. Masachs

    2007-08-01

    Full Text Available Introducción: se ha sugerido una potencial asociación entre la enfermedad celíaca y la enfermedad inflamatoria intestinal, que puede justificar que ambas enfermedades puedan presentarse en un mismo enfermo o en sus familiares de primer orden con mayor frecuencia de lo esperado. Objetivo: determinar la prevalencia de la enfermedad de Crohn y la colitis ulcerosa en los enfermos celíacos y en sus familiares. Método: estudio epidemiológico prospectivo transversal en un grupo de pacientes celíacos, sus familiares de primer grado y un grupo control de características epidemiológicas similares, constituido por familiares de pacientes que acuden al Servicio de Urgencias por un problema agudo. Para detectar la existencia de colitis ulcerosa y enfermedad de Crohn en los celíacos y sus familiares, se realizó una entrevista semiestructurada. Resultados: se han incluido 86 celíacos y 432 familiares, que se han comparado con 809 controles (129 pacientes con una enfermedad aguda y 680 familiares de primer grado suyos. Se han detectado 3 casos de enfermedad de Crohn en el grupo de los enfermos celíacos y 4 casos de enfermedad de Crohn en sus familiares. Sólo se ha detectado 1 caso de enfermedad de Crohn en el grupo control (p Introduction: a potential association between celic disease and inflammatory bowel disease hs been suggested, which may explain the fact that both disorders occasionally present in one patient or in his/her first-degree relatives more frequently than expected. Objective: to establish the prevalence of Crohn's disease and ulcerative colitis in celiac patients and their relatives. Method: a cross-sectional, prospective epidemiological study in a group of celiac patients, their first-degree relatives, and a control group with similar epidemiological characteristics including the relatives of patients presenting at the ER for acute conditions. A semistructured interview was used to identify the presence of Crohn's disease and

  5. Inflammatory bowel disease: pathogenesis.

    Science.gov (United States)

    Zhang, Yi-Zhen; Li, Yong-Yu

    2014-01-07

    Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is characterized by chronic relapsing intestinal inflammation. It has been a worldwide health-care problem with a continually increasing incidence. It is thought that IBD results from an aberrant and continuing immune response to the microbes in the gut, catalyzed by the genetic susceptibility of the individual. Although the etiology of IBD remains largely unknown, it involves a complex interaction between the genetic, environmental or microbial factors and the immune responses. Of the four components of IBD pathogenesis, most rapid progress has been made in the genetic study of gut inflammation. The latest internationally collaborative studies have ascertained 163 susceptibility gene loci for IBD. The genes implicated in childhood-onset and adult-onset IBD overlap, suggesting similar genetic predispositions. However, the fact that genetic factors account for only a portion of overall disease variance indicates that microbial and environmental factors may interact with genetic elements in the pathogenesis of IBD. Meanwhile, the adaptive immune response has been classically considered to play a major role in the pathogenesis of IBD, as new studies in immunology and genetics have clarified that the innate immune response maintains the same importance in inducing gut inflammation. Recent progress in understanding IBD pathogenesis sheds lights on relevant disease mechanisms, including the innate and adaptive immunity, and the interactions between genetic factors and microbial and environmental cues. In this review, we provide an update on the major advances that have occurred in above areas.

  6. Prevalence of Apical Periodontitis in Patients with Inflammatory Bowel Diseases: A Retrospective Clinical Study.

    Science.gov (United States)

    Piras, Vanessa; Usai, Paolo; Mezzena, Silvia; Susnik, Marta; Ideo, Francesca; Schirru, Elia; Cotti, Elisabetta

    2017-03-01

    We evaluated the prevalence of apical periodontitis (AP) and the oral health status in patients with inflammatory bowel diseases (IBDs) treated with immunomodulators, with particular attention to biologic medications (BMs). One hundred ten patients, 49 men and 61 women (average age, 46 ± 13.8 years), from the Gastroenterology Unit of the University Hospital with IBDs who were treated with BMs or corticosteroids were included in the study. One hundred ten patients who registered for a dental check-up at the Dental Clinic were matched for age, sex, and physical characteristics with the study group without systemic diseases and not taking medications who were the control. Patients underwent a complete oral, dental, and radiographic examination. Decayed, missing, and filled teeth and periapical index score indexes were recorded. Student t test, χ2, and Mann-Whitney U test were used as appropriate. The prevalence of AP was 64% in IBD patients and 59% in the control; according to the gender-stratified analysis, the difference was not significant among the male groups, whereas the number of teeth with AP was significantly higher in female patients with IBDs than in the controls (P ≤ .05). The prevalence of AP in patients treated with BMs was 65%; women showed 69% higher risk for AP and presented a significantly higher number of teeth with AP (P ≤ .05). Decayed, missing, and filled teeth index was similar in both groups, whereas patients with IBDs had a higher periapical index score than the controls. Women with IBDs and taking immunomodulators had a higher prevalence of AP. All patients with IBDs had larger lesions than healthy subjects. These data emphasize the influence of the status of the immune system in the onset of AP and the need for further studies to confirm these findings. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  7. Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease.

    Directory of Open Access Journals (Sweden)

    Dejan Micic

    Full Text Available Management of inpatients with inflammatory bowel disease (IBD requires increasing resources. We aimed to identify factors associated with hospital readmissions among individuals with IBD.We collected data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database 2013. We identified individuals with index hospitalizations for IBD. Patient-specific factors, comorbidities and hospitalization characteristics were extracted for the index hospitalization. We performed logistic regression modeling to create adjusted odds ratios (ORs for 30-day hospital readmission. Subgroup analysis was performed based on disease type and performance of surgery.We analyzed a total of 55,942 index hospital discharges; 3037 patients (7.0% were readmitted to the hospital within 30 days. Increasing patient age (> 65: OR: 0.45; 95% CI 0.39-0.53 was associated with a decreased risk of readmission, while a diagnosis of Crohn's disease (OR: 1.09; 95% CI 1.00-1.18 and male sex (OR: 1.16; 95% CI 1.07-1.25 were associated with an increased risk of readmission. The comorbidities of smoking (OR: 1.09; 95% CI 1.00-1.19, anxiety (OR: 1.17; 95% CI 1.01-1.36 and opioid dependence (OR: 1.40; 95% CI 1.06-1.86 were associated with an increased risk of 30-day readmission. Individual hospitalization characteristics and disease complications were significantly associated with readmission. Performance of a surgery during the index admission was associated with a decreased risk of readmission (OR: 0.57; 95% CI 0.33-0.96.Analyzing data from a US publicly available all-payer inpatient healthcare database, we identified patient and hospitalization risk factors associated with 30-day readmission. Identifying patients at high risk for readmission may allow for interventions during or after the index hospitalization to decrease this risk.

  8. Hirschsprung disease-Bowel function beyond childhood.

    Science.gov (United States)

    Wester, Tomas; Granström, Anna Löf

    2017-10-01

    Hirschsprung disease is a developmental defect of the enteric nervous system characterized by lack of enteric neurons in the distal hindgut. There are numerous reports on short-term outcomes indicating that impaired bowel function is common. Recently, several controlled studies show that bowel function outcomes are affected beyond childhood, in adolescents and adults, compared with healthy control subjects. Constipation and fecal incontinence are common. The impaired bowel function appears to have a negative impact on quality of life, although, a majority of patients have adapted to their symptoms. On the other hand, Hirschsprung disease seems to have limited impact on education and occupation in adult life. The aim of this review was to summarize current knowledge of bowel function outcome beyond childhood in patients with Hirschsprung disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Female gender and surgery impair relationships, body image, and sexuality in inflammatory bowel disease: patient perceptions.

    Science.gov (United States)

    Muller, Kate R; Prosser, Ruth; Bampton, Peter; Mountifield, Reme; Andrews, Jane M

    2010-04-01

    There is a paucity of literature on the impact of inflammatory bowel disease (IBD) on relationships, body image, and sexual function from a patient perspective. This study sought to describe patients' perceptions of these issues. In all, 347 patients, age 18-50 years, from a hospital-based IBD database were surveyed by post. Quantitative and qualitative data were obtained on demographics, relationships, quality of life (QoL), body image, and sexual function. Comparisons were made by diagnosis, gender, and operative status. Univariate and multivariable analyses and logistic regressions were performed; P body image (females 74.8% versus males 51.4%, P = 0.0007; operated 81.4% versus nonoperated 51.3%, P = 0.0003). A greater proportion of women reported decreased frequency of sexual activity, as did operated subjects (female 66.3% versus male 40.5%, P male 41.9% P = 0.0005; operated 67.4% versus nonoperated 52.6%, P = 0.035). 9.7% omitted medication because of perceived negative effect(s) on sexual function. Logistic regression revealed that female gender negatively affected body image, libido, and sexual activity, while limited resection surgery negatively affected body image (all P < 0.005). A large proportion of patients perceive IBD to negatively affect many aspects of sexuality. Females and operated subjects more frequently perceived these negative effects. These findings are important in overall clinical care of patients with IBD and should be addressed.

  10. Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Amir Rumman

    2017-01-01

    Full Text Available Background. Antitumor necrosis factor (anti-TNF therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD. Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007–2014 in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations. Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days, P=0.002. After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45–0.95. After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19–4.43 and ED visits (IRR 2.42; 95% CI: 1.44–4.08 related to IBD. Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD.

  11. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease.

    Science.gov (United States)

    Jharap, Bindia; de Boer, Nanne K H; Stokkers, Pieter; Hommes, Daniel W; Oldenburg, Bas; Dijkstra, Gerard; van der Woude, C Janneke; de Jong, Dirk J; Mulder, Chris J J; van Elburg, Ruurd M; van Bodegraven, Adriaan A

    2014-03-01

    Several studies have demonstrated a favourable safety profile for thiopurine use for inflammatory bowel disease (IBD) during pregnancy. We performed a study in pregnant patients with IBD who were using thiopurines, in order to determine the influence of pregnancy on thiopurine metabolism and to assess intrauterine exposure of the fetus to thiopurines. Female patients with IBD receiving steady-state thiopurines and planning a pregnancy were prospectively enrolled. 6-Thioguanine nucleotide (6-TGN) and 6-methylmercaptopurine (6-MMP) concentrations were determined, combined with routine laboratory tests, before, during and after pregnancy. Thiopurine metabolites were measured in umbilical cord blood immediately after delivery. Thirty patients who were using azathioprine (28 patients, median dose 1.93 mg/kg) or mercaptopurine (two patients, doses 1.32 and 0.94 mg/kg) were included. During pregnancy, median 6-TGN decreased over time (p=0.001). while 6-MMP increased, without causing myelotoxicity or hepatotoxicity. After delivery, both 6-TGN and 6-MMP levels returned to preconception baseline levels. Fetal 6-TGN concentrations correlated positively with maternal 6-TGN levels (pPregnancy has a major effect on maternal thiopurine metabolism. In utero the unborn child is exposed to 6-TGN, but not to 6-MMP. Sixty per cent of the infants were born with anaemia, which raises the question whether infants should be tested for possible anaemia immediately after birth.

  12. [Inflammatory bowel disease and pregnancy].

    Science.gov (United States)

    Parfenov, A I

    2012-01-01

    Inflammatory bowel disease (IBD) in pregnant women in their characteristics do not differ from general population, unless they had operations on the pelvic organs. Women with a first pregnancy, regardless of the activity of IBD have an increased risk of adverse pregnancy and high risk births. Most treatment methods are compatible with pregnancy and breastfeeding. Women affected by IBD should discuss their plans for pregnancy with the doctor first in order to know the possible dangers. Every patient in the IBD during pregnancy must be observed by a gastroenterologist, accoucheur and pediatrician to ensure peace of mother and child.

  13. Assessing overall patient satisfaction in inflammatory bowel disease using structural equation modeling.

    Science.gov (United States)

    Soares, João-Bruno; Marinho, Ana S; Fernandes, Dália; Moreira Gonçalves, Bruno; Camila-Dias, Cláudia; Gonçalves, Raquel; Magro, Fernando

    2015-08-01

    Structural equation modeling (SEM) is a very popular data-analytic technique for the evaluation of customer satisfaction. We aimed to measure the overall satisfaction of inflammatory bowel disease (IBD) patients with healthcare in Portugal and to define its main determinants using SEM. The study included three steps: (i) specification of a patient satisfaction model that included the following dimensions: Image, Expectations, Facilities, Admission process, Assistant staff, Nursing staff, Medical staff, Treatment, Inpatient care, Outpatient care, Overall quality, Overall satisfaction, and Loyalty; (ii) sample survey from 2000 patients, members of the Portuguese Association of the IBD; and (iii) estimation of the satisfaction model using partial least squares (XLSTAT-PLSPM). We received 498 (25%) valid questionnaires from 324 (66%) patients with Crohn's disease and 162 (33%) patients with ulcerative colitis. Our model provided a substantial explanation for Overall satisfaction (R=0.82). The mean index of overall satisfaction was 74.4 (0-100 scale). The main determinants of Overall satisfaction were the Image (β=0.26), Outpatient care (β=0.23), and Overall quality (β=0.21), whose mean indices were 83, 75, and 81, respectively. Facilities and Inpatient care were the variables with a significant impact on Overall satisfaction and the worst mean indices. SEM is useful for the evaluation of IBD patient satisfaction. The Overall satisfaction of IBD patients with healthcare in Portugal is good, but to increase it, IBD services need to focus on the improvement of Outpatient care, Facilities, and Inpatient care. Our model could be a matrix for a global model of IBD patient satisfaction.

  14. Patients' views on fecal microbiota transplantation: an acceptable therapeutic option in inflammatory bowel disease?

    Science.gov (United States)

    Zeitz, Jonas; Bissig, Marina; Barthel, Christiane; Biedermann, Luc; Scharl, Sylvie; Pohl, Daniel; Frei, Pascal; Vavricka, Stephan R; Fried, Michael; Rogler, Gerhard; Scharl, Michael

    2017-03-01

    Fecal microbiota transplantation (FMT) represents a new therapeutic option that has been studied in two randomized-controlled trials in ulcerative colitis patients. Our study aimed to identify patients' views on the use of this novel therapeutic approach. Using an anonymous questionnaire, we obtained data from 574 inflammatory bowel disease (IBD) patients on their knowledge and willingness to undergo FMT. A large proportion of IBD patients (53.5%) are unaware that FMT is a therapeutic option in Clostridium difficile infection and potentially IBD. More responders preferred FMT (31.5%) to a study with a new medication (28.9%), although the difference was not significant (P=0.37), and the preferred way of transplantation was colonoscopy (49.7%). In all, 38.3% preferred a family member as a donor, but there was fear about the procedure (41.5% mentioned fear of infectious diseases, 26.5% expressed disgust). The knowledge of successful FMT treatment in other patients was important for 82.2% of responders and for 50.7%, a discussion with a specialist would likely change their opinion about FMT. FMT represents a therapeutic procedure that is of interest for IBD patients. As FMT has been receiving increasing interest as an alternative treatment in IBD and more studies on FMT in IBD are being carried out, it is important to learn about the knowledge, attitude, and preferences of patients to provide better education to patients on this topic. However, there are reservations because of the fact that data on the benefits of FMT in IBD are controversial and several limitations exist on the use of FMT in IBD.

  15. The education and employment status of patients with inflammatory bowel diseases.

    Science.gov (United States)

    Marri, Sheetal R; Buchman, Alan L

    2005-02-01

    Inflammatory bowel disease (IBD) has the propensity to affect patients who are in their late teens and early 20s, an age when most people decide on their educational and career directions. This review describes the effects that IBD has on the continuum of education and employment. Patients with Crohn's disease and ulcerative colitis attain a similar level of education as that of the general population. The quality of life of such patients in school, as measured by both patients' and teachers' perceptions, indicates that, despite the difficulties that students face in terms of missed school time and physical inconveniences, teachers are generally perceived by students to have favorable attitudes toward helping them. Even though earlier work in the area of employment has suggested that the occurrence of IBD is clustered among people in white-collar positions, recent data have suggested that certain environmental risks for IBD (i.e., sedentary or indoor jobs) may be associated with jobs classified as being white-collar, and therefore having a white-collar job may in itself not be a risk factor for the development of IBD. Patients with IBD have a higher rate of nonparticipation in the labor force, and the participation rate seems to maintain steady levels over time. A majority of patients with IBD continue in the same employment positions over a period of years. Patients with IBD, especially those who have undergone surgery, took more sick leave than their counterparts without IBD. A majority of patients with IBD favored the disclosure of their diagnosis to their employers and perceived little discrimination in the workplace. Furthermore, most employers were perceived by their employees with IBD as having fair attitudes toward the compensation provided for their employees with IBD.

  16. INFLAMMATORY BOWEL DISEASE: OUTPATIENT TREATMENT PROFILE

    Directory of Open Access Journals (Sweden)

    Rachael Miranda dos SANTOS

    2017-03-01

    Full Text Available ABSTRACT BACKGROUND Crohn’s disease and ulcerative colitis are the two major forms of inflammatory bowel disease. The incidence and prevalence of both conditions have increased and are progressively increasing. These diseases are frequently recurrent and clinically highly severe. In Brazil, the lack of epidemiological data related to such diseases has left these patients in a vulnerable state and contributed to increased morbidity. OBJECTIVE To describe the profiles of patients with inflammatory bowel disease treated in an outpatient service in Brazil. METHODS This descriptive, exploratory, and retrospective documentary study with a quantitative approach was performed in an outpatient treatment service for inflammatory bowel disease, at a university polyclinic located in Rio de Janeiro, Brazil, from May to July 2016. The study included 556 patients and was approved by the research ethics committee of the institution (CAAE no. 55179316.6.0000.5259/2016. RESULTS The data showed a high prevalence of inflammatory bowel disease in white female patients. Crohn’s disease was diagnosed in more patients than was ulcerative colitis; the ileocolon was the most commonly affected location in patients with Crohn’s disease. The stenotic phenotype was prevalent in patients with Crohn’s disease. CONCLUSION The prevalence of the stenotic phenotype in Crohn’s disease in relation to others demonstrates the need for further investigations in this field of study in Brazil. In conclusion, the data showed that the epidemiologic profile of the study population is similar to that published in the national and international literature.

  17. Tc-99m labeled leukocyte scintigraphy and CT for the evaluation of patients with inflammatory bowel disease

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    Miyazaki, Chihoko; Kubo, Kohzoh; Aoyama, Hidefumi; Endoh, Hideho; Odashima, Yae; Saitoh, Eri [Sapporo City General Hospital (Japan)

    1997-06-01

    Seventeen cases of inflammatory bowel disease (IBD) were studied to define the intensity and extent of disease by {sup 99m}Tc-HMPAO-labeled leukocytes scintigraphy (TLLS), and 10 cases underwent CT examination to evaluate the bowel wall, lymph-nodes, and mesenteric surroundings. Serial TLLS were obtained up to 4 hours and CT was carried out within one week before or after TLLS. The sensitivities to early and delayed TLLS were 91% and 100%, respectively. The respective specificities were 100% and 33%. However, it appeared that mild IBD may yield false negative results in early TLLS while nonspecific bowel activity and migration of white cells may cause false positive results in delayed imaging. By setting the diagnostic criteria for labeled leukocyte accumulation on visualization of the small bowel regardless of uptake or activity of the large bowel similar to or greater than lumbar bone marrow, the sensitivity and specificity of delayed TLLS changed to 91% and 83%, respectively. On CT examination, mesenteric lymph-node swelling, periintestinal blurring and dilatation of mesenteric vasa recta were observed in all five patients with active Crohn`s disease, while wall thickening and enhancement were seen in four of them. None of the other three cases of inflammatory disease showed positive findings of dilatation of the mesenteric vasa recta, and they revealed relatively low uptake of labeled leukocytes in TLLS. A `scintigram score` was calculated by comparing uptake of tracer in five bowel segments with lumbar bone marrow activity, and a `CT score` was calculated by adding abnormalities of the intestine and mesenteric surroundings. The scintigram score correlated closely with CT score and clinical disease activity. (K.H.)

  18. Thalidomide for inflammatory bowel disease

    Science.gov (United States)

    Bramuzzo, Matteo; Ventura, Alessandro; Martelossi, Stefano; Lazzerini, Marzia

    2016-01-01

    Abstract Background: Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases. Methods: CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events. Results: The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3%) patients. Clinical remission was achieved in 220/427 (51.5%) cases. Maintenance of remission was reported in 128/160 (80.0%) patients at 6 months and in 96/133 (72.2%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7%) patients. Fistulas improved in 49/81 (60.5%) cases and closed in 28/81 (34.6%). Endoscopic improvement was observed in 46/66 (69.7%) and complete mucosal healing in 35/66 (53.0%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3%) adverse events and were the most frequent cause of drug withdrawal. Conclusion: Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments. PMID:27472695

  19. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe

    DEFF Research Database (Denmark)

    Burisch, J; Pedersen, Natalia; Cukovic-Cavka, S

    2014-01-01

    BACKGROUND AND AIMS: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior ...

  20. Is safety infliximab during pregnancy in patients with inflammatory bowel disease?

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    Federico Argüelles-Arias

    Full Text Available Background: in most cases, inflammatory bowel disease (IBD debuts at reproductive age. The data available in the literature show infliximab (IFX to be a safe drug during pregnancy but there is very little evidence about the activity of the disease following drug withdrawal during pregnancy. Aims: determine the drug´s safety in pregnant women in our setting and assess its effect on the foetus, drawing on the experience of several hospitals. Secondly, observe the effect of treatment withdrawal on disease activity during pregnancy. Material and methods: a retrospective study was conducted of women with IBD who had received IFX treatment during pregnancy in five hospitals in Spain. Disease activity was assessed using Crohn´s Disease Activity Index, while UC was assessed using the Truelove-Witts Index in each trimester of pregnancy. Gestational age, weight and diseases in the foetus were determined at birth. Results: the study included 12 women with a mean age of 29 years; 4 had ulcerative colitis and 8 Crohn´s disease, with mean disease duration of 7 years. All but one, who was diagnosed during pregnancy, was receiving IFX treatment at conception. Six patients received uninterrupted treatment throughout the pregnancy, 2 requested voluntary interruption and in 3 cases treatment was interrupted in the third trimester as a precaution. They received a mean IFX dose of 400 mg every 8 weeks. Of the 6 patients who received continuous treatment, in 50% disease was held in remission. The 6 remaining patients suspended treatment for different reasons, presenting disease recurrence in all but one case (83.3%. Eight deliveries were vaginal and 4 by caesarean section. Newborns presented no congenital anomalies, intrauterine growth retardation or low birth weight and there was only one premature delivery. Conclusions: although cases included in the stduy are not significant, in our experience, IFX during pregnancy is a safe treatment for the mother and the

  1. Is safety infliximb during pregnancy in patients with inflammatory bowel disease?

    Science.gov (United States)

    Argüelles-Arias, Federico; Castro-Laria, Luisa; Barreiro-de Acosta, Manuel; García-Sánchez, Ma Valle; Guerrero-Jiménez, Pedro; Gómez-García, Ma Rosa; Cordero-Ruiz, Patricia; Iglesias-Flores, Eva; Gómez-Camacho, Federico; Domínguez-Muñoz, Enrique J; Herrerías-Gutiérrez, Juan Manuel

    2012-02-01

    in most cases, inflammatory bowel disease (IBD) debuts at reproductive age. The data available in the literature show infliximab (IFX) to be a safe drug during pregnancy but there is very little evidence about the activity of the disease following drug withdrawal during pregnancy. determine the drug's safety in pregnant women in our setting and assess its effect on the foetus, drawing on the experience of several hospitals. Secondly, observe the effect of treatment withdrawal on disease activity during pregnancy. a retrospective study was conducted of women with IBD who had received IFX treatment during pregnancy in five hospitals in Spain. Disease activity was assessed using Crohn's Disease Activity Index, while UC was assessed using the Truelove-Witts Index in each trimester of pregnancy. Gestational age, weight and diseases in the foetus were determined at birth. the study included 12 women with a mean age of 29 years; 4 had ulcerative colitis and 8 Crohn's disease, with mean disease duration of 7 years. All but one, who was diagnosed during pregnancy, was receiving IFX treatment at conception. Six patients received uninterrupted treatment throughout the pregnancy, 2 requested voluntary interruption and in 3 cases treatment was interrupted in the third trimester as a precaution. They received a mean IFX dose of 400 mg every 8 weeks. Of the 6 patients who received continuous treatment, in 50% disease was held in remission. The 6 remaining patients suspended treatment for different reasons, presenting disease recurrence in all but one case (83.3%). Eight deliveries were vaginal and 4 by caesarean section. Newborns presented no congenital anomalies, intrauterine growth retardation or low birth weight and there was only one premature delivery. although cases included in the study are not significant, in our experience, IFX during pregnancy is a safe treatment for the mother and the foetus. In fact, in our study and in some cases, its withdrawal may lead to a

  2. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis.

    Science.gov (United States)

    Weismüller, Tobias J; Trivedi, Palak J; Bergquist, Annika; Imam, Mohamad; Lenzen, Henrike; Ponsioen, Cyriel Y; Holm, Kristian; Gotthardt, Daniel; Färkkilä, Martti A; Marschall, Hanns-Ulrich; Thorburn, Douglas; Weersma, Rinse K; Fevery, Johan; Mueller, Tobias; Chazouillères, Olivier; Schulze, Kornelius; Lazaridis, Konstantinos N; Almer, Sven; Pereira, Stephen P; Levy, Cynthia; Mason, Andrew; Naess, Sigrid; Bowlus, Christopher L; Floreani, Annarosa; Halilbasic, Emina; Yimam, Kidist K; Milkiewicz, Piotr; Beuers, Ulrich; Huynh, Dep K; Pares, Albert; Manser, Christine N; Dalekos, George N; Eksteen, Bertus; Invernizzi, Pietro; Berg, Christoph P; Kirchner, Gabi I; Sarrazin, Christoph; Zimmer, Vincent; Fabris, Luca; Braun, Felix; Marzioni, Marco; Juran, Brian D; Said, Karouk; Rupp, Christian; Jokelainen, Kalle; Benito de Valle, Maria; Saffioti, Francesca; Cheung, Angela; Trauner, Michael; Schramm, Christoph; Chapman, Roger W; Karlsen, Tom H; Schrumpf, Erik; Strassburg, Christian P; Manns, Michael P; Lindor, Keith D; Hirschfield, Gideon M; Hansen, Bettina E; Boberg, Kirsten M

    2017-06-01

    Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. We performed a retrospective outcome analysis of patients diagnosed with PSC from 1980 through 2010 at 37 centers in Europe, North America, and Australia. For each patient, we collected data on sex, clinician-reported age at and date of PSC and IBD diagnoses, phenotypes of IBD and PSC, and date and indication of IBD-related surgeries. The primary and secondary endpoints were liver transplantation or death (LTD) and hepatopancreatobiliary malignancy, respectively. Cox proportional hazards models were applied to determine the effects of individual covariates on rates of clinical events, with time-to-event analysis ascertained through Kaplan-Meier estimates. Of the 7121 patients in the cohort, 2616 met the primary endpoint (median time to event of 14.5 years) and 721 developed hepatopancreatobiliary malignancy. The most common malignancy was cholangiocarcinoma (n = 594); patients of advanced age at diagnosis had an increased incidence compared with younger patients (incidence rate: 1.2 per 100 patient-years for patients younger than 20 years old, 6.0 per 100 patient-years for patients 21-30 years old, 9.0 per 100 patient-years for patients 31-40 years old, 14.0 per 100 patient-years for patients 41-50 years old, 15.2 per 100 patient-years for patients 51-60 years old, and 21.0 per 100 patient-years for patients older than 60 years). Of all patients with PSC studied, 65.5% were men, 89.8% had classical or large-duct disease, and 70.0% developed IBD at some point. Assessing the development of IBD as a time-dependent covariate, Crohn's disease and no IBD (both vs ulcerative colitis) were associated with a lower risk of LTD (unadjusted hazard ratio [HR], 0.62; P primary endpoint, small-duct PSC

  3. Safety of anti-tumor necrosis factor therapy during pregnancy in patients with inflammatory bowel disease.

    Science.gov (United States)

    Androulakis, Ioannis; Zavos, Christos; Christopoulos, Panagiotis; Mastorakos, George; Gazouli, Maria

    2015-12-21

    Treatment of inflammatory bowel disease has significantly improved since the introduction of biological agents, such as infliximab, adalimumab, certolizumab pegol, and golimumab. The Food and Drug Administration has classified these factors in category B, which means that they do not demonstrate a fetal risk. However, during pregnancy fetuses are exposed to high anti-tumor necrosis factor (TNF) levels that are measurable in their plasma after birth. Since antibodies can transfer through the placenta at the end of the second and during the third trimesters, it is important to know the safety profile of these drugs, particularly for the fetus, and whether maintaining relapse of the disease compensates for the potential risks of fetal exposure. The limited data available for the anti-TNF drugs to date have not demonstrated any significant adverse outcomes in the pregnant women who continued their therapy from conception to the first trimester of gestation. However, data suggest that anti-TNFs should be discontinued during the third trimester, as they may affect the immunological system of the newborn baby. Each decision should be individualized, based on the distinct characteristics of the patient and her disease. Considering all the above, there is a need for more clinical studies regarding the effect of anti-TNF therapeutic agents on pregnancy outcomes.

  4. A Survey of Social Media Use and Preferences in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Reich, Jason; Guo, Ling; Hall, Julia; Tran, Ashley; Weinberg, Janice; Groshek, Jacob; Rowell, Tanya E; DiPalma, Jack A; Farraye, Francis A

    2016-11-01

    With the recent increase in the use of social media, patients with chronic illnesses are using the Internet as a resource for disease management. As the peak incidence of inflammatory bowel disease (IBD) occurs in patients between the ages of 15 and 30, IBD is a suitable condition to study social media use. The aim of this study was to assess social media usage and preferences in patients with IBD. We administered a survey to 118 patients with IBD at our outpatient practice at the Boston Medical Center (BMC), Center for Digestive Disorders, and the University of Southern Alabama (USA) between November 1, 2015, and March 9, 2016. The most frequently used IBD-specific social media website was the CCFA (86%). High-frequency social media users were more likely to agree that "social media is useful for managing my IBD," compared with low-frequency social media users (OR 3.23, 0.3-10.1, P = 0.199). Fifty-five percent of respondents were interested in obtaining patient-with-IBD education through social media, or organizations such as the CCFA, whereas 45% did not express interest. Sixty-two percent of patients would be interested in following a social media account established by their gastroenterologist. Privacy and/or confidentiality issues were the primary barriers to social media use. Last, most patients were unsure of the quality of IBD information posted online. The results of this study suggest that patients who frequently use social media are highly interested in using social media in the management of their IBD. Most patients with IBD in our study were interested in receiving IBD information from their gastroenterologist and other patient-related organizations through social media. Most patients are unsure of the quality of IBD information posted on social media. Gastroenterologists should be aware that their patients may use social media to obtain disease education. Future studies should assess the quality of IBD information on social media and the effectiveness

  5. Dominant Fecal Microbiota in Newly Diagnosed Untreated Inflammatory Bowel Disease Patients

    Directory of Open Access Journals (Sweden)

    Lill Therese Thorkildsen

    2013-01-01

    Full Text Available Our knowledge about the microbiota associated with the onset of IBD is limited. The aim of our study was to investigate the correlation between IBD and the fecal microbiota for early diagnosed untreated patients. The fecal samples used were a part of the Inflammatory Bowel South-Eastern Norway II (IBSEN II study and were collected from CD patients (n=30, UC patients (n=33, unclassified IBD (IBDU patients (n=3, and from a control group (n=34. The bacteria associated with the fecal samples were analyzed using a direct 16S rRNA gene-sequencing approach combined with a multivariate curve resolution (MCR analysis. In addition, a 16S rRNA gene clone library was prepared for the construction of bacteria-specific gene-targeted single nucleotide primer extension (SNuPE probes. The MCR analysis resulted in the recovery of five pure components of the dominant bacteria present: Escherichia/Shigella, Faecalibacterium, Bacteroides, and two components of unclassified Clostridiales. Escherichia/Shigella was found to be significantly increased in CD patients compared to control subjects, and Faecalibacterium was found to be significantly reduced in CD patients compared to both UC patients and control subjects. Furthermore, a SNuPE probe specific for Escherichia/Shigella showed a significant overrepresentation of Escherichia/Shigella in CD patients compared to control subjects. In conclusion, samples from CD patients exhibited an increase in Escherichia/Shigella and a decrease in Faecalibacterium indicating that the onset of the disease is associated with an increase in proinflammatory and a decrease in anti-inflammatory bacteria.

  6. Insurance Rating of Patients with Inflammatory Bowel Disease: Report of a Conference on Morbidity and Mortality

    Directory of Open Access Journals (Sweden)

    Ivan T Beck

    1994-01-01

    Full Text Available Patient members reported to the Crohn’s and Colitis Foundation of Canada (CCFC about their difficulties to obtain insurance. In 1991, the Lay Board of the CCFC requested its Medical Advisory Board (MAB to investigate this problem. At that time, insurance ratings could be illustrated by the 1985 edition of Brackenridge’s monograph on life risks. The MAB found that data on mortality were outdated. A conference on morbidity and mortality of inflammatory bowel disease (IBD was organized by the authors and held in May 1992. Based on questionnaires to patients, evidence provided by invited speakers and the results of small group conferences, it was concluded that patients with IBD have difficulties in obtaining insurance, even though the quality of life and mortality of IBD patients is not very different from that of the general population. However, the mortality rate of the healthy insured population is lower than that of the general population, and thus much lower than that of IBD patients. Patients have a better chance to obtain insurance if there is a close cooperation between the treating physician and the medical officer of the insurance company. Changes have occurred since the conference held in May 1992. The recent edition of Brackenridge’s text (1992 provides a better prognosis but unfortunately unchanged rating for patients with IBD than did the 1985 edition. Close cooperation between the Patient Advisory Committee of the CCFC and the Executives of the Canadian Life Insurance Medical Officers Association may further improve the insurance rating of patients with IBD.

  7. Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease.

    Science.gov (United States)

    Kelsen, Judith R; Kim, Jason; Latta, Dan; Smathers, Sarah; McGowan, Karin L; Zaoutis, Theodore; Mamula, Petar; Baldassano, Robert N

    2011-01-01

    The incidence and associated morbidity of Clostridium difficile (CD) infection has been increasing at an alarming rate in North America. Clostridium difficile-associated diarrhea (CDAD) is the leading cause of nosocomial diarrhea in the USA. Patients with CDAD have longer average hospital admissions and additional hospital costs. Evidence has demonstrated that patients with inflammatory bowel disease (IBD) have a higher incidence of CD in comparison to the general population. The aim of this study was to compare the rate of recurrence of CD in hospitalized pediatric patients with IBD compared to hospitalized controls. The secondary aim was to evaluate whether infection with CD resulted in a more severe disease course of IBD. This was a nested case control retrospective study of hospitalized pediatric patients. Diagnosis of CD was confirmed with stool Toxin A and B analysis. The following data were obtained from the medical records: demographic information, classification of IBD including location of disease, IBD therapy, and prior surgeries. In addition, prior hospital admissions within 1 year and antibiotic exposure were recorded. The same information was recorded following CD infection. Cases were patients with IBD and CD; two control populations were also studied: patients with CD but without IBD, and patients with IBD but without CD. For aim 1, a total of 111 eligible patients with IBD and CD infection and 77 eligible control patients with CD infection were included. The rate of recurrence of CD in the IBD population was 34% compared to 7.5% in the control population (P < 0.0001). In evaluating the effect of CD infection on IBD disease severity, we compared the 111 IBD patients with CD to a second control population of 127 IBD patients without CD. 57% of IBD-CD patients were readmitted with an exacerbation of disease within 6 months of infection with CD and 67% required escalation of therapy following CD infection, compared to 30% of IBD patients without CD (P

  8. Self-management in patients with inflammatory bowel disease: strategies, outcomes, and integration into clinical care

    Directory of Open Access Journals (Sweden)

    Plevinsky JM

    2016-08-01

    Full Text Available Jill M Plevinsky,1 Rachel N Greenley,1 Laurie N Fishman2 1Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 2Department of Gastroenterology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA Abstract: Self-management, including medication adherence, is associated with improved health and outcomes for patients with inflammatory bowel disease. The concept of self-management is complex, but can be divided into those aspects that involve the individual patient, those that involve the provider–patient relationship, and those that encompass the social environment. At the individual level, enhancing problem-solving skills and self-efficacy have both been shown to improve self-management tasks, particularly adherence to treatment. However, it is critical to consider these domains from a lifespan perspective because these processes by which self-management can be improved are distinct for children, adolescents, young adults, and adults. A particular emphasis is placed on strategies to improve self-management of older adolescents and young adults as they transition from pediatric to adult providers. The review concludes with recommendations for providers, including rationale and techniques for assessing and promoting patient self-efficacy, encouraging the development of problem-solving skills, improving the patient–provider relationship, and enhancing social support. Providers are encouraged to utilize elements of problem-solving skills training, engage in collaborative relationships with their patients, and offer their patients recommendations for how to increase the quality of their social support networks as ways of increasing overall self-management. Keywords: adherence, self-efficacy, communication, social support, Crohn’s disease, ulcerative colitis

  9. Pregnancy and Inflammatory Bowel Disease.

    Science.gov (United States)

    Hashash, Jana G; Kane, Sunanda

    2015-02-01

    Many patients with inflammatory bowel disease (IBD), whether Crohn's disease or ulcerative colitis, are of reproductive age. Young women with IBD are usually very worried about their fertility, the activity of their disease during pregnancy, the heritability of the disease to their unborn child, and the effect of their underlying IBD on the pregnancy itself. Additionally, patients express concerns about using IBD medications during pregnancy, fearing that the medications may negatively affect the fetus. For this reason, it is of the utmost importance that gastroenterologists and patients with IBD be aware of the effect of IBD on pregnancy, the effect of pregnancy on IBD, and the effect of IBD medications on the fetus and on pregnancy outcomes. Increasing the awareness of patients with IBD about the importance of maintaining disease remission at the time of conception and throughout pregnancy is key to improving the outcomes of both mothers and fetuses. This article addresses the fertility of patients with IBD, the effect of pregnancy on disease activity, and the effect of IBD on pregnancy. Also discussed are which IBD medications can be used during conception and pregnancy and which medications must be avoided.

  10. Measuring Severity of Anxiety and Depression in Patients with Inflammatory Bowel Disease: Low Concordance Between Patients and Male Gastroenterologists.

    Science.gov (United States)

    Janmohamed, Neha; Steinhart, A Hillary

    2017-07-01

    Studies have indicated that anxiety and depression are significant contributors to reporting of increased disease activity in patients with inflammatory bowel disease (IBD). Thus, for the appropriate clinical management of these patients, it is important that gastroenterologists are able to recognize these conditions. This study aimed to examine the level of agreement between gastroenterologists and patients with IBD for the presence of clinically significant anxiety and depression. Before consultation, patients completed the Hospital Anxiety and Depression Survey. After the consultation, the gastroenterologist recorded whether they believed the patient was anxious and depressed and if so, whether any further action had been taken. Seventy-five patients participated in this study, with a response rate of 88%. Self-reported questionnaires indicated that 31% and 11% of patients were identified as probable for having anxiety and depression, respectively. The level of agreement between the patient and gastroenterologist as to the presence of anxiety or depression was fair to moderate (kappa statistic 0.32 and 0.41, respectively). In only 50% of cases was further action taken by gastroenterologists during consultation for distressed patients, mostly in the form of a patient discussion. Agreement between gastroenterologists and IBD patients regarding the presence of clinically significant anxiety or depression was low, with no further action taken after consultation for 50% of patients who were identified by gastroenterologists as being anxious or depressed. This study highlights the need for educating gastroenterologists to improve their ability to identify IBD patient distress.

  11. Oxidative Stress Markers in Intestinal Mucosa of Tunisian Inflammatory Bowel Disease Patients

    OpenAIRE

    Bouzid, Dorra; Gargouri, Bochra; Mansour, Riadh Ben; Amouri, Ali; Tahri, Nabil; Lassoued, Saloua; Masmoudi, Hatem

    2013-01-01

    Background / Aims: Inflammatory bowel diseases (IBDs), Crohn′s disease (CrD) and ulcerative colitis (UC), are chronic gastrointestinal inflammatory disorders. The precise etiology of IBD remains unclear, and it is thought that interactions among various factors, including, genetic factors, the host immune system and environmental factors, cause disruption of intestinal homeostasis, leading to dysregulated inflammatory responses of the gut. As inflammation is intimately related to formation of...

  12. Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up

    NARCIS (Netherlands)

    Lam, T.J.; van Bodegraven, A.A.; Felt-Bersma, R.J.F.

    2014-01-01

    Aim: The aim of this study is to describe the long-term course of anorectal complains and function in a single centre cohort patients suffering from inflammatory bowel disease (IBD) with perianal lesions. Methods: Between 1993 and 2000, 56 IBD patients (43 Crohn's disease and 13 ulcerative colitis)

  13. How do patients with inflammatory bowel disease want their biological therapy administered?

    LENUS (Irish Health Repository)

    Allen, Patrick B

    2010-01-01

    BACKGROUND: Infliximab is usually administered by two monthly intravenous (iv) infusions, therefore requiring visits to hospital. Adalimumab is administered by self subcutaneous (sc) injections every other week. Both of these anti-TNF drugs appear to be equally efficacious in the treatment of Crohn\\'s Disease and therefore the decision regarding which drug to choose will depend to some extent on patient choice, which may be based on the mode of administration.The aims of this study were to compare preferences in Inflammatory Bowel Disease (IBD) patients for two currently available anti-TNF agents and the reasons for their choices. METHODS: An anonymous questionnaire was distributed to IBD patients who had attended the Gastroenterology service (Ulster Hospital, Dundonald, Belfast, N. Ireland. UK) between January 2007 and December 2007. The patients were asked in a hypothetical situation if the following administering methods of anti-TNF drugs (intravenous or subcutaneous) were available, which drug route of administration would they choose. RESULTS: One hundred and twenty-five patients fulfilled the inclusion criteria and were issued questionnaires, of these 78 questionnaires were returned (62 percent response). The mean age of respondent was 44 years. Of the total number of respondents, 33 patients (42 percent) preferred infliximab and 19 patients (24 percent) preferred adalimumab (p = 0.07). Twenty-six patients (33 percent) did not indicate a preference for either biological therapy and were not included in the final analysis. The commonest reason cited for those who chose infliximab (iv) was: "I do not like the idea of self-injecting," (67 percent). For those patients who preferred adalimumab (sc) the commonest reason cited was: "I prefer the convenience of injecting at home," (79 percent). Of those patients who had previously been treated with an anti-TNF therapy (n = 10, all infliximab) six patients stated that they would prefer infliximab if given the choice

  14. What is the best way to manage screening for infections and vaccination of inflammatory bowel disease patients?

    Science.gov (United States)

    Andrisani, Gianluca; Armuzzi, Alessandro; Marzo, Manuela; Felice, Carla; Pugliese, Daniela; Papa, Alfredo; Guidi, Luisa

    2016-08-06

    The use of biological agents and immunomodulators for inflammatory bowel disease (IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination in those patients with IBD, which are candidate for biologic therapy. Available strategies to screen, diagnose and prevent bacterial and viral infections in patients with IBD prior to start biological therapy are discussed in this review.

  15. Physicians Should Provide Shared Decision-Making for Anti-TNF Therapy to Inflammatory Bowel Disease Patients

    OpenAIRE

    Cha, Jae Myung; Park, Dong Il; Park, Sang Hyoung; Shin, Jeong Eun; Kim, Wan Soo; Yang, Suk-Kyun

    2016-01-01

    Shared decision-making may increase the effectiveness of inflammatory bowel disease (IBD) treatment, as different anti-tumor necrosis factor (anti-TNF) administrations may have different effects on the quality of life (QOL). Patient preference is integral to the selection of anti-TNFs and their routes of administration, however, previous studies on the patient preference to anti-TNFs are inconsistent and limited. We evaluated the predictive factors for preferences to anti-TNF administrations ...

  16. Effectiveness of anti-tumour necrosis factor-α therapy in Danish patients with inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bank, Steffen; Andersen, Paal Skytt; Burisch, Johan

    2015-01-01

    personal identification number of Danish citizens (the CPR number) from blood samples with data from the National Patient Registry, patients with International Classification of Diseases, Version 10 (ICD-10) codes K50-K63 were identified. Treatment efficacy reflected the maximum response within 22 weeks......INTRODUCTION: The objective of this study was to evaluate the outcome of anti-tumour necrosis factor-α (anti-TNF) treatment in a large cohort of patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) in clinical practice and to establish a cohort...

  17. Mortality and Extraintestinal cancers in patients with Primary sclerosing cholangitis and inflammatory bowel disease

    Science.gov (United States)

    Ananthakrishnan, Ashwin N.; Cagan, Andrew; Gainer, Vivian S.; Cheng, Su-Chun; Cai, Tianxi; Szolovits, Peter; Shaw, Stanley Y; Churchill, Susanne; Karlson, Elizabeth W.; Murphy, Shawn N.; Kohane, Isaac; Liao, Katherine P.

    2014-01-01

    Introduction: Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) frequently co-occur. PSC is associated with increased risk for colorectal cancer (CRC). However, whether PSC is associated with increased risk of extraintestinal cancers or affects mortality in an IBD cohort has not been examined previously. Methods: In a multi-institutional IBD cohort of IBD, we established a diagnosis of PSC using a novel algorithm incorporating narrative and codified data with high positive and negative predictive value. Our primary outcome was occurrence of extraintestinal and digestive tract cancers. Mortality was determined through monthly linkage to the social security master death index. Results: In our cohort of 5,506 patients with CD and 5,522 patients with UC, a diagnosis of PSC was established in 224 patients (2%). Patients with IBD-PSC were younger and more likely to be male compared to IBD patients without PSC; three-quarters had UC. IBD-PSC patients had significantly increased overall risk of cancers compared to patients without PSC (OR 4.36, 95% CI 2.99 – 6.37). Analysis of specific cancer types revealed that a statistically significant excess risk for digestive tract cancer (OR 10.40, 95% CI 6.86 – 15.76), pancreatic cancer (OR 11.22, 95% CI 4.11 – 30.62), colorectal cancer (OR 5.00, 95% CI 2.80 – 8.95), and cholangiocarcinoma (OR 55.31, 95% CI 22.20 – 137.80) but not for other solid organ or hematologic malignancies. Conclusions: PSC is associated with increased risk of colorectal and pancreatobiliary cancer but not with excess risk of other solid organ cancers. PMID:24559536

  18. Evolution after switching to biosimilar infliximab in inflammatory bowel disease patients in clinical remission.

    Science.gov (United States)

    Guerrero Puente, Lourdes; Iglesias Flores, Eva; Benítez, José Manuel; Medina Medina, Rosario; Salgueiro Rodríguez, Isabel; Aguilar Melero, Patricia; Cárdenas Aranzana, Manuel Jesús; González Fernández, Rafael; Manzanares Martin, Bárbara; García-Sánchez, Valle

    2017-11-01

    The biosimilar of infliximab (CT-P13) has been approved for the same indications held by the infliximab reference product (Remicade®); however, there are few clinical data on switching in inflammatory bowel disease (IBD). The aim of this study was to assess the efficacy, safety, bioavailability profile and factors associated with relapse after switching to biosimilar infliximab in IBD patients in clinical remission. Observational study with IBD patients treated with Remicade® for at least 6 months and in clinical remission for at least 3 months who switched to infliximab biosimilar. The incidence of relapse, adverse effects and possible changes in drug bioavailability (trough level and antidrug antibodies) were evaluated. Thirty six patients were included (63.9% CD) with a mean follow-up of 8.4 months (SD±3.5). The 13.9% had clinical relapse. The longer clinical remission time before switching (HR=0.54, 95% CI=0.29-0.98, P=.04) and detectable infliximab levels at the time of switching (HR=0.03, 95% CI=0.001-0.89, P=.04) were associated with a lower risk of relapse. No differences were found between infliximab levels at the time of switching and at weeks 8 and 16 (P=.94); 8.3% of the patients had some adverse event, requiring the suspension of biosimilar in one patient for severe pneumonia. Switching to biosimilar infliximab in a real-life cohort of IBD patients in clinical remission did not have a significant impact on short-term clinical outcomes. The factors associated with relapse were similar to those expected in patients continuing with Remicade®. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  19. Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA.

    Science.gov (United States)

    Gurvits, Grigoriy E; Lan, Gloria; Tan, Amy; Weissman, Arlene

    2017-06-01

    Increasing prevalence of inflammatory bowel disease (IBD) poses significant challenges to medical community. Preventive medicine, including vaccination against opportunistic infections, is important in decreasing morbidity and mortality in patients with IBD. We conduct first study to evaluate general awareness and adherence to immunisation guidelines by primary care physicians in the USA. We administered an electronic questionnaire to the research panel of the American College of Physicians (ACP) assessing current vaccination practices, barriers to vaccination and provider responsibility for administering vaccinations and compared responses with the European Crohn's and Colitis Organization consensus guidelines and expert opinion from the USA. All of surveyed physicians (276) had experience with patients with IBD and spent majority of their time in direct patient care. 49% of physicians took immunisation history frequently or always, and 76% reported never or rarely checking immunisation antibody titres with only 2% doing so routinely. 65% of physicians believed that primary care providers (PCPs) were responsible for determining patient's immunisation. Vaccine administration was felt to be the duty of primary care doctor 80% of the time. 2.5% of physicians correctly recommended vaccinations all the time. Physicians were more likely to recommend vaccination to immunocompetent than immunocompromised patients. Up to 23% of physicians would incorrectly recommend live vaccine to immunocompromised patients with IBD. Current knowledge and degree of comfort among PCPs in the USA in preventing opportunistic infections in IBD population remain low. Management of patients with IBD requires structured approach to their healthcare maintenance in everyday practice, including enhanced educational policy aimed at primary care physicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME Study.

    Science.gov (United States)

    Coelho, Jessica; Beaugerie, Laurent; Colombel, Jean Frédéric; Hébuterne, Xavier; Lerebours, Eric; Lémann, Marc; Baumer, Philippe; Cosnes, Jacques; Bourreille, Arnaud; Gendre, Jean Pierre; Seksik, Philippe; Blain, Antoine; Metman, Etienne H; Nisard, Andrée; Cadiot, Guillaume; Veyrac, Michel; Coffin, Benoît; Dray, Xavier; Carrat, Fabrice; Marteau, Philippe

    2011-02-01

    Few studies have been conducted addressing the safety of thiopurine treatment in pregnant women with inflammatory bowel disease (IBD). The aim of this study was to evaluate the pregnancy outcome of women with IBD who have been exposed to thiopurines. 215 pregnancies in 204 women were registered and documented in the CESAME cohort between May 2004 and October 2007. Physicians documented the following information from the women: last menstrual date, delivery term, details of pregnancy outcome, prematurity, birth weight and height, congenital abnormalities, medication history during each trimester, smoking history and alcohol ingestion. Data were compared between three groups: women exposed to thiopurines (group A), women receiving a drug other than thiopurines (group B) and women not receiving any medication (group C). Mean age at pregnancy was 28.3 years. 75.7% of the women had Crohn's disease and 21.8% had ulcerative colitis, with a mean disease duration of 6.8 years at inclusion. Of the 215 pregnancies, there were 138 births (142 newborns), and the mean birth weight was 3135 g. There were 86 pregnancies in group A, 84 in group B and 45 in group C. Interrupted pregnancies occurred in 36% of patients enrolled in group A, 33% of patients enrolled in group B, and 40% of patients enrolled in group C; congenital abnormalities arose in 3.6% of group A cases and 7.1% of group B cases. No significant differences were found between the three groups in overall pregnancy outcome. The results obtained from this cohort indicate that thiopurine use during pregnancy is not associated with increased risks, including congenital abnormalities.

  1. Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications.

    Science.gov (United States)

    McConnell, Ryan A; Mahadevan, Uma

    2016-06-01

    For many women with inflammatory bowel disease (IBD), the illness coincides with their childbearing years. IBD increases the risk of pregnancy complications and adverse pregnancy outcomes. The multidisciplinary care team should emphasize the importance of medication adherence to achieve preconception disease control and maintain corticosteroid-free remission throughout pregnancy. Medication adjustments to reduce fetal exposure may be considered on an individualized basis in quiescent disease; however, any benefits of such adjustments remain theoretic and there is risk of worsening disease activity. Mode of delivery is determined by obstetric indications, except for women with active perianal disease who should consider cesarean delivery. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Patients' perception of colonoscopy: patients with inflammatory bowel disease and irritable bowel syndrome experience the largest burden

    NARCIS (Netherlands)

    Denters, M.J.; Schreuder, M.; Depla, A.C.; Mallant-Hent, R.C.; Kouwen, M.C.A. van; Deutekom, M.; Bossuyt, P.M.; Fockens, P.; Dekker, E. den

    2013-01-01

    BACKGROUND: Colonoscopy is a frequently performed procedure worldwide with a negative perception, leading to reluctance to undergo the procedure. Perceptions could differ depending on the specific indication for the colonoscopy. AIMS: To compare patient satisfaction with the colonoscopy procedure

  3. Assessment of disease-related knowledge and possible factors associated with the knowledge level among Chilean patients with inflammatory bowel disease.

    Science.gov (United States)

    Simian, Daniela; Flores, Lilian; Quera, Rodrigo; Kronberg, Udo; Ibáñez, Patricio; Figueroa, Carolina; Lubascher, Jaime

    2017-06-01

    To assess disease-related knowledge among patients with inflammatory bowel disease and to identify the factors that are possibly associated with the knowledge level. Disease-related knowledge can positively influence the acceptance of the disease, increase treatment compliance and improve the quality of life in patients with inflammatory bowel disease. An observational, cross-sectional study was conducted and prospectively included patients from the inflammatory bowel disease programme between October 2014-July 2015. A Spanish-translated version of the 24-item Crohn's and Colitis Knowledge score was used to assess disease-related knowledge. Patients also completed a demographic and clinical questionnaire. A total of 203 patients were included, 62% were female, and 66% were diagnosed with ulcerative colitis; the median age was 34 years (range 18-79), and the median disease duration was four years. The median disease-related knowledge score was 9 (range 1-20). Only 29% of the patients answered more than 50% of the questions correctly. Lower disease-related knowledge was observed in questions related to pregnancy/fertility and surgery/complications. Patients older than 50 years, with ulcerative colitis, with disease durations less than five years and patients without histories of surgery exhibited lower disease-related knowledge. There was no association between the knowledge scores and the educational levels. The patients who attended our inflammatory bowel disease programme exhibited poor disease-related knowledge that was similar to the knowledge levels that have been observed in developed countries. It is necessary to assess patient knowledge to develop educational strategies and evaluate the influences of these strategies on patient compliance and quality of life. These results will allow the inflammatory bowel disease team to develop educational programmes that account for the disease-related knowledge of each patient. Inflammatory bowel disease nurses

  4. A Disease-Associated Microbial and Metabolomics State in Relatives of Pediatric Inflammatory Bowel Disease PatientsSummary

    Directory of Open Access Journals (Sweden)

    Jonathan P. Jacobs

    2016-11-01

    Full Text Available Background & Aims: Microbes may increase susceptibility to inflammatory bowel disease (IBD by producing bioactive metabolites that affect immune activity and epithelial function. We undertook a family based study to identify microbial and metabolic features of IBD that may represent a predisease risk state when found in healthy first-degree relatives. Methods: Twenty-one families with pediatric IBD were recruited, comprising 26 Crohn’s disease patients in clinical remission, 10 ulcerative colitis patients in clinical remission, and 54 healthy siblings/parents. Fecal samples were collected for 16S ribosomal RNA gene sequencing, untargeted liquid chromatography–mass spectrometry metabolomics, and calprotectin measurement. Individuals were grouped into microbial and metabolomics states using Dirichlet multinomial models. Multivariate models were used to identify microbes and metabolites associated with these states. Results: Individuals were classified into 2 microbial community types. One was associated with IBD but irrespective of disease status, had lower microbial diversity, and characteristic shifts in microbial composition including increased Enterobacteriaceae, consistent with dysbiosis. This microbial community type was associated similarly with IBD and reduced microbial diversity in an independent pediatric cohort. Individuals also clustered bioinformatically into 2 subsets with shared fecal metabolomics signatures. One metabotype was associated with IBD and was characterized by increased bile acids, taurine, and tryptophan. The IBD-associated microbial and metabolomics states were highly correlated, suggesting that they represented an integrated ecosystem. Healthy relatives with the IBD-associated microbial community type had an increased incidence of elevated fecal calprotectin. Conclusions: Healthy first-degree relatives can have dysbiosis associated with an altered intestinal metabolome that may signify a predisease microbial

  5. A cross-sectional study on nutrient intake and -status in inflammatory bowel disease patients.

    Science.gov (United States)

    Vidarsdottir, Jona B; Johannsdottir, Sigridur E; Thorsdottir, Inga; Bjornsson, Einar; Ramel, Alfons

    2016-06-08

    Inflammatory bowel disease (IBD) can be associated with nutritional problems. The aim of this study was to investigate diet and nutritional status of IBD patients. A total of 78 participants (35 men and 43 women aged 18-74 years) were included in this cross-sectional study. The majority (80 %) of the participant received infliximab treatment. Participants filled out disease related questionnaires and 31 participants also a 3-day food record. Body composition was measured and blood samples analysed in order to estimate nutritional status. The majority (87 %) claimed that diet affects digestive tract symptoms and 72 % had changed diet accordingly. The most common foods restricted were dairy products (60 %), processed meat (55 %), soft drinks (46 %), alcohol (45 %) and fast food (44 %). Body mass index was mostly in the overweight range but 46 % of the participants had been diagnosed with some nutritional deficiency since IBD diagnosis (most common was iron deficiency: 39 %). Patients who restricted meat products had lower ferritin values (48 ± 39 vs. 95 ± 74 μg/L, P = 0.011). Intake of vitamin D and calcium were not adequate (65 % below recommeded intake for both) and 60 % had poor vitamin D status. IBD patients often change their dietary intake in order to affect digestive tract symptoms. Many patients have a history of nutrient deficiency. Restriction of dairy and meat consumption is common and is negatively associated with intake or status of micronutrients like calcium and iron. Dietary advice by a dietitian and use of potentially helpful dietary supplements is indicated.

  6. Screening of coeliac disease in undetected adults and patients diagnosed with irritable bowel syndrome in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulrahman S. Al-Ajlan

    2016-07-01

    Full Text Available The present study is to determine the prevalence and implication of coeliac disease (CD among adult Saudis and compared to those with diagnosed irritable bowel syndrome. This prospective study was conducted among 980 adults. Out of that, 482 subjects (staff and students of Riyadh Health Science College were designated as control cohorts for undetected coeliac disease. Furthermore, another contingent of 498 subjects diagnosed with irritable bowel syndrome (IBS at Prince Salman Hospital and Al-Iman General Hospital also constituted a segment of the overall initial 1020 subjects. Both cases and control were tested for serological markers of coeliac disease (tissues transglutaminase (tTGAs and endomysial autoantibody (EMAs and were confirmed by histopathology test. All the positive for cases of coeliac disease were screened for iron deficiency anaemia, Vitamin D deficiency, and osteoporosis and weight assessment. The percentage of coeliac disease in control subjects and patients diagnosed with irritable bowel syndrome (IBS were found to be 1.9% and 9.6% respectively, about 38% of the total coeliac disease patients are among females of middle age (20–39-years and 16% of the males in the same age range. Whereas, 20% and 25% of all coeliac disease cases with ages of 40–59 were remarked as females and males respectively. The identical nature and overlap of symptoms of the two conditions could possibly result in misdiagnosis of coeliac diseases or over-diagnosis of irritable bowel syndrome. The findings of the study might also give considerable implications of the disease in the nutritional level which is noticeable.

  7. Screening of Inflammatory Bowel Disease and Spondyloarthritis for Referring Patients Between Rheumatology and Gastroenterology.

    Science.gov (United States)

    Sanz Sanz, Jesús; Juanola Roura, Xavier; Seoane-Mato, Daniel; Montoro, Miguel; Gomollón, Fernando

    2017-09-04

    To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. Systematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria. Positive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. Screening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  8. The Prevalence of Nodular Regenerative Hyperplasia in Inflammatory Bowel Disease Patients Treated with Thioguanine Is Not Associated with Clinically Significant Liver Disease

    NARCIS (Netherlands)

    Asseldonk, D.P. van; Jharap, B.; Verheij, Joanne; Hartog, G. den; Westerveld, D.B.; Becx, M.C.; Russel, M.G.; Engels, L.G.; Jong, D.J. de; Witte, B.I.; Mulder, C.J.; Nieuwkerk, C.M. van; Bloemena, E.; Boer, N.K. de; Bodegraven, A.A. van

    2016-01-01

    BACKGROUND: Nodular regenerative hyperplasia (NRH) of the liver is associated with inflammatory-mediated diseases and certain drugs. There is conflicting data on the prevalence of NRH and its clinical implications in inflammatory bowel disease (IBD) patients treated with thioguanine. METHODS: A

  9. Inflammatory bowel disease in pregnancy.

    Science.gov (United States)

    Beaulieu, Dawn B; Kane, Sunanda

    2011-06-14

    Crohn's disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient. Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the best pregnancy outcomes, similar to those in the general population. Active disease prior to and during pregnancy, can lead to complications such as pre-term labor, low birth weight, and small for gestational age infants. Although there are no definitive long term effects of pregnancy on IBD, there are some limited studies that suggest that it may alter the disease course. Understanding the literature and its limitations is important in the modern era of IBD care. Educating the patient and taking a team approach with the obstetrician will help achieve successful outcomes for mother and baby.

  10. Risk of Stroke in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Xiao, Zhilong; Pei, Zhimin; Yuan, Min; Li, Xueli; Chen, Shenjian; Xu, Lijun

    2015-12-01

    Observational studies, to date, have provided inconsistent findings on whether inflammatory bowel disease (IBD) is associated with an increased risk of stroke. We therefore performed a meta-analysis to evaluate the association of IBD and its specific subtypes with risk of stroke. We searched electronic databases for studies through May 13, 2015 assessing risk of stroke in patients with IBD. Cohort and case-control studies that reported incident cases of stroke in patients with IBD and a non-IBD control population were eligible. We calculated pooled hazard ratios (HRs) with 95% confidence intervals (CIs). A total of 8 articles (126,493 IBD patients and 4748 cases of stroke) were included in this meta-analysis. The presence of IBD revealed a trend toward a modest increase in the risk of stroke incidence (HR = 1.29; 95% CI, 1.16-1.43). After subgroup analysis, Crohn's disease showed an increased risk of stroke incidence (7 studies: HR = 1.32; 95% CI, 1.13-1.56), and a significant association was also identified in ulcerative colitis (6 studies: HR = 1.18; 95% CI, 1.06-1.31). In addition, this risk is higher in women (6 studies: HR = 1.49; 95% CI, 1.24-1.79) than in men (HR = 1.22; 95% CI, 1.12-1.32). In the overall analysis we found considerable heterogeneity. Our results show a positive association between IBD and the risk of stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Use of surveillance colonoscopy in medicare patients with inflammatory bowel disease prior to colorectal cancer diagnosis.

    Science.gov (United States)

    Wang, Yize R; Cangemi, John R; Loftus, Edward V; Picco, Michael F

    2014-01-01

    Patients with longstanding inflammatory bowel disease (IBD) involving large intestine proximal to rectum are considered to be at increased risk for colorectal cancer (CRC). One prior study showed low utilization of surveillance colonoscopy in patients with ≥ 8 years of ulcerative colitis (UC) in the USA. To study use of surveillance colonoscopy among Medicare beneficiaries with IBD in the 2-year period prior to CRC diagnosis. Our study sample included Medicare beneficiaries in the SEER-Medicare-linked database who were diagnosed with CRC during 2001-2005 and had ≥ 3 physician visits with ICD-9 diagnosis code for IBD prior to CRC diagnosis. Medicare beneficiaries aged >85 years without Part B coverage or enrolled in HMOs were excluded. Colonoscopy performed within 6-30 months prior to CRC diagnosis was defined as surveillance colonoscopy. The χ² test and multivariate logistic regression were used in statistical analysis. Of 241 Medicare beneficiaries with IBD and diagnosed with CRC, 92 (38%) patients underwent ≥ 1 surveillance colonoscopy in the 2 years prior to cancer diagnosis. The use of surveillance colonoscopy was similar between Crohn's disease (28/86, 33%) and UC (64/155, 41%). In multivariate logistic regression, older age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-0.99) was negative associated with surveillance colonoscopy use and personal history of colon polyp (OR 2.73, 95% CI 1.09-6.87) was positively associated with surveillance colonoscopy use. Use of surveillance colonoscopy was low among Medicare beneficiaries with IBD in the 2 years prior to CRC diagnosis. © 2014 S. Karger AG, Basel.

  12. Serum YKL-40, a potential new marker of disease activity in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Vind, Ida; Johansen, J S; Price, P A

    2003-01-01

    BACKGROUND: YKL-40 is secreted by macrophages and neutrophils and is a growth factor for vascular endothelial cells and fibroblasts. Elevated serum concentrations of YKL-40 are found in patients with diseases characterized by inflammation or ongoing fibrosis. The aim of this study was to seek ass...... were found between serum YKL-40 and CRP, albumin and leucocytes. CONCLUSIONS: Serum YKL-40 is elevated in patients with active IBD and may be complementary to inflammatory markers and clinical characteristics in the assessment of disease activity....

  13. Serum YKL-40, a potential new marker of disease activity in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Vind, Ida; Johansen, J S; Price, P A

    2003-01-01

    BACKGROUND: YKL-40 is secreted by macrophages and neutrophils and is a growth factor for vascular endothelial cells and fibroblasts. Elevated serum concentrations of YKL-40 are found in patients with diseases characterized by inflammation or ongoing fibrosis. The aim of this study was to seek...... were found between serum YKL-40 and CRP, albumin and leucocytes. CONCLUSIONS: Serum YKL-40 is elevated in patients with active IBD and may be complementary to inflammatory markers and clinical characteristics in the assessment of disease activity....

  14. Infections in inflammatory bowel disease.

    Science.gov (United States)

    Rodríguez de Santiago, Enrique; Albillos Martínez, Agustín; López-Sanromán, Antonio

    2017-05-10

    Patients with inflammatory bowel disease constitute a population with a special predisposition to develop bacterial, viral and fungal infections. Iatrogenic immunosuppression, frequent contact with healthcare facilities and surgical interventions are some of the risk factors that explain why these infections are one of the main causes of morbi-mortality in this disease. Some of these infections follow a subtle and paucisymptomatic evolution; their diagnosis and management may become a real challenge for the attending physician if their screening is not systematized or they are not considered in the differential diagnosis. The objective of this review is to provide an update from a practical and concise perspective on the knowledge regarding the epidemiology, prevention, diagnosis and treatment of the most common infections. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  15. Multidetector CT Enterography versus Double-Balloon Enteroscopy: Comparison of the Diagnostic Value for Patients with Suspected Small Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Jingjing Wang

    2016-01-01

    Full Text Available Aim. To compare the diagnostic value of multidetector CT enterography (MDCTE and double-balloon enteroscopy (DBE for patients with suspected small bowel diseases. Methods. From January 2009 to January 2014, 190 patients with suspected small bowel diseases were examined with MDCTE and DBE. The characteristics of the patients, detection rates, diagnostic yields, sensitivity, specificity, positive predictive value, and negative predictive value were described and analyzed. Results. The overall detection rates of DBE and MDCTE were 92.6% and 55.8%, respectively (P<0.05, while the overall diagnostic yields were 83.2% and 33.7%, respectively (P<0.05. The sensitivity, specificity, positive predictive value, and negative predictive value of DBE were all higher than those of MDCTE. DBE had a higher diagnostic yield for OGIB (87.3% versus 20.9%, P<0.05. The diagnostic yields of DBE were higher than those of MDCTE for inflammatory diseases, angioma/angiodysplasia, and diverticulums, while being not for gastrointestinal tumors/polyps. Conclusions. The diagnostic value of DBE for small bowel diseases is better than that of MDCTE as a whole, but if gastrointestinal tumors are suspected, MDCTE is also needed to gain a comprehensive and accurate diagnosis.

  16. Nutrition in inflammatory bowel disease

    Science.gov (United States)

    Martínez Gómez, María Josefa; Melián Fernández, Cristóbal; Romeo Donlo, María

    2016-07-12

    Inflammatory bowel disease (IBD) is a chronic pathology that has an outbreaks course that in recent years have seen an increase in incidence, especially at younger ages. Malnutrition is frequently associated with this condition, therefore, it is very important to ensure a right nutritional intervention, especially in pediatric patients, to ensure an optimal growth and also an improvement in the clinic. Our goal will be updated the role of nutrition in this disease and in its treatment based on the published evidence. Malnutrition in these patients is frequent and is influenced by various factors such as, decreased food intake, increased nutrient requirements, increased protein loss and malabsorption of nutrients. Therefore there should be a nutritional monitoring of all of them, in which anthropometric measurements, laboratory tests and densitometry were made to establish the needs and sufficient caloric intake tailored to each patient. The use of enteral nutrition as a treatment in Crohn’s disease with mild to moderate outbreak in child population, is amply demonstrated, has even shown to be superior to the use of corticosteroids. Therefore we can conclude by stressing that nutritional intervention is a mainstay in the management of patients with IBD, which aims to prevent and / or control disease-related malnutrition to decrease morbidity and mortality and improve quality of life.

  17. The Short Health Scale: a valid and reliable measure of health related quality of life in English speaking inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    McDermott, Edel

    2013-09-01

    Health related quality of life in inflammatory bowel disease is influenced both by disease activity as well as by the psychosocial characteristics of the individual patient. The Short Health Scale (SHS) is a four-part visual analogue scale questionnaire using open-ended questions that are designed to assess the impact of inflammatory bowel disease on a health related quality of life. The four dimensions include bowel symptoms, activities of daily life, worry and general wellbeing. It has previously been validated in Swedish and Norwegian speaking patients.

  18. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

    Science.gov (United States)

    Hosseini-Carroll, Pegah; Mutyala, Monica; Seth, Abhishek; Nageeb, Shaheen; Soliman, Demiana; Boktor, Moheb; Sheth, Ankur; Chapman, Jonathon; Morris, James; Jordan, Paul; Manas, Kenneth; Becker, Felix; Alexander, Jonathan Steven

    2015-01-01

    Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using “top-down” care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed. PMID:26558150

  19. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Moller, Frederik Trier; Andersen, Vibeke; Wohlfahrt, Jan

    2015-01-01

    OBJECTIVES: Estimates of familial risk of inflammatory bowel diseases (IBDs), Crohn's disease (CD), and ulcerative colitis (UC) are needed for counseling of patients and could be used to target future prevention. We aimed to provide comprehensive population-based estimates of familial risk of IBD...

  20. Management of inflammatory bowel disease in pregnancy

    NARCIS (Netherlands)

    S. Vermeire (Silvio); F. Carbonnel (Franck); P.G. Coulie (Pierre); V. Geenen (Vincent); J.M.W. Hazes (Mieke); P.L. Masson (Pierre); F. de Keyser (Filip); E. Louis (Edouard)

    2012-01-01

    textabstractBackground and Aims: Inflammatory bowel disease (IBD) is a chronic disease affecting mainly young people in their reproductive years. IBD therefore has a major impact on patients' family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal

  1. Familial occurrence of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, M; Munkholm, P; Langholz, E

    1991-01-01

    BACKGROUND AND METHODS: We assessed the familial occurrence of inflammatory bowel disease in Copenhagen County, where there has been a long-term interest in the epidemiology of such disorders. In 1987 we interviewed 662 patients in whom inflammatory bowel disease had been diagnosed before 1979......, asking whether their first- and second-degree relatives had this disorder. Ninety-six percent of the patients (504 with ulcerative colitis and 133 with Crohn's disease) provided adequate information. RESULTS: As compared with the general population, the first-degree relatives of the 637 patients...... with ulcerative colitis or Crohn's disease had a 10-fold increase in the risk of having the same disease as the patients, after standardization for age and sex. The risk of having the other of the two diseases was also increased, but less so, and the increase in the risk of having Crohn's disease...

  2. [Immune-mediated inflammatory diseases in patients with inflammatory bowel disease. Baseline data from the Aquiles study].

    Science.gov (United States)

    Marín-Jiménez, Ignacio; García Sánchez, Valle; Gisbert, Javier P; Lázaro Pérez Calle, José; Luján, Marisol; Gordillo Ábalos, Jordi; Tabernero, Susana; Juliá, Berta; Romero, Cristina; Cea-Calvo, Luis; García-Vicuña, Rosario; Vanaclocha, Francisco

    2014-11-01

    To determine the prevalence of immune-mediated inflammatory diseases (IMID) in a cohort of patients with inflammatory bowel disease (IBD) enrolled in hospital gastroenterology outpatients units for the AQUILES study, a prospective 2-year follow-up study. We included patients ≥18 years old with a prior or new diagnosis of IBD (Crohn disease [CD], ulcerative colitis [UC] or indeterminate colitis). Diagnoses were collected in a cross-sectional manner from the clinical records at enrollment of a new patient in the study. We included 526 patients (mean age 40.2 years; 47.3% men, 52.7% women), 300 with CD (57.0%), 218 with UC (41.4%) and 8 with indeterminate colitis. Other types of IMID were present in 71 patients (prevalence: 13.5%, 95% CI: 10.8-16.7): 47 were spondyloarthropathies (prevalence: 8.9%); 18 psoriasis (3.4%); 5 pyoderma gangrenosum (1.0%), and 11 uveitis (2.1%). The prevalence of IMID was higher in patients with CD than in those with UC (17.0% [95% CI: 13.2-21.7] vs 9.2% [95% CI: 6.0-13.8], p=0.011). In the multivariate analysis, the variables associated with the presence of IMID were diagnosis of CD (OR=1.8 [95% CI: 1.1-3.2]) and duration of IBD ≥4 years (OR=2.1 [95% CI: 1.1-4.1] in those with disease duration 4-8 years, and OR=2.1 [95% CI: 1.2-3.9] in those with ≥8 years vs. 4 years since disease onset. Copyright © 2013 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  3. Surgical treatment in childhood-onset inflammatory bowel disease -A nationwide register-based study of 4,695 incident patients in Sweden 2002-2014.

    Science.gov (United States)

    Nordenvall, Caroline; Rosvall, Oda; Bottai, Matteo; Everhov, Åsa H; Malmborg, Petter; Smedby, Karin E; Ekbom, Anders; Askling, Johan; Ludvigsson, Jonas F; Myrelid, Pär; Olén, Ola

    2017-09-27

    The incidence of childhood-onset (inflammatory bowel disease is increasing worldwide, and some studies suggest that it represents a more severe disease phenotype. Few nationwide, population-based studies have evaluated the surgical burden in patients with childhood-onset IBD, and whether the improved medical treatment has influenced the need for gastrointestinal surgery. The aim was to examine whether the surgical treatment at any age of patients with childhood-onset IBD has changed over time. In a nationwide cohort study we identified 4,695 children (disease: n=2,174; inflammatory bowel disease-unclassified: n=226). Abdominal (intestinal resections and colectomies) and perianal surgery were identified through the Swedish Patient Register. The cumulative incidences of surgeries were calculated using the Kaplan Meier method. In the cohort, 44% were females and 56% males. The median age at inflammatory bowel disease diagnosis was 15 years and the maximum age at end of follow-up was 31 years. The three-year cumulative incidence of intestinal surgery was 5% in patients with ulcerative colitis and 7% in patients with Crohn's disease, and lower in children inflammatory bowel disease diagnosis (3%) than in those aged 15-17 years at diagnosis (7%). Calendar period of inflammatory bowel disease diagnosis was not associated with risk of surgery. Over the last 13 years, the risk of surgery in childhood-onset inflammatory bowel disease has remained unchanged.

  4. Immunoregulation of Inflammatory and Inhibitory Cytokines by Vitamin D3 in Patients with Inflammatory Bowel Diseases.

    Science.gov (United States)

    Alhassan Mohammed, H; Mirshafiey, A; Vahedi, H; Hemmasi, G; Moussavi Nasl Khameneh, A; Parastouei, K; Saboor-Yaraghi, A A

    2017-06-01

    Inflammatory bowel disease (IBD) is a group of idiopathic, chronic and relapsing inflammatory conditions of the gastrointestinal tract, caused by an aberrant and exaggerated immunological response in the gut. Supplementation of vitamin D3 in patients with IBD exerts both direct and indirect regulatory roles on the naïve T cells, thereby maintaining a balance between inflammatory and inhibitory cytokines. The direct actions of vitamin D3 on naïve T cells result in the proliferation of more regulatory T cells and inhibitory cytokines such as IL-4, IL-10 and IL-5. The binding of vitamin D to dendritic cells (DCs) through vitamin D receptors inhibits the action of IL-12 on DCs, resulting in the downregulation of Th1 and Th17. On the other hand, this interaction favours Th2 and Treg upregulation and facilitates the maintenance of immune homoeostasis between inflammatory and inhibitory cytokines which is essentially significant in the management of patients with IBD. The aim of this review was to explore the current and mounting scientific evidence on the roles of vitamin D3 in immunoregulation of inflammatory and inhibitory cytokines in patients with IBDs. An extensive literature search was conducted using keywords such as Vitamin D3*, IBD*, inflammatory cytokines*, inhibitory cytokines*, naïve-T-cells* and antigen presenting cells* through PubMed, SCOPUS and MEDLINE search engines. The results of the accumulated bodies of research that have been conducted demonstrate that vitamin D3 plays a major role not only in the immunoregulation of cytokines involved in the pathogenesis of IBDs but also in many other inflammatory disorders. © 2017 The Foundation for the Scandinavian Journal of Immunology.

  5. Time Course and Clinical Implications of Development of Antibodies Against Adalimumab in Patients With Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Frederiksen, Madeline Therese; Bendtzen, Klaus

    2016-01-01

    . METHODS: Cohort study including inflammatory bowel disease patients in whom anti-ADL Abs had been assessed by radioimmunoassay (RIA) and, in case of disappearance, by enzyme immunoassay, and functional reporter gene assay. RESULTS: Anti-ADL Abs were evaluated in 133 serum samples from 72 patients....... Seventeen patients (24%) tested positive after median of 194 days, interquartile range of 66 to 361. The proportion with anti-ADL Abs was 22% after 1 year, and 32% from 21 months onwards. Anti-ADL Abs generally persisted at repeat assessments during continued ADL therapy (n=8). Disappearance of anti-ADL Abs...... below limit of detection versus 7.4 μg/mL in anti-ADL Ab-negative samples (Pfourth of inflammatory bowel...

  6. Isotretinoin-induced inflammatory bowel disease

    NARCIS (Netherlands)

    Passier, J L M; Srivastava, N; van Puijenbroek, E P

    Three case reports on inflammatory bowel disease associated with use of isotretinoin are described. All three patients were male adolescents, in good health when starting isotretinoin (for acne treatment for about six months). Several weeks after discontinuation of isotretinoin the patients

  7. Inflammatory bowel disease with primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Sørensen, Jakob Ørskov; Nielsen, Ole Haagen; Andersson, Mikael

    2017-01-01

    BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) may be complicated by primary sclerosing cholangitis (PSC). We aimed to assess the characteristics of Danish PSC-IBD patients and to compare their prognosis with IBD patients without PSC. METHODS: A retrospective nationwide population...

  8. Fibromyalgia in inflammatory bowel disease.

    Science.gov (United States)

    Buskila, D; Odes, L R; Neumann, L; Odes, H S

    1999-05-01

    Studies of the rheumatological complications of inflammatory bowel disease (IBD; Crohn's disease and ulcerative colitis) have focused on peripheral arthritis and spondylitis, and less is known about soft tissue rheumatism, specifically the fibromyalgia syndrome (FM). Our aim was to estimate the prevalence of FM and assess pain thresholds in patients with Crohn's disease (CD) and ulcerative colitis (UC). Seventy-two patients with UC and 41 with CD attending consecutively at the Gastroenterology Outpatient Clinic were assessed for the presence of FM and tenderness thresholds. FM was diagnosed according to the American College of Rheumatology 1990 criteria. Tenderness was measured by manual palpation and with a dolorimeter. One hundred twenty healthy subjects served as controls. FM was documented in 30 of 113 patients with IBD (30%), specifically in 49% of patients with CD and 19% with UC (p = 0.001); in controls the rate was 0%. Subjects with CD exhibited more tenderness and reported more frequent and more severe FM associated symptoms than subjects with UC. Patients with CD had a higher tender point count, 11.3 (+/- 6.5), than those with UC, 6.4 (+/- 5.7) (p = 0.001); in healthy controls, the count was 0.1 (+/- 0.5). Tenderness thresholds (kg) were lower in CD 2.9 (+/- 1.7) than UC 3.9 (+/- 2.0) (p = 0.005) and controls 5.8 (+/- 0.9). FM is common in IBD, particularly Crohn's disease. The lower pain threshold in Crohn's disease may suggest a disease-specific effect. Recognizing FM in patients with IBD will prevent misdiagnosis and ensure correct treatment.

  9. Examining systemic steroid Use in older inflammatory bowel disease patients using hurdle models: a cohort study.

    Science.gov (United States)

    Johnson, Sophia L; Palta, Mari; Bartels, Christie M; Thorpe, Carolyn T; Weiss, Jennifer M; Smith, Maureen A

    2015-12-08

    Interpreting clinical guideline adherence and the appropriateness of medication regimens requires consideration of individual patient and caregiver factors. Factors leading to initiation of a medication may differ from those determining continued use. We believe this is the case for systemic steroid therapy in inflammatory bowel disease (IBD), resulting in a need to apply methods that separately consider factors associated with initiation and duration of therapy. To evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use we apply a 2-part hurdle model to Medicare data. We do so in older patients with tumor necrosis factor antagonist (anti-TNFs) contraindications, as they are of special interest for compliance with Medicare-adopted, quality metrics calling for anti-TNFs and nonbiologic immune therapies to reduce steroid utilization. Many older patients have contraindications to anti-TNFs. However, nonbiologics cause adverse events that are concerning in older adults, limiting their use in this population and increasing reliance on systemic steroids. We used a national Medicare sample for 2006-2009 including patients with 12 months or greater of Parts A and B and 6 months or greater of Part D coverage, IBD confirmed with at least 2 claims for ICD-9CM 555.xx or 556.xx, anti-TNF contraindications and without contraindications to nonbiologic agents. We applied a negative binomial-logit hurdle model to examine patient characteristics associated with systemic steroid utilization. Among the 1,216 IBD patients without baseline steroid use, 21% used systemic steroids. Odds of receiving systemic steroids were greater in those younger, rural, and those receiving other agents. Available patient characteristics failed to predict longer steroid treatment duration. Our study identified differences in predictors of frequency and duration of medication use and suggests the utility of two-part models to examine drug utilization

  10. Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases.

    Science.gov (United States)

    Wu, Xian-Rui; Remzi, Feza H; Liu, Xiu-Li; Lian, Lei; Stocchi, Luca; Ashburn, Jean; Shen, Bo

    2014-11-01

    To evaluate the disease course and management strategy for pouch neoplasia. Patients undergoing ileal pouch surgery for underlying ulcerative colitis who developed low-grade dysplasia (LGD), high-grade dysplasia, or adenocarcinoma in the pouch were identified. All eligible 44 patients were evaluated. Of the 22 patients with initial diagnosis of pouch LGD, 6 (27.3%) had persistence or progression after a median follow-up of 9.5 (4.1-17.6) years. Family history of colorectal cancer was shown to be a risk factor associated with persistence or progression of LGD (P = 0.03). Of the 12 patients with pouch high-grade dysplasia, 5 (41.7%) had a history of (n = 2, 16.7%) or synchronous (n = 4, 33.3%) pouch LGD. Pouch high-grade dysplasia either persisted or progressed in 3 patients (25.0%) after the initial management, during a median time interval of 5.4 (2.2-9.2) years. Of the 14 patients with pouch adenocarcinoma, 12 (85.7%) had a history of (n = 2, 14.3%) or synchronous dysplasia (n = 12, 85.7%). After a median follow-up of 2.1 (0.6-5.2) years, 6 patients with pouch cancer (42.9%) died. Comparison of patients with a final diagnosis of pouch adenocarcinoma (14, 32.6%), and those with dysplasia (29, 67.4%) showed that patients with adenocarcinoma were older (P = 0.04) and had a longer duration from IBD diagnosis or pouch construction to the detection of pouch neoplasia (P = 0.007 and P = 0.0013). The risk for progression of pouch dysplasia can be stratified. The presence of family history of colorectal cancer seemed to increase the risk for persistence or progression for patients with pouch LGD. The prognosis for pouch adenocarcinoma was poor.

  11. The epidemiology of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2015-01-01

    BACKGROUND AND AIMS: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing disorders of unknown aetiology. The aim of this review is to present the latest epidemiology data on occurrence, disease course, risk for surgery, as well as mortality...... and cancer risks. MATERIAL AND METHODS: Gold standard epidemiology data on the disease course and prognosis of patients with inflammatory bowel disease (IBD) are based on unselected population-based cohort studies. RESULTS: The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has increased...... IBD patients. CONCLUSION: In recent years, self-management and patient empowerment, combined with evolving eHealth solutions, has utilized epidemiological knowledge on disease patterns and has been improving compliance and the timing of adjusting therapies, thus optimizing efficacy by individualizing...

  12. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient.

    Science.gov (United States)

    Habal, F M; Huang, V W

    2012-03-01

    Inflammatory bowel disease affects patients who are in their reproductive years. There are many questions regarding the management of IBD patients who are considering or who are already pregnant. These include the effect of the disease and the medications on fertility and on the pregnancy outcome. To create an evidence-based decision-making algorithm to help guide physicians through the management of pregnancy in the IBD patient. A literature review using phrases that include: 'inflammatory bowel disease', 'Crohn's disease', 'ulcerative colitis', 'pregnancy', 'fertility', 'breast feeding', 'delivery', 'surgery', 'immunomodulators', 'azathioprine', 'mercaptopurine', 'biologics', 'infliximab', 'adalimumab', 'certolizumab'. The four decision-making nodes in the algorithm for the management of pregnancy in the IBD patient, and the key points for each one are as follows: (i) preconception counselling - pregnancy outcome is better if patients remain in remission during pregnancy, (ii) contemplating pregnancy or is already pregnant - drugs used to treat IBD appear to be safe during pregnancy, with the exception of methotrexate and thalidomide, (iii) delivery and (iv) breast feeding - drugs used to treat IBD appear to be safe during lactation, except for ciclosporin. Another key point is that biological agents may be continued up to 30 weeks gestation. The management of pregnancy in the IBD patient should be multi-disciplinary involving the patient and her partner, the family physician, the gastroenterologist and the obstetrician. © 2012 Blackwell Publishing Ltd.

  13. Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.

    Science.gov (United States)

    Rubin, David T; Krugliak Cleveland, Noa

    2015-09-01

    The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

  14. Timing of Last Preoperative Dose of Infliximab Does Not Increase Postoperative Complications in Inflammatory Bowel Disease Patients.

    Science.gov (United States)

    Alsaleh, Anas; Gaidos, Jill K J; Kang, Le; Kuemmerle, John F

    2016-09-01

    The association between preoperative use of infliximab and postoperative complications in patients with inflammatory bowel disease (IBD) is a subject of continued debate. Results from studies examining an association between the timing of last preoperative dose of infliximab and postoperative complications remain inconsistent. To assess whether timing of last dose of infliximab prior to surgery affects the rate of postoperative complications in patients with Crohn's disease or ulcerative colitis. Retrospective chart review of IBD patients who have undergone surgery while receiving therapy with infliximab was conducted. Forty-seven patients were included in the analysis. No significant association was found between timing of infliximab and the rate of postoperative complications. Age, gender, disease type, steroid use, preoperative status, surgery type, or surgeon type was not associated with increased rate of postoperative complications. Timing of last dose of infliximab does not affect the rate of postoperative complications in patients with Crohn's disease or ulcerative colitis.

  15. Impact of serum-derived bovine immunoglobulin/protein isolate therapy on irritable bowel syndrome and inflammatory bowel disease: a survey of patient perspective.

    Science.gov (United States)

    Shaw, Audrey L; Tomanelli, Adam; Bradshaw, Timothy P; Petschow, Bryon W; Burnett, Bruce P

    2017-01-01

    Patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) commonly experience diarrhea, abdominal pain, bloating, and urgency. These symptoms significantly compromise the patient's quality of life (QoL) by limiting participation in normal daily activities and adversely affect work productivity and performance. The aim of this study was to understand from the patient's perspective how oral serum-derived bovine immunoglobulin/protein isolate (SBI) impacts bowel habits, management of condition, and basic QoL. A 1-page questionnaire was distributed randomly to >14,000 patients who were prescribed SBI (EnteraGam®) for relevant intended uses. The survey was designed to collect data related to the influence of IBS or IBD on daily life activities and the impact of SBI usage on daily stool frequency, management of their condition, and QoL. Patient-reported responses were analyzed using a paired t-test to compare mean change in daily stool output and descriptive statistics for continuous variables. A total of 1,377 patients returned the surveys. Results from 595 surveys were analyzed with a focus on patients with IBS or IBD who had provided numeric responses regarding daily stool frequency. Respondents with IBS who reported having a normal stool frequency (≤4 stools per day) increased from 35% prior to using SBI to 91% while using SBI. A similar change toward normal stool frequency was reported by IBD respondents. Mean daily stool numbers decreased for respondents in the combined IBS and IBD groups (P=0.0001) from 6.5±4.3 before SBI to 2.6±1.9 following SBI use. The majority of respondents agreed strongly or very strongly that SBI helped them manage their condition (66.9%) and helped them return to the activities they enjoyed (59.1%). Results from this patient survey suggest that SBI use can lead to clinically relevant decreases in daily stool frequency in patients with IBS or IBD along with improvements in the overall management of their

  16. Virtual chromoendoscopy for prediction of severity and disease extent in patients with inflammatory bowel disease: a randomized controlled study.

    Science.gov (United States)

    Neumann, Helmut; Vieth, Michael; Günther, Claudia; Neufert, Clemens; Kiesslich, Ralf; Grauer, Martin; Atreya, Raja; Neurath, Markus F

    2013-08-01

    Increased vascular permeability and angiogenesis play a crucial role in the pathogenesis of inflammatory bowel disease (IBD). Aim was to determine whether computed virtual chromoendoscopy has the potential to enhance assessment of disease severity and extent in patients with mild or inactive IBD in comparison to high-definition white-light endoscopy. Consecutive patients with IBD were randomly assigned at a 1:1 ratio to undergo colonoscopy with high-definition white light (group A) or computed virtual chromoendoscopy (group B). The mucosal vascular pattern and any mucosal abnormalities were recorded. Subsequent to endoscopic characterization targeted, biopsies were obtained from every segment for subsequent histopathological analysis of disease activity. Overall, 100 patients were screened to participate in this study of whom 78 patients (high-definition white light, n = 39; computed virtual chromoendoscopy, n = 39) completed the study protocol thereby matching the previously calculated sample size. Average duration of the examination was 18 minutes in group A and 20.5 minutes in group B that was not statistically significant. When comparing the endoscopic prediction of inflammatory extent and activity with the histological results, an overall agreement of 48.71% and 53.85% (group A) and 92.31% and 89.74% (group B) was found, respectively. These differences were statistically significant (P = 0.0009 and P = 0.066). This study indicates that computed virtual chromoendoscopy significantly improves the diagnosis of the severity and extent of mucosal inflammation in patients with IBD. This newly developed imaging technique may therefore have important implications for therapeutic interventions in patients with IBD.

  17. Increased population of immature enteric glial cells in the resected proximal ganglionic bowel of Hirschsprung's disease patients.

    Science.gov (United States)

    Tani, Gakuto; Tomuschat, Christian; O'Donnell, Anne Marie; Coyle, David; Puri, Prem

    2017-10-01

    Enteric glial cells are essential for normal gastrointestinal function. Abnormalities in glial structure, development, or function lead to disturbances in gastrointestinal physiology. Fatty acid-binding protein 7 (FABP7) is a marker of immature enteric glial cells, whereas S100 is expressed only by mature glial cells. Patients with Hirschsprung's disease (HSCR) often suffer from dysmotility and enterocolitis despite proper surgery. We designed this study to determine the distribution and expression of glial cells in patients with HSCR compared to normal controls. We investigated FABP7, S100, and PGP 9.5 expressions in both the ganglionic and aganglionic bowel of patients with HSCR (n = 6) versus normal control colon (n = 6). Protein distribution was assessed by using immunofluorescence and confocal microscopy. Gene and protein expressions were quantified using quantitative real-time polymerase chain reaction (qPCR), Western blot analysis, and densitometry. qPCR and Western blot analysis demonstrated a significantly increased FABP7 expression in ganglionic specimens compared to control specimen (P < 0.05). Confocal microscopy revealed FABP7+ glia cells lie under the colonic epithelium and in close apposition to enteric neurons in the ganglionic bowel. The significantly increased number of immature enteric glial cells (EGCs) in the ganglionic bowel of HSCR patients may have adverse effect on the function of enteric neurons and intestinal barrier and thus predispose these patients to intestinal motility problems and enterocolitis. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The impact of nurse-led annual telephone follow-up of patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bager, Palle

    2014-01-01

    % of the patients included were pleased with the service. The programme has shortened the waiting time for most other services, but no improvement in the workload was observed. The BIA showed limited savings. The CEA showed an annual saving of 100€ per patient when using the annual phone service over routine visits......Inflammatory bowel diseases (IBD) are characterised by periods of disease activity and period with disease in remission. In Denmark all patients are seen in hospital settings. The aim of this study was to introduce a nurse-led phone service for stable patients replacing annual visits. The study....... In conclusion, changing the method of contact from routine annual visits to annual phone calls from a nurse was feasible and well accepted for stable patients with IBD. The benefits of the service were most marked for the patients....

  19. Impact of serum-derived bovine immunoglobulin/protein isolate therapy on irritable bowel syndrome and inflammatory bowel disease: a survey of patient perspective

    Directory of Open Access Journals (Sweden)

    Shaw AL

    2017-05-01

    Full Text Available Audrey L Shaw,1 Adam Tomanelli,2 Timothy P Bradshaw,1 Bryon W Petschow,1 Bruce P Burnett3 1Clinical Research, Entera Health, Inc., Cary, NC, 2Market Research, Praxis Research Partners, Fairfield, CT, 3Medical Affairs, Entera Health, Inc., Cary, NC, USA Background: Patients with irritable bowel syndrome (IBS or inflammatory bowel disease (IBD commonly experience diarrhea, abdominal pain, bloating, and urgency. These symptoms significantly compromise the patient’s quality of life (QoL by limiting participation in normal daily activities and adversely affect work productivity and performance.Purpose: The aim of this study was to understand from the patient’s perspective how oral serum-derived bovine immunoglobulin/protein isolate (SBI impacts bowel habits, management of condition, and basic QoL.Methods: A 1-page questionnaire was distributed randomly to >14,000 patients who were prescribed SBI (EnteraGam® for relevant intended uses. The survey was designed to collect data related to the influence of IBS or IBD on daily life activities and the impact of SBI usage on daily stool frequency, management of their condition, and QoL. Patient-reported responses were analyzed using a paired t-test to compare mean change in daily stool output and descriptive statistics for continuous variables.Results: A total of 1,377 patients returned the surveys. Results from 595 surveys were analyzed with a focus on patients with IBS or IBD who had provided numeric responses regarding daily stool frequency. Respondents with IBS who reported having a normal stool frequency (≤4 stools per day increased from 35% prior to using SBI to 91% while using SBI. A similar change toward normal stool frequency was reported by IBD respondents. Mean daily stool numbers decreased for respondents in the combined IBS and IBD groups (P=0.0001 from 6.5±4.3 before SBI to 2.6±1.9 following SBI use. The majority of respondents agreed strongly or very strongly that SBI helped them

  20. Development, validation and clinical assessment of a short questionnaire to assess disease-related knowledge in inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    Keegan, Denise

    2013-02-01

    Only two inflammatory bowel disease (IBD) knowledge scales are available, both primarily aimed at evaluating the effectiveness of clinical education programs. The aim of this study was to develop and validate a short knowledge questionnaire for clinical and academic research purposes.

  1. Inflammatory Bowel Disease (IBD) and Pregnancy

    Science.gov (United States)

    Inflammatory Bowel Disease In every pregnancy, a woman starts out with a 3-5% chance of having a baby ... risk. This sheet talks about whether exposure to inflammatory bowel disease may increase the risk for birth defects over ...

  2. Significance of the genetic polymorphism of CYP2D6 and NAT2 in patients with inflammatory bowel diseases.

    Science.gov (United States)

    Dudarewicz, Michał; Rychlik-Sych, Mariola; Barańska, Małgorzata; Wojtczak, Anna; Trzciński, Radzisław; Dziki, Adam; Skrętkowicz, Jadwiga

    2014-08-01

    The main types of inflammatory bowel diseases (IBD) are ulcerative colitis (UC) and Crohn's disease (CD). There is evidence that, in addition to immunological and environmental factors, genetic factors also play an important role in the pathogenesis of IBD. Determination of polymorphism of CYP2D6 and NAT2 genes encoding I and II phase enzymes of xenobiotic biotransformation may have clinical value as an indicator of individual predisposition to diseases, and also contribute to effective and safe pharmacotherapy. The aim of this study was to investigate the association between genetic polymorphism of CYP2D6 and NAT2 and the incidence of IBD, including UC and CD, among inhabitants of central Poland. The study was performed in 258 individuals from central Poland (115 patients with IBD, including 65 patients with UC and 50 with CD; and in 143 healthy controls). The CYP2D6 genotypes of oxidation and NAT2 genotypes of acetylation were analyzed using the PCR-RFLP method. There were no statistically significant differences in the frequency of the CYP2D6 genotypes and alleles in patients with IBD, UC and CD in comparison with the control group. The relative risk (OR) of IBD, UC and CD was higher in carriers of the allele NAT2*7 and was OR=3.49 (p=0.0019), OR=3.86 (p=0.0019), and OR=3.02 (p=0.0247), respectively. Polymorphism of the gene encoding CYP2D6 does not affect the incidence of inflammatory bowel diseases. The carriers of the NAT2*7 allele which determines slow acetylation may be more predisposed to inflammatory bowel diseases, including ulcerative colitis and Crohn's disease. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  3. THE ROLE OF A COLONOSCOPY IN INFLAMMATORY BOWEL DISEASE (IBD)

    OpenAIRE

    Davorin Dajčman

    2008-01-01

    BACKGROUND Gastrointestinal endoscopy provides details of the surface of the gastrointestinal tract, whichhas made it possible to examine it. Despite significant advances in our understanding andtreatment of inflammatory bowel disease, the role of gastrointestinal endoscopy in diagnosis, surveillance and therapy of inflammatory bowel disease patients is still controversal.Of course, endoscopy plays a key role in the management of inflammatory bowel disease.Indication for endoscopy in patie...

  4. [Treatment of inflammatory bowel diseases].

    Science.gov (United States)

    Gomollón, Fernando

    2015-09-01

    In addition to immunosuppressive drugs and anti-TNF, there are a number of new options in the treatment of inflammatory bowel diseases. Vedolizumab has been approved by the FDA and EMA and has demonstrated utility both in the treatment of ulcerative colitis (UC) and Crohn's disease (CD), even in anti-TNF refractory patients. Other monoclonal antibodies with different targets such as PF-005447659 (antiMAd-CAM1), ustekinumab (anti-IL23/IL12) or MEDI2070 (anti-IL23) have shown promising results in distinct clinical scenarios. Mongersen (antisense oligonucleotide anti-Smad7) and oznimod (an SP-1 modulator) are new alternatives with proven efficacy in clinical trials in CD and UC, respectively. Some data suggest that faecal microbiota transplantation could be efficacious in individual patients, although controlled data do not show clear differences with placebo. Autologous stem-cell transplantation has shown long-term efficacy in "ultra-refractory" CD. The number of possible treatments is constantly increasing, and future research should focus both on the selection of the most appropriate treatment for any given patient and on comparative trials between options. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  5. Gut microbial diversity in health and disease: experience of healthy Indian subjects, and colon carcinoma and inflammatory bowel disease patients.

    Science.gov (United States)

    Bamola, V Deepak; Ghosh, Arnab; Kapardar, Raj Kishor; Lal, Banwari; Cheema, Simrita; Sarma, Priyangshu; Chaudhry, Rama

    2017-01-01

    Background: The intestinal microbiota, through complex interactions with the gut mucosa, play a key role in the pathogenesis of colon carcinoma and inflammatory bowel disease (IBD). The disease condition and dietary habits both influence gut microbial diversity. Objective: The aim of this study was to assess the gut microbial profile of healthy subjects and patients with colon carcinoma and IBD. Healthy subjects included 'Indian vegetarians/lactovegetarians', who eat plant produce, milk and milk products, and 'Indian non-vegetarians', who eat plant produce, milk and milk products, certain meats and fish, and the eggs of certain birds and fish. 'Indian vegetarians' are different from 'vegans', who do not eat any foods derived wholly or partly from animals, including milk products. Design: Stool samples were collected from healthy Indian vegetarians/lactovegetarians and non-vegetarians, and colon cancer and IBD patients. Clonal libraries of 16S ribosomal DNA (rDNA) of bacteria were created from each sample. Clones were sequenced from one representative sample of each group. Approximately 500 white colonies were picked at random from each sample and 100 colonies were sequenced after amplified rDNA restriction analysis. Results: The dominant phylum from the healthy vegetarian was Firmicutes (34%), followed by Bacteroidetes (15%). The balance was reversed in the healthy non-vegetarian (Bacteroidetes 84%, Firmicutes 4%; ratio 21:1). The colon cancer and IBD patients had higher percentages of Bacteroidetes (55% in both) than Firmicutes (26% and 12%, respectively) but lower Bacteroidetes:Firmicutes ratios (3.8:1 and 2.4:1, respectively) than the healthy non-vegetarian. Bacterial phyla of Verrucomicrobiota and Actinobacteria were detected in 23% and 5% of IBD and colon patients, respectively. Conclusions: Ribosomal Database Project profiling of gut flora in this study population showed remarkable differences, with unique diversity attributed to different diets and disease

  6. Environmental factors in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Hansen, Tanja Stenbaek; Jess, Tine; Vind, Ida

    2011-01-01

    The role of environmental factors in development of inflammatory bowel disease (IBD) remains uncertain. The aim of the present study was to assess a number of formerly suggested environmental factors in a case-control study of an unselected and recently diagnosed group of patients with IBD...

  7. Prognosis after first-time myocardial infarction in patients with inflammatory bowel disease according to disease activity

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper

    2014-01-01

    -cause mortality, and a composite of recurrent MI, cardiovascular death, and stroke were estimated by Cox regression-models. Odds ratio of death during hospitalization or within 30 days of discharge (n=13 339) corresponded to 3.29 (95% confidence interval [CI], 1.98-5.45) for patients in IBD flares, 1.62 (95% CI......BACKGROUND: Inflammatory bowel disease (IBD) is associated with increased cardiovascular risk. We examined the effect of active IBD on major adverse cardiovascular outcomes after myocardial infarction (MI). METHODS AND RESULTS: In nationwide registries, we identified 86 790 patients with first-time......, 0.95-2.77) for persistent activity, and 0.97 (95% CI, 0.78-1.19) for remission when compared with the non-IBD group. Among 73 451 patients, including 863 with IBD, alive 30 days after discharge, IBD was associated with hazard ratios of 1.21 (95% CI, 0.99-1.49) for recurrent MI, 1.14 (95% CI, 1...

  8. Nutrition in inflammatory bowel disease.

    Science.gov (United States)

    Stein, R B; Lichtenstein, G R; Rombeau, J L

    1999-09-01

    Clinical and basic research continues to expand our understanding of the complex pathogenesis of inflammatory bowel diseases. The potential roles played by fatty acid intake, serum leptin, and nitric oxide in the promotion of intestinal inflammation in Crohn's disease and ulcerative colitis will be reviewed. In addition, important advances in the areas of bone disease, vitamin deficiency, growth failure, and home parenteral nutrition will be discussed.

  9. Association between psoriasis and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Mallbris, L; Warren, R B

    2016-01-01

    BACKGROUND: Psoriasis, Crohn disease (CD) and ulcerative colitis (UC) are chronic inflammatory disorders with overlapping genetic architecture. However, data on the frequency and risk of CD and UC in psoriasis are scarce and poorly understood. OBJECTIVES: To investigate the association between CD......-associated increased risk of CD and UC, which was higher in severe psoriasis, and an increased risk of psoriasis in patients with inflammatory bowel disease. Increased focus on gastrointestinal symptoms in patients with psoriasis may be warranted....

  10. Clinical variables related to small bowel obstruction: comparison of patients with and without Crohn’s disease

    Directory of Open Access Journals (Sweden)

    Awad Al Qahtani

    2012-06-01

    Full Text Available Small bowel obstruction is a known complication of Crohn’s disease. Determining need for operation is a demanding task. The aim of this study was to fine tune the decision-making process by evaluating standard clinical and laboratory parameters in small bowel obstruction of any cause and compare etiologies. Consecutive patients with Crohn’s disease and small bowel obstruction were selected retrospectively and compared to a randomly selected group of non Crohn’s patients with obstruction over a 9 year period. Twenty-two clinical, laboratory and radiological variables were assessed for the following outcomes: i diagnosis of Crohn’s; ii operative or non operative treatment in Crohn’s; iii operative or non operative treatment without Crohn’s; iv exacerbation or adhesions causing obstruction among Crohn’s patients. Multivariable models were developed for each outcome using logistic regression. Age less than 50, history of smoking, Jewish ethnicity, white count >11x10E9, neutrophils >7.5x10E9 and platelet volume <9.9 fL, supported the diagnosis of Crohn’s disease. Operation in Crohn’s disease within the same admission was associated with a history of smoking, temperature >38˚, high pulse >100, leukocytosis (>11x10E9 and obstruction on abdominal scan, while operation in patients without Crohn’s in the sentinel admission, was associated with temperature >38˚, tachycardia, leukocytosis (>11x10E9 and previous operation. Confirmation of these predictive patterns in a validation group could help in clinical decisions regarding therapeutic options in an emergency setting.

  11. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

    Science.gov (United States)

    Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

    2015-06-01

    The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

  12. Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Santiago Camacho

    2010-12-01

    Full Text Available The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS, dyspepsia, non-erosive reflux disease (NERD and erosive esophagitis (EE. IBS criteria were fulfilling for dyspepsia patients in 47%, for NERD in 48%, and for EE patients in 48% of cases. Esophagitis was present in 42% of patients with IBS and in 45% of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: ucus in feces, abdoinal distension, nausea and gastritis; and oen ore frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95% CI 1.08 to 5.99, p=0.04, tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.O objetivo deste estudo foi analisar os dados de endoscopia e sintomas de 118 pacientes mexicanos com síndrome do intestino irritável (IBS, dispepsia, doença do refluxo não-erosiva (NERD e esofagite erosiva (EE. Os pacientes com IBS preencheram os critérios para dispepsia em 47%, para NERD em 48%, e para pacientes EE em 48% dos casos. Esofagite estava presente em 42% dos pacientes com IBS e em 45% dos pacientes com dispepsia. A maior prevalência de hérnia de hiato foi encontrada na EE em comparação com NERD. Azia e eructação ácida foram associadas à presença de esofagite; eructação ácida, regurgitação e dor noturna, com duodenite; e azia e regurgitação com hérnia de hiato. Os homens relataram mais

  13. Cutaneous Manifestations in Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Simona Roxana Georgescu

    2015-10-01

    Full Text Available Inflammatory bowel diseases have a high frequency in Europe. They are chronic disorders that evolve with relapses and remissions. Clinical features include the signs of underlying inflammatory bowel disease and also signs of extraintestinal manifestations. Cutaneous disorders are the most common extraintestinal manifestations associated with inflammatory bowel diseases, which can be dependent on or independent of gastrointestinal disease activity. The main cutaneous disorders are erythema nodosum and pyodermagangrenosum. The pathogenic mechanisms are not fully understood but it seems that related mechanisms are involved in the development of inflammatory bowel diseases and extraintestinal manifestations. Treatment should be aimed at both the cutaneous manifestations and the bowel inflammation

  14. Neurological Manifestations In Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    youssef HNACH

    2015-06-01

    Full Text Available IntroductionThe purpose of this retrospective study was to report neurological manifestations noted in patients who were monitored for inflammatory bowel disease, in order to document the pathophysiological, clinical, progressive, and therapeutic characteristics of this entity.Material and methodsWe conducted a retrospective study on patients monitored -in the gastroenterology service in Ibn Sina Hospital in Rabat, Morocco- for inflammatory bowel disease from 1992 till 2013 and who developed neurological manifestations during its course. Patients with iatrogenic complications were excluded, as well as patients with cerebrovascular risk factors.ResultsThere were 6 patients, 4 of whom have developed peripheral manifestations. Electromyography enabled the diagnosis to be made and the outcome was favorable with disappearance of clinical manifestations and normalization of the electromyography.The other 2 patients, monitored for Crohn’s disease, developed ischemic stroke. Cerebral computed tomography angiography provided positive and topographic diagnosis. Two patients were admitted to specialized facilities.ConclusionNeurological manifestations in inflammatory bowel disease are rarely reported.  Peripheral neuropathies and stroke remain the most common manifestations. The mechanisms of these manifestations are not clearly defined yet. Currently, we hypothesize the interaction of immune mediators.

  15. Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies.

    Science.gov (United States)

    Stepaniuk, Peter; Bernstein, Charles N; Targownik, Laura E; Singh, Harminder

    2015-01-01

    The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients. Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.

  16. Medico-legal significance of service difficulties and clinical errors in the management of patients with inflammatory bowel diseases.

    Science.gov (United States)

    Farrukh, Affifa; Mayberry, John F

    2015-03-01

    There is a significant growth in medical litigation, and cases involving the care and management of patients with inflammatory bowel disease are becoming common. There is no central register of such cases, and the majority are settled before court proceedings. As a result, there is no specific case law related to such conditions, and secrecy usually surrounds the outcome with "no admission of guilt" by the defendant and a clause about non-disclosure and discussion linked to the financial compensation received by the claimant. This review discusses common areas of potential litigation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.

    LENUS (Irish Health Repository)

    Clayton, Evelyn M

    2009-05-01

    Comorbidity with Clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (IBD) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. Retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of C. difficile carriage in IBD patients using molecular methods specifically in an outpatient setting.

  18. Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease.

    Directory of Open Access Journals (Sweden)

    Braden Kuo

    Full Text Available Irritable Bowel Syndrome (IBS and Inflammatory Bowel Disease (IBD can profoundly affect quality of life and are influenced by stress and resiliency. The impact of mind-body interventions (MBIs on IBS and IBD patients has not previously been examined.Nineteen IBS and 29 IBD patients were enrolled in a 9-week relaxation response based mind-body group intervention (RR-MBI, focusing on elicitation of the RR and cognitive skill building. Symptom questionnaires and inflammatory markers were assessed pre- and post-intervention, and at short-term follow-up. Peripheral blood transcriptome analysis was performed to identify genomic correlates of the RR-MBI.Pain Catastrophizing Scale scores improved significantly post-intervention for IBD and at short-term follow-up for IBS and IBD. Trait Anxiety scores, IBS Quality of Life, IBS Symptom Severity Index, and IBD Questionnaire scores improved significantly post-intervention and at short-term follow-up for IBS and IBD, respectively. RR-MBI altered expression of more genes in IBD (1059 genes than in IBS (119 genes. In IBD, reduced expression of RR-MBI response genes was most significantly linked to inflammatory response, cell growth, proliferation, and oxidative stress-related pathways. In IBS, cell cycle regulation and DNA damage related gene sets were significantly upregulated after RR-MBI. Interactive network analysis of RR-affected pathways identified TNF, AKT and NF-κB as top focus molecules in IBS, while in IBD kinases (e.g. MAPK, P38 MAPK, inflammation (e.g. VEGF-C, NF-κB and cell cycle and proliferation (e.g. UBC, APP related genes emerged as top focus molecules.In this uncontrolled pilot study, participation in an RR-MBI was associated with improvements in disease-specific measures, trait anxiety, and pain catastrophizing in IBS and IBD patients. Moreover, observed gene expression changes suggest that NF-κB is a target focus molecule in both IBS and IBD-and that its regulation may contribute to

  19. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease.

    Science.gov (United States)

    Cantorna, Margherita T; McDaniel, Kaitlin; Bora, Stephanie; Chen, Jing; James, Jamaal

    2014-11-01

    The inflammatory bowel diseases are complex diseases caused by environmental, immunological, and genetic factors. Vitamin D status is low in patients with inflammatory bowel diseases, and experimental inflammatory bowel diseases are more severe in vitamin D-deficient or vitamin D receptor knockout animals. Vitamin D is beneficial in inflammatory bowel diseases because it regulates multiple checkpoints and processes essential for homeostasis in the gut. Vitamin D inhibits IFN-γ and IL-17 production while inducing regulatory T cells. In addition, vitamin D regulates epithelial cell integrity, innate immune responses, and the composition of the gut microbiota. Overall, vitamin D regulates multiple pathways that maintain gastrointestinal homeostasis. The data support improving vitamin D status in patients with inflammatory bowel diseases. © 2014 by the Society for Experimental Biology and Medicine.

  20. Pitfalls when implementing nurse-led annual telephone calls to replace outpatient visits for Inflammatory Bowel Disease patients

    DEFF Research Database (Denmark)

    Jakobsen, Dorrit; Bager, Palle; Hentze, Runa

    Background: In Denmark, patients with Inflammatory Bowel Disease (IBD) and disease in remission are mainly seen on a regularly basis in outpatient clinics, by gastroenterologists. Replacing the regular visits with annual telephone calls performed by IBD nurses seems beneficial, both...... eligible IBD patients were shifted from regularly visits to annual telephone calls performed by an IBD nurse. As the intervention contained of several sub-elements and the elements were subject to adjustment during implementation, the intervention was regarded as a Complex Intervention. All the elements...... for the patients and for the outpatient clinic. The purpose of this study was to identify potential barriers and pitfalls in the planning and implementation phase of a nurse-led telephone service. Methods: Preparations prior to introducing the annual telephone calls were done in 2010. From January 2011 all...

  1. Quality of life of patients with irritable bowel syndrome is low compared to others with chronic diseases

    NARCIS (Netherlands)

    ten Berg, Maarten J.; Goettsch, Wim G.; van den Boom, Guido; Smout, André J. P. M.; Herings, Ron M. C.

    2006-01-01

    BACKGROUND: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal dysmotility disorder. This study aimed to estimate the burden of illness of a Dutch population of community dwelling patients suffering from IBS. METHODS: Patients identified at community pharmacies, using

  2. Internet Searches About Therapies Do Not Impact Willingness to Accept Prescribed Therapy in Inflammatory Bowel Disease Patients.

    Science.gov (United States)

    Feathers, Alexandra; Yen, Tommy; Yun, Laura; Strizich, Garrett; Swaminath, Arun

    2016-04-01

    A significant majority of patients with inflammatory bowel disease (IBD) search the Internet for information about their disease. While patients who search the Internet for disease or treatment information are believed to be more resistant to accepting medical therapy, no studies have tested this hypothesis. All IBD patients over a 3-month period across three gastroenterology practices were surveyed about their disease, treatments, websites visited, attitudes toward medications, and their willingness to accept prescribed therapies after disease-related Internet searches. Of 142 total patients, 91 % of respondents searched the Internet for IBD information. The vast majority (82 %) reported taking medication upon their doctor's recommendation and cited the desire to acquire additional information about their disease and prescribed therapies as their most important search motivator (77 %). Internet usage did not affect the willingness of 52 % of our cohort to accept prescribed medication. The majority of IBD patients who searched the Internet for disease and treatment-related information were not affected in their willingness to accept prescribed medical therapy.

  3. PedsQL gastrointestinal symptoms scales and gastrointestinal worry scales in pediatric patients with inflammatory bowel disease in comparison with healthy controls

    Science.gov (United States)

    Patient-reported outcomes are essential in determining the broad impact of inflammatory bowel disease (IBD) and treatments from the patient's perspective. The primary study objectives were to compare the gastrointestinal symptoms and worry of pediatric patients with IBD with matched healthy controls...

  4. Diagnostic Workup of Paediatric Inflammatory Bowel Disease Patients In Europe: Results of A 5-Year Audit of The EUROKIDS Registry

    DEFF Research Database (Denmark)

    de Bie, Charlotte I; Buderus, Stephan; Sandhu, Bhupinder K

    2011-01-01

    OBJECTIVES:: In 2005, the Inflammatory Bowel Disease (IBD) Working Group of ESPGHAN published consensus guidelines on the diagnostic workup of paediatric IBD, the Porto criteria. According to these guidelines, children suspected of IBD should have an oesophagogastroduodenoscopy (OGD), ileocolonos...

  5. Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease.

    Science.gov (United States)

    Abhyankar, A; Ham, M; Moss, A C

    2013-09-01

    The rate of exacerbation of inflammatory bowel disease (IBD) during pregnancy varies in the published literature. We sought to perform a systematic review and meta-analysis of the effects of disease activity at conception on disease course during pregnancy in women with IBD. Published studies and abstracts from standard sources were screened for appropriate studies. Data were pooled and analysed using funnel and forest plots. Quality assessment scores were given using GRADE criteria. Fourteen studies were eligible for inclusion; ten studies contained patients with UC (N = 1130), and six studies contained patients with CD (N = 590). In patients with UC there was a significantly higher risk ratio of active disease during pregnancy in patients who commenced pregnancy with active disease (55%), when compared with those in remission at conception (36%) (RR 2.0, 95% CI: 1.5-3, P disease is active are more likely to have active disease during pregnancy than those who conceive when in remission. All studies used in this analysis had a high risk of bias therefore further studies are required. © 2013 John Wiley & Sons Ltd.

  6. Inflammatory Bowel Disease

    Science.gov (United States)

    ... Taking medication Counseling and stress relief Changing your diet Foods do not cause IBS, but eating certain ... Carpal tunnel syndrome Depression HIV and AIDS Menstruation Polycystic ovary syndrome (PCOS) Pregnancy Thyroid disease All A-Z health ...

  7. Fermentable Carbohydrate Restriction (Low FODMAP Diet) in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Prince, Alexis C; Myers, Clio E; Joyce, Triona; Irving, Peter; Lomer, Miranda; Whelan, Kevin

    2016-05-01

    A significant proportion of patients with inflammatory bowel disease (IBD) experience functional-like gastrointestinal symptoms (FGS) even during remission. Research suggests that dietary restriction of fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet) can improve FGS, albeit in irritable bowel syndrome. The aim of this study was to investigate the effectiveness of the low FODMAP diet delivered in routine clinical practice in patients with IBD and coexisting FGS. Gastrointestinal symptom scores were compared in consecutive patients with IBD referred for low FODMAP dietary education for symptom management (n = 88). Symptoms were assessed using the Gastrointestinal Symptoms Rating Scale, and stool output was assessed using the Bristol Stool Form Scale at both baseline and follow-up (minimum of 6 weeks). There was a significant and large increase in the numbers of patients reporting satisfactory relief of symptoms between baseline (14/88, 16%) and low FODMAP diet (69/88, 78%; P FODMAP diet mean: 0.7, SD: 0.5; P FODMAP diet delivered in routine clinical practice seems effective in improving satisfaction with, and severity of, FGS in IBD. Randomized controlled trials are warranted to definitively establish effectiveness.

  8. Primary sclerosing cholangitis and disease distribution in inflammatory bowel disease.

    LENUS (Irish Health Repository)

    O'Toole, Aoibhlinn

    2012-04-01

    The relationship between site of intestinal inflammation and primary sclerosing cholangitis (PSC) development in inflammatory bowel disease (IBD) has not been studied extensively, but may be important in understanding the pathogenesis of PSC. We aimed to determine patterns of disease distribution in IBD patients with and without PSC.

  9. Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines

    Directory of Open Access Journals (Sweden)

    Ashish Atreja

    2012-01-01

    Full Text Available Background. Patients with inflammatory bowel disease (IBD are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis. Methods. We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA findings. Results. 59% of patients (1004/1703 in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%, and of these, 196 patients had DXA completed (“at-risk” group. Ninety-five patients not meeting guidelines-based risk factors also had DXA completed (“not at-risk” group. 139 (70.9% patients in “at-risk” group had low BMD, while 51 (53.7% of “not-at-risk” patients had low BMD. Majority of the patients with osteoporosis (83.3% missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47–6.42; P=0.003. Conclusions. Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.

  10. Clostridium difficile and pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Martinelli, Massimo; Strisciuglio, Caterina; Veres, Gabor

    2014-01-01

    BACKGROUND: Clostridium difficile infection is associated with pediatric inflammatory bowel disease (IBD) in several ways. We sought to investigate C. difficile infection in pediatric patients with IBD in comparison with a group of children with celiac disease and to evaluate IBD disease course...... period, stool specimens for C. difficile toxins analysis were collected from 112 children with celiac disease as controls. RESULTS: Clostridium difficile occurrence was significantly higher in patients with IBD compared with patients with celiac disease (7.5% versus 0.8%; P = 0.008). Clostridium...... difficile was associated with active disease in 71.4% of patients with IBD (P = 0.01). Colonic involvement was found in 85.7% of patients with C. difficile. Antibiotics, proton pump inhibitors, hospitalization, and IBD therapies were not associated with increased C. difficile detection. At 12 months...

  11. Inflammatory bowel disease and colorectal cancer

    Directory of Open Access Journals (Sweden)

    Andreja Ocepek

    2006-12-01

    Full Text Available Background: Colorectal cancer is one of the most frequent cancers in developed countries and Slovenia, and the incidence is still rising. Groups of people with higher risk for colorectal cancer are well defined. Among them are patients with inflammatory bowel disease. The risk is highest in patients in whom whole large bowel is affected by inflammation, it rises after 8 to 10 years and increases with the duration of the disease. Precancerous lesion is a displastic, chronically inflammed mucosa and not an adenoma as in cases of sporadic colorectal carcinoma.Conclusions: Many studies suggest that the influence of genetic factors differs between sporadic and inflammatory bowel disease related colorectal cancer. Symptomatic patients at the time of diagnosis have a much worse prognosis. The goal of prevention programes is therefore discovering early precancerous lesions. Established screening protocols are based on relatively frequent colonoscopies which are inconvinient for the patient as well as the endoscopist. Use of specific genetic markers, mutations of candidate genes, as a screening method and a prognostic predictor could greatly lighten therapeutic decisions.

  12. Nutritional status in patients with active inflammatory bowel disease: prevalence of malnutrition and methods for routine nutritional assessment.

    Science.gov (United States)

    Mijac, Dragana D; Janković, Goran L J; Jorga, Jagoda; Krstić, Miodrag N

    2010-08-01

    Malnutrition is a common feature of inflammatory bowel disease (IBD). There are numerous methods for the assessment of nutritional status, but the gold standard has not yet been established. The aims of the study were to estimate the prevalence of undernutrition and to evaluate methods for routine nutritional assessment of active IBD patients. Twenty-three patients with active Crohn disease, 53 patients with active ulcerative colitis and 30 controls were included in the study. The nutritional status was assessed by extensive anthropometric measurements, percentage of weight loss in the past 1-6 months and biochemical markers of nutrition. All investigated nutritional parameters were significantly different in IBD patients compared to control subjects, except MCV, tryglicerides and serum total protein level. Serum albumin level and body mass index (BMI) were the most predictive parameters of malnutrition. According to different assessment methods the prevalence of undernutrition and severe undernutrition in patients with active IBD were 25.0%-69.7% and 1.3%-31.6%, respectively, while in the control subjects no abnormalities have been detected. There was no statistically significant difference of nutritional parameters between UC and CD patients except lower mid-arm muscle circumference in UC group. Malnutrition is common in IBD patients. BMI and serum albumin are simple and convenient methods for the assessment of the nutritional status in IBD patients. Further studies with larger group of patients are necessary to elucidate the prevalence of malnutrition and the most accurate assessment methods in IBD patients.

  13. Nutrigenomics and inflammatory bowel diseases.

    Science.gov (United States)

    Ferguson, Lynnette R

    2010-07-01

    The field of nutrigenomics recognizes gene-diet interactions, with regard to both the impact of genetic variation on nutrient requirements, and conversely nutrient regulation of the expression of genes. Crohn's disease and ulcerative colitis are inflammatory bowel diseases for which twin studies reveal genetic susceptibility that is impacted by diet and environment. Apparently contradictory data on the role of diet in inflammatory bowel disease would be entirely explainable if genetic variability determined dietary requirements and intolerances. Considering Crohn's disease, we recognize three major classes of genes. The first of these involves bacterial recognition through pattern recognition receptors and autophagy genes, while the second act through secondary immune response, and the third concern epithelial barrier integrity. Despite genetic overlap with CD, the first two groups of genes appear to be less important in ulcerative colitis, while other genes, particularly those involved in barrier function, gain prominence. Case-control studies suggest that these different genetic groups reflect distinct dietary requirements. Such studies suggest nutrigenomic approaches to maintaining disease remission at present, and preventing disease development in the future.

  14. Surgical treatment of complex small bowel Crohn disease.

    Science.gov (United States)

    Michelassi, Fabrizio; Sultan, Samuel

    2014-08-01

    The clinical presentations of Crohn disease of the small bowel vary from low to high complexity. Understanding the complexity of Crohn disease of the small bowel is important for the surgeon and the gastroenterologist caring for the patient and may be relevant for clinical research as a way to compare outcomes. Here, we present a categorization of complex small bowel Crohn disease and review its surgical treatment as a potential initial step toward the establishment of a definition of complex disease. The complexity of small bowel Crohn disease can be sorted into several categories: technical challenges, namely, fistulae, abscesses, bowel or ureteral obstruction, hemorrhage, cancer and thickened mesentery; extensive disease; the presence of short gut; a history of prolonged use of medications, particularly steroids, immunomodulators, and biological agents; and a high risk of recurrence. Although the principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as strictureplasty techniques and limited resection margins, such practices by themselves are often not sufficient for the management of complex small bowel Crohn disease. This manuscript reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surgical strategy.

  15. Monitoring of small bowel Crohn's disease.

    Science.gov (United States)

    Kopylov, Uri; Koulaouzidis, Anastasios; Klang, Eyal; Carter, Dan; Ben-Horin, Shomron; Eliakim, Rami

    2017-11-01

    In recent years, the therapeutic paradigm in Crohn's disease has shifted from a mere symptom-oriented approach, to aiming to healing of the underlying inflammation and prevention of long-term structural complications. Such 'treat-to-target' approach may allow for a more stable disease course with less hospitalizations, lower requirement for surgery and improved quality of life. In Crohn's disease, the small bowel is affected in the majority of patients; frequently, Crohn's involves only the small bowel, which remains inaccessible to conventional ileocolonoscopic techniques. Thus, non-invasive monitoring techniques are crucial for accurate disease assessment. Areas covered: This review addresses the indications and clinical implications of non-invasive small bowel monitoring modalities (magnetic resonance enterography, intestinal ultrasound, capsule endoscopy) in the assessment and management of Crohn's disease. Expert commentary: This review addresses the limitations of the current knowledge and future areas of research, including the possible utilization of transmural healing as an imaging target and the need to establish clear quantitative target values to guide treatment by imaging findings in Crohn's disease.

  16. Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator.

    Directory of Open Access Journals (Sweden)

    Valérie Pittet

    Full Text Available Patient-reported disease perceptions are important components to be considered within a holistic model of quality of care. Gender may have an influence on these perceptions. We aimed to explore gender-specific concerns of patients included in a national bilingual inflammatory bowel disease cohort.Following a qualitative study, we built a questionnaire comprising 37 items of concern. Answers were collected on a visual analog scale ranging from 0 to 100. Principal axis factor analysis was used to explore concern domains. Linear multiple regressions were conducted to assess associations with patient characteristics.Of 1102 patients who replied to the survey, 54% were female and 54% had Crohn's disease. We identified six domains of concern: socialization and stigmatization, disease-related constraints and uncertainty, symptoms and their impact on body and mind, loss of body control (including sexuality, disease transmission, and long-term impact of the disease. Cancer concerns were among the highest scored by all patients (median 61.8. Severity of symptoms was the only factor associated with concerns, unrelated to dimension and gender (p40 years decreased disease-related constraints and uncertainty concerns, and being at home or unemployed increased them. Treatments were associated with increased socialization and stigmatization and with increased disease-related constraints and uncertainty concerns in men. Overall, psychosomatic characteristics were highly associated with concerns for both men and women. Depending on the concern dimensions, increased levels of concern were associated with the highest signs of anxiety in women or depression in men, as well as lower health-related quality of life in men.Patients have numerous concerns related to their illness that need to be reassessed regularly. Concerns differ between men and women, suggesting that information and communication about the disease should take gender differences and subjective

  17. Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator.

    Science.gov (United States)

    Pittet, Valérie; Vaucher, Carla; Froehlich, Florian; Burnand, Bernard; Michetti, Pierre; Maillard, Michel H

    2017-01-01

    Patient-reported disease perceptions are important components to be considered within a holistic model of quality of care. Gender may have an influence on these perceptions. We aimed to explore gender-specific concerns of patients included in a national bilingual inflammatory bowel disease cohort. Following a qualitative study, we built a questionnaire comprising 37 items of concern. Answers were collected on a visual analog scale ranging from 0 to 100. Principal axis factor analysis was used to explore concern domains. Linear multiple regressions were conducted to assess associations with patient characteristics. Of 1102 patients who replied to the survey, 54% were female and 54% had Crohn's disease. We identified six domains of concern: socialization and stigmatization, disease-related constraints and uncertainty, symptoms and their impact on body and mind, loss of body control (including sexuality), disease transmission, and long-term impact of the disease. Cancer concerns were among the highest scored by all patients (median 61.8). Severity of symptoms was the only factor associated with concerns, unrelated to dimension and gender (pwomen, being >40 years decreased disease-related constraints and uncertainty concerns, and being at home or unemployed increased them. Treatments were associated with increased socialization and stigmatization and with increased disease-related constraints and uncertainty concerns in men. Overall, psychosomatic characteristics were highly associated with concerns for both men and women. Depending on the concern dimensions, increased levels of concern were associated with the highest signs of anxiety in women or depression in men, as well as lower health-related quality of life in men. Patients have numerous concerns related to their illness that need to be reassessed regularly. Concerns differ between men and women, suggesting that information and communication about the disease should take gender differences and subjective

  18. Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies for inflammatory bowel disease : High prevalence in patients with celiac disease

    NARCIS (Netherlands)

    Damoiseaux, JGMC; Bouten, B; Linders, AMLW; Austen, J; Roozendaal, C; Russel, MGVM; Forget, PP; Tervaert, JWC

    Both celiac disease and inflammatory bowel disease (IBD) are characterized by chronic diarrhea and the presence of distinct (auto)antibodies. In the present study we wanted to determine the prevalence of serological markers for inflammatory bowel disease, i.e., perinuclear antineutrophil cytoplasmic

  19. FOXP3+ T Regulatory Cell Modifications in Inflammatory Bowel Disease Patients Treated with Anti-TNFα Agents

    Directory of Open Access Journals (Sweden)

    Luisa Guidi

    2013-01-01

    Full Text Available Treg modulation has been hypothesized as one of the mechanisms by which antitumor necrosis factor α (TNFα agents exert their action in rheumatoid arthritis (RA and inflammatory bowel disease (IBD. However, data in IBD are still conflicting. We evaluated CD4+CD25+FOXP3+ (Tregs by flow cytometry in peripheral blood from 32 adult IBD patient before (T0 and after the induction of anti-TNFα therapy (T1. Eight healthy controls (HCs were included. We also evaluated the number of FOXP3+ cells in the lamina propria (LP in biopsies taken in a subset of patients and controls. Treg frequencies were significantly increased in peripheral blood from our patients after anti-TNFα therapy compared to T0. T1 but not T0 levels were higher than HC. The increase was detectable only in clinical responders to the treatment. A negative correlation was found among delta Treg levels and the age of patients or disease duration and with the activity score of Crohn’s disease (CD. No significant differences were found in LP FOXP3+ cells. Our data suggest the possibility that in IBD patients the treatment with anti-TNFα may affect Treg percentages and that Treg modifications may correlate with clinical response, but differently in early versus late disease.

  20. FOXP3⁺ T regulatory cell modifications in inflammatory bowel disease patients treated with anti-TNFα agents.

    Science.gov (United States)

    Guidi, Luisa; Felice, Carla; Procoli, Annabella; Bonanno, Giuseppina; Martinelli, Enrica; Marzo, Manuela; Mocci, Giammarco; Pugliese, Daniela; Andrisani, Gianluca; Danese, Silvio; De Vitis, Italo; Papa, Alfredo; Armuzzi, Alessandro; Rutella, Sergio

    2013-01-01

    Treg modulation has been hypothesized as one of the mechanisms by which antitumor necrosis factor α (TNFα) agents exert their action in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). However, data in IBD are still conflicting. We evaluated CD4⁺CD25⁺FOXP3⁺ (Tregs) by flow cytometry in peripheral blood from 32 adult IBD patient before (T0) and after the induction of anti-TNFα therapy (T1). Eight healthy controls (HCs) were included. We also evaluated the number of FOXP3⁺ cells in the lamina propria (LP) in biopsies taken in a subset of patients and controls. Treg frequencies were significantly increased in peripheral blood from our patients after anti-TNFα therapy compared to T0. T1 but not T0 levels were higher than HC. The increase was detectable only in clinical responders to the treatment. A negative correlation was found among delta Treg levels and the age of patients or disease duration and with the activity score of Crohn's disease (CD). No significant differences were found in LP FOXP3⁺ cells. Our data suggest the possibility that in IBD patients the treatment with anti-TNFα may affect Treg percentages and that Treg modifications may correlate with clinical response, but differently in early versus late disease.

  1. Avoidance and Inhibition Do Not Predict Nonrespondent Bias Among Patients With Inflammatory Bowel Disease

    Science.gov (United States)

    Cámara, Rafael J. A.; Begré, Stefan; von Känel, Roland

    2011-01-01

    Background It has been suggested that participant withdrawal from studies can bias estimates. However, this is only possible when withdrawers and nonwithdrawers differ in an important way. We tested the hypothesis that withdrawers are more likely than nonwithdrawers to be avoidant and negatively affected. Methods A total of 1160 participants with inflammatory bowel disease were recruited at different sites in Switzerland. Their levels of avoidance coping and negative affectivity were rated by means of 2 short baseline questionnaires. One year later, they were sent a longer follow-up questionnaire. The primary outcome was return versus non-return of the follow-up questionnaire within 3 months. After controlling for potential confounders identified in an extensive literature search, we estimated the odds of returning the follow-up questionnaire for 1 standard deviation of avoidance coping and negative affectivity. Results The odds ratio for 1 standard deviation was 1.03 (95% confidence interval: 0.89–1.18) for avoidance coping and 1.02 (0.89–1.17) for negative affectivity. Conclusions The odds of returning the questionnaires did not depend on avoidance coping or negative affectivity. PMID:21088371

  2. Accumulation of Mast Cells in the Lesions and Effects of Antiallergic Drugs on the Patients with Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Motohiro Kurosawa

    2013-01-01

    Full Text Available The pathomechanism of inflammatory bowel disease (IBD has not yet been fully demonstrated. However, it is well known that mast cells are present in the gastrointestinal tract, suggesting that mast cells may take part in it. So, we investigated the number of mast cells in IBD, such as ulcerative colitis (UC and eosinophilic colitis, and showed that the number of mast cells was increased in the inflammatory lesions. We also presented a case of UC which was treated successfully with an antiallergic drug, tranilast. Furthermore, possible new approaches to treating the disease with immunomodulators including suplatast are introduced. However, our investigations were performed with a limited number of patients with IBD, and additional further studies are required to confirm the findings.

  3. Prevalence of hepatobiliary dysfunction in a regional group of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Wewer, V; Gluud, C; Schlichting, P

    1991-01-01

    primary sclerosing cholangitis, of whom two were primarily diagnosed; one patient had cholangiocarcinoma also primarily diagnosed; and two patients were found to have alcoholic hepatic damage. Among the 125 patients with Crohn's disease, 38 (30%; 95% confidence limits, 23-38%) had at least 1 abnormal...

  4. A Patient With Parenteral Nutrition-Dependent Short Bowel Syndrome and Cardiovascular Disease With 4-Year Exposure to Teduglutide.

    Science.gov (United States)

    Compher, Charlene; Levinson, Katherine Boothe; Cambor, Carolyn L; Stoner, Nancy; Boullata, Joseph I; Piarulli, Amanda; Kinosian, Bruce

    2016-07-01

    Clinical trials of the glucagon-like peptide 2 analogue teduglutide resulted in approval of the drug by the Food and Drug Administration in 2012 as a treatment for parenteral nutrition-dependent short bowel syndrome in adults. This report presents the case study of a man with short bowel syndrome caused by portal vein thrombosis who had 4 years exposure to the drug at the time of his death due to cardiovascular disease. © 2015 American Society for Parenteral and Enteral Nutrition.

  5. Over-reaching beyond disease activity: the influence of anxiety and medical economic burden on health-related quality of life in patients with inflammatory bowel disease.

    Science.gov (United States)

    Luo, Xia-Peng; Mao, Ren; Chen, Bai-Li; Qiu, Yun; Zhang, Sheng-Hong; He, Yao; Chen, Jie; Zeng, Zhi-Rong; Ben-Horin, Shomron; Chen, Min-Hu

    2017-01-01

    Many patients with inflammatory bowel disease (IBD) have impaired health-related quality of life (HRQOL). The influence of psychological and economic factors on HRQOL has not been fully elucidated in IBD. Therefore, we aimed to identify the predictors of HRQOL in an IBD cohort. This was a cross-sectional cohort study of patients presenting to our tertiary IBD center. HRQOL was measured using the 36-item Short Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Perceived stress and perceived social support were also assessed by standardized scales. Demographic, socioeconomic and clinical data were obtained from a prespecified questionnaire and patients' medical records. Univariate analyses and multiple regression analysis were performed to identify predictors of HRQOL. A total of 242 IBD patients were recruited, and the questionnaire return rate was 90.5% (219/242). The prevalence rates of anxiety and depression were 24.7% and 17.4%, respectively. In all, 30.6% of the patients spent over half of their income to cover medical costs. Multivariate analysis revealed that anxiety symptoms (P<0.001), active disease (P<0.001) and higher medical expenditures (P=0.001) were strong and independent predictors of reduced HRQOL. Psychological factors and costs of medical care strongly impair HRQOL in IBD, independent of the disease activity. Psychological counseling and socioeconomic support programs should be considered for integration into the management of IBD patients.

  6. Effective advocacy for patients with inflammatory bowel disease: communication with insurance companies, school administrators, employers, and other health care overseers.

    Science.gov (United States)

    Jaff, Jennifer C; Arnold, Janis; Bousvaros, Athos

    2006-08-01

    In addition to their physical challenges, children and adolescents with inflammatory bowel disease (IBD) living in the United States face a number of administrative and regulatory hurdles that affect their quality of life. This article, written by a physician, attorney/patient advocate, and social worker, discusses a number of these challenges and describes how the provider can help his or her patient overcome them. Specifically, the article discusses 4 areas in detail: appeals of denials of coverage from insurance companies and third party payors; assisting children with IBD with classroom and school accommodations; assisting uninsured children in obtaining Social Security benefits; and aiding a parent to care for their child using the Family and Medical Leave Act. Although this article has a pediatric focus, adults have similar advocacy needs. Case examples and sample letters to third-party payors, schools, and employers are included in this article.

  7. The Changing Phenotype of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Carthage Moran

    2016-01-01

    Full Text Available It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades.

  8. The Changing Phenotype of Inflammatory Bowel Disease

    Science.gov (United States)

    Sheehan, Donal; Shanahan, Fergus

    2016-01-01

    It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD) worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades. PMID:28050166

  9. Comparison of Quantiferon-TB Gold versus tuberculin skin test for tuberculosis screening in inflammatory bowel disease patients.

    Science.gov (United States)

    Andrisani, Gianluca; Armuzzi, Alessandro; Papa, Alfredo; Marzo, Manuela; Felice, Carla; Pugliese, Daniela; De Vitis, Italo; Rapaccini, Gian Lodovico; Guidi, Luisa

    2013-03-01

    Screening for latent tuberculosis (LTB) is recommended before starting anti-TNF-alpha therapy. We compared the performance of Quantiferon-TB Gold (QFT-G) with the tuberculin skin test (TST) for the screening of LTB in a population of inflammatory bowel disease (IBD) patients who were candidates for anti-TNF-α therapy. Ninety-two IBD patients who were candidates for anti-TNF-α therapy were tested with QTF-G and TST. Concomitant therapy and laboratory parameters were recorded. One subject was vaccinated with Bacille Calmette Guèrin (BCG), 76% of patients were on immunosuppressive therapy (IST), and all patients had a negative TB history and negative chest X-ray. Agreement between the two tests was observed in 89.2% of patients (79.4% +/+, 9.8% -/-), QFT-G+/TST- was observed in 4.4% (4) patients, and QFT-G-/TST+ was observed in 5.5%, one of which was previously vaccinated. All disagreements were observed in patients on IST (14.3% in this group). The agreement analysis showed moderate strength among the patients (k=0.508), while the agreement was only fair in the subgroup of patients on IST (k=0.388). Given the high risk of LTB reactivation in patients subjected to anti-TNF-α therapy, our results suggest that in our population, with low TB rate and very low BCG vaccination rate, both tests could be employed.

  10. Intestinal barrier integrity and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Holmberg, Fredrik Eric Olof; Pedersen, Jannie; Jørgensen, Peter

    2017-01-01

    Disruption of normal barrier function is a fundamental factor in the pathogenesis of inflammatory bowel disease, which includes increased epithelial cell death, modified mucus configuration, altered expression and distribution of tight junction-proteins, along with a decreased expression......, novel treatment strategies to accomplish mucosal healing and to re-establish normal barrier integrity in inflammatory bowel disease are warranted, and luminal stem cell-based approaches might have an intriguing potential. Transplantation of in vitro expanded intestinal epithelial stem cells derived...... either directly from mucosal biopsies or from directed differentiation of human pluripotent stem cells may constitute complementary treatment options for patients with mucosal damage, as intestinal epithelial stem cells are multipotent and may give rise to all epithelial cell types of the intestine...

  11. Vedolizumab in pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Ledder, Oren; Assa, Amit; Levine, Arie

    2017-01-01

    Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with Inflammatory Bowel Disease (IBD), but the data in pediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-center pediatric IBD cohort. Method: Retro...... was safe and effective in this cohort of pediatric refractory IBD. These data support previous findings of slow induction rate of vedolizumab in CD and a trend to be less effective compared to patients with UC.......Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with Inflammatory Bowel Disease (IBD), but the data in pediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-center pediatric IBD cohort. Method...

  12. Heritability in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Gordon, Hannah; Trier Moller, Frederik; Andersen, Vibeke

    2015-01-01

    estimation regard genetic and environmental variance as separate entities, although it is now understood that there is a complex multidirectional interplay between genetic are environmental factors mediated by the microbiota, the epigenome, and the innate and acquired immune systems. Due to the limitations...... of heritability estimates, it is unlikely that a true value for heritability will be reached. Further work aimed at quantifying the variance explained across GWAS, epigenome-wide, and microbiota-wide association studies will help to define factors leading to inflammatory bowel disease....

  13. [Morphological and immunohistochemical characteristic of oral mucosa in patients with inflammatory bowel disease].

    Science.gov (United States)

    Kvetnoĭ, I M; Robakidze, N S; Kostiuchek, I N; Shchukina, O B; Proshchaev, K I

    2010-01-01

    The aim of presented study was to investigate the morphological and immunohistochemical characteristics of the oral mucosa in patients with Crohn's disease and ulcerative colitis. The study involved 40 patients aged from 18 to 64 years, among them 30 patients with Crohn's disease and 10 patients with ulcerative colitis. Clinical, endoscopic, morphometric and immunohistochemical study have shown that Crohn's disease is characterized by generalized inflammation in the gastrointestinal tract with signs of immune inflammation in the mouth, whereas in ulcerative colitis the pathologic process is limited to the colon. In this context, the defeat of the oral mucosa can be regarded as a distinct phenotypic characteristic of the localization of Crohn's disease, with some differential-diagnostic and prognostic criteria.

  14. Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study.

    Science.gov (United States)

    Click, Benjamin; Anderson, Alyce M; Ramos Rivers, Claudia; Koutroubakis, Ioannis E; Hashash, Jana G; Dunn, Michael A; Schwartz, Marc; Swoger, Jason; Barrie, Arthur; Szigethy, Eva; Regueiro, Miguel; Schoen, Robert E; Binion, David G

    2017-04-27

    Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (Pfinancial charges the following year after controlling for demographic, utilization, and medication covariates. Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.

  15. Role of capsule endoscopy in inflammatory bowel disease.

    Science.gov (United States)

    Kopylov, Uri; Seidman, Ernest G

    2014-02-07

    Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn's disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.

  16. Frequency, risk factors, and adverse sequelae of bone loss in patients with ostomy for inflammatory bowel diseases.

    Science.gov (United States)

    Gupta, Supriya; Wu, Xianrui; Moore, Travis; Shen, Bo

    2014-02-01

    Bone loss in patients with inflammatory bowel disease (IBD) with ostomy has not been systemically studied. The aims of the study were to evaluate the frequency, risk factors, and sequelae of bone loss in patients with IBD and stomas and to monitor the change in bone mineral density (BMD) over time after ostomy. A total of 126 patients met the inclusion criteria (i.e., those with IBD diagnosis and stoma), including ileostomy (N = 120), colostomy (N = 3), and jejunostomy (N = 3). BMD was measured on dual-energy X-ray absorptiometry (DEXA). Patients were classified as having normal or low BMD based on the International Society for Clinical Densitometry criteria. Thirty-two demographic and clinical variables were evaluated with logistic regression models. At a median of 6.6 years (interquartile range, 2-18.7 yr) after stoma, 37 (29.4%) patients had a low BMD. On univariate analysis, there were no significant differences between the normal and low BMD groups in the following variables: gender, race, age at diagnosis of IBD, prevalence of Crohn's disease and ulcerative colitis, age at ostomy, duration from diagnosis to DEXA and from ostomy to DEXA, menopausal age, diabetes, hypothyroidism, renal stones, short bowel syndrome, history of smoking or excessive alcohol use, family history of IBD or osteoporosis, daily calcium and vitamin D supplement, estrogen replacement, and steroid use. Body mass index was significantly lower in the low BMD group than the normal BMD group (23.3 ± 5.5 versus 26.0 ± 5.2, P = 0.013). Fragility fracture occurred in 8 (21.6%) patients in low BMD group and 4 (4.5%) patients in normal BMD group (P = 0.006). In a multivariate analysis, low body mass index was the only covariate-adjusted factor associated with low BMD. In patients with multiple DEXA scans available over time after ostomy, hip BMD was found to improve marginally, and the lumbar and femoral BMD remained stable. Low BMD was common in patients with IBD after ostomy, largely based on

  17. Pregnancy and inflammatory bowel disease: Do we provide enough patient education? A British study of 1324 women.

    Science.gov (United States)

    Carbery, Isabel; Ghorayeb, Jihane; Madill, Anna; Selinger, Christian P

    2016-09-28

    To examine patient knowledge and factors influencing knowledge about pregnancy in British women with inflammatory bowel disease (IBD). This is a post hoc analysis of a study of female members of Crohn's and Colitis United Kingdom, aged 18-45 years who were sent an online questionnaire recording patient demographics, education, employment, marital status, and disease characteristics. Disease related pregnancy knowledge was recorded using Crohn's and colitis pregnancy knowledge score (CCPKnow). Of 1324 responders, 776 (59%) suffered from Crohn's disease, 496 (38%) from ulcerative colitis and 52 (4%) from IBD-uncategorised. CCPKnow scores were poor (0-7) in 50.8%, adequate (8-10) in 23.6%, good (11-13) in 17.7% and very good (≥ 14) in 7.8%. Multiple linear regression analysis revealed that higher CCPKnow scores were independently associated with higher educational achievement (P pregnancy and IBD (P = 0.001). Knowledge was poor in 50%. Speaking with health-care professionals was a modifiable factor associated with better knowledge. This illustrates the importance of disease related pregnancy education.

  18. Effects and treatment of inflammatory bowel disease during pregnancy

    OpenAIRE

    Brar, Harvinder; Einarson, Adrienne

    2008-01-01

    QUESTION I have several patients with inflammatory bowel disease (IBD) who are pregnant or planning pregnancies. What information can I give them regarding the possible effects of IBD on pregnancy and the medications used to treat IBD during pregnancy?

  19. The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease.

    Science.gov (United States)

    Yanartas, O; Kani, H T; Bicakci, E; Kilic, I; Banzragch, M; Acikel, C; Atug, O; Kuscu, K; Imeryuz, N; Akin, H

    2016-01-01

    Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn's disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn's disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.

  20. Frequency of Celiac Disease in Irritable Bowel Syndrome Patients with Predominant Diarrhea Referred to Gastroenterology Clinics in Yazd, Iran

    Directory of Open Access Journals (Sweden)

    Rabei

    2011-12-01

    Full Text Available Introduction: Irritable Bowel Syndrome(IBS is a common clinical syndrome that presents with abdominal pain, diarrhea and constipation, and flatulence which may be intermittent. Also celiac disease, an enteropathy due to gluten sensitivity, presents with diarrhea resulting from mal-absorption, which should be considered as a differential diagnosis of IBS. If celiac is diagnosed in a patient suspicious to IBS, the treatment method will be changed completely. This study was designed to evaluate celiac disease in IBS patients. Methods: A cross-sectional study was conducted on 125 patients 15-50 years old suffering from IBS with diarrhea- predominant clinical picture, who were referred to Yazd gastroenterology clinics. The study data including age, gender and results of anti TTG measurement were collected and analyzed by SPSS 13. Duodenal biopsy was performed in patients that were positive for anti TTG for confirmation of diagnosis. Results: 125 patients suffering from IBS with diarrhea- predominant clinical picture entered the study. Their mean age was 29.85±9.22 years. 74 subjects (59.2% were males and 51 (40.8% were females. Four patients showed positive anti TTG (3 males and 1 female. Duodenal biopsy was performed and diagnosis of celiac disease was confirmed in all four patients (3 with March II and with March I grade. Totally the frequency of celiac disease was 3.2% in this study. There was no significant relationship between age, gender and anti TTG results, which can be explained by small sample size. Conclusion: According to the results of the study and the frequency of celiac, it is not an uncommon and rare disease, so it should be considered as one of the differential diagnoses of IBS.

  1. Inflammatory bowel disease patients are frequently nonadherent to scheduled induction and maintenance infliximab therapy: A Canadian cohort study

    Science.gov (United States)

    Ma, Christopher; Evaschesen, Chad J; Gracias, Grenvil; Huang, Vivian W; Fedorak, Darryl K; Kroeker, Karen I; Dieleman, Levinus A; Halloran, Brendan P; Fedorak, Richard N

    2015-01-01

    BACKGROUND: Adherence to maintenance medication regimens in inflammatory bowel disease patients has traditionally been poor. Although infliximab has demonstrated efficacy in inducing and maintaining disease remission, adherence to regularly scheduled infliximab infusions is required to maintain therapeutic trough drug levels and prevent the development of anti-infliximab antibodies. OBJECTIVES: To characterize patient adherence to regularly scheduled induction and maintenance infliximab infusions. METHODS: A retrospective cohort study was conducted evaluating adult outpatients with Crohn disease or ulcerative colitis on an induction or maintenance regimen of regularly scheduled infliximab from 2008 to 2010 at the University of Alberta (Edmonton, Alberta). Nonadherence was defined by a discrepancy of >72 h between the scheduled date of infusion and the actual date of administration. Patients were defined as nonadherent if they received infliximab infusions per schedule. RESULTS: A total of 215 patients (173 Crohn disease, 42 ulcerative colitis) met the inclusion criteria. Patients received a median of 12.0 infliximab infusions (interquartile range 7.0 to 13.0) during the study period; 412 induction and 1837 maintenance infliximab infusions were administered. Of 140 patients, 109 (77.9%) were adherent to their infliximab induction regimen, while 68 of 215 (31.6%) were adherent to their infliximab maintenance regimen. One hundred ninety-eight of 215 (92.1%) patients received at least one delayed maintenance infliximab infusion and 20 (10.1%) received maintenance infusions, on average, >1 week late. CONCLUSIONS: While three-quarters of patients are adherent to infliximab induction therapy, fewer than one-third remained adherent to their scheduled maintenance infliximab regimen. PMID:26069894

  2. Use of complementary and alternative medicine in Germany – a survey of patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Hahn Eckhart G

    2006-05-01

    Full Text Available Abstract Background Previous studies have suggested an increasing use of complementary and alternative medicine (CAM in patients with inflammatory bowel disease (IBD. The aim of our study was to evaluate the use of CAM in German patients with IBD. Methods A questionnaire was offered to IBD patients participating in patient workshops which were organized by a self-help association, the German Crohn's and Colitis Association. The self-administered questionnaire included demographic and disease-related data as well as items analysing the extent of CAM use and satisfaction with CAM treatment. Seven commonly used CAM methods were predetermined on the questionnaire. Results 413 questionnaires were completed and included in the analysis (n = 153 male, n = 260 female; n = 246 Crohn's disease, n = 164 ulcerative colitis. 52 % of the patients reported CAM use in the present or past. In detail, homeopathy (55%, probiotics (43%, classical naturopathy (38%, Boswellia serrata extracts (36% and acupuncture/Traditional Chinese Medicine (TCM (33% were the most frequently used CAM methods. Patients using probiotics, acupuncture and Boswellia serrata extracts (incense reported more positive therapeutic effects than others. Within the statistical analysis no significant predictors for CAM use were found. 77% of the patients felt insufficiently informed about CAM. Conclusion The use of CAM in IBD patients is very common in Germany, although a large proportion of patients felt that information about CAM is not sufficient. However, to provide an evidence-based approach more research in this field is desperately needed. Therefore, physicians should increasingly inform IBD patients about benefits and limitations of CAM treatment.

  3. Management of psoriasis in patients with inflammatory bowel disease: From the Medical Board of the National Psoriasis Foundation.

    Science.gov (United States)

    Whitlock, Scott M; Enos, Clinton W; Armstrong, April W; Gottlieb, Alice; Langley, Richard G; Lebwohl, Mark; Merola, Joseph F; Ryan, Caitriona; Siegel, Michael P; Weinberg, Jeffrey M; Wu, Jashin J; Van Voorhees, Abby S

    2018-02-01

    There is a significant association between psoriasis and inflammatory bowel disease (IBD). Many treatments for psoriasis and psoriatic arthritis are also used for IBD. To assess therapeutic options for patients with psoriasis and concurrent IBD. A systematic literature search was performed for clinical studies of biologic and systemic psoriasis medications in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease, for the period from January 1, 1947, to February 14, 2017. Randomized, controlled, double-blinded studies were selected if available. If not, the next highest level of available evidence was selected. Of the 2282 articles identified, 132 were selected. Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative; colitis, and Crohn's disease. Ustekinumab has demonstrated efficacy in psoriasis, psoriatic arthritis, and Crohn's disease. Certolizumab has demonstrated efficacy in psoriatic arthritis and Crohn's disease. Etanercept, secukinumab, brodalumab, and ixekizumab have demonstrated efficacy in psoriasis and psoriatic arthritis but may exacerbate or induce IBD. Guselkumab has demonstrated efficacy in psoriasis. There are no known clinical trials of treatment specifically for concurrent psoriasis and IBD. Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease; other agents have demonstrated efficacy for some, but not all, of these indications. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Development and Application of a Plant-Based Diet Scoring System for Japanese Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Chiba, Mitsuro; Nakane, Kunio; Takayama, Yuko; Sugawara, Kae; Ohno, Hideo; Ishii, Hajime; Tsuda, Satoko; Tsuji, Tsuyotoshi; Komatsu, Masafumi; Sugawara, Takeshi

    2016-01-01

    Plant-based diets (PBDs) are a healthy alternative to westernized diets. A semivegetarian diet, a PBD, has been shown to prevent a relapse in Crohn disease. However, there is no way to measure adherence to PBDs. To develop a simple way of evaluating adherence to a PBD for Japanese patients with inflammatory bowel disease (IBD). PBD scores were assigned according to the frequency of consumption provided on a food-frequency questionnaire, obtained on hospitalization for 159 patients with ulcerative colitis and 70 patients with Crohn disease. Eight items considered to be preventive factors for IBD were scored positively, and 8 items considered to be IBD risk factors were scored negatively. The PBD score was calculated from the sum of plus and minus scores. Higher PBD scores indicated greater adherence to a PBD. The PBD scores were evaluated on hospitalization and 2 years after discharge for 22 patients with Crohn disease whose dietary pattern and prognosis were established. Plant-Based Diet score. The PBD scores differed significantly, in descending order, by dietary type: pro-Japanese diet, mixed type, and pro-westernized diet (Wilcoxon/Kruskal-Wallis test). The PBD scores in the ulcerative colitis and Crohn disease groups were 10.9 ± 9.5 and 8.2 ± 8.2, respectively. For patients with Crohn disease, those with long-term remission and normal C-reactive protein concentration were significantly more likely to have PBD scores of 25 or greater than below 25 (χ2). The PBD score is a valid assessment of PBD dietary adherence.

  5. Information resources used by patients with inflammatory bowel disease: Satisfaction, expectations and information gaps.

    Science.gov (United States)

    Catalán-Serra, Ignacio; Huguet-Malavés, Jose María; Mínguez, Miguel; Torrella, Emilio; Paredes, Jose María; Vázquez, Narciso; Ramírez, Jose Joaquín; Calvo, Félix; Nos, Pilar; Gutiérrez, Ana; Palau, Antonio; Cortés, Javier; Ramón-Monllor, Pilar; Hinojosa, Joaquín

    2015-01-01

    Information received by IBD patients about their disease is of particular importance. The objective of the study was to determine the information resources these patients used, together with their perceived information gaps and expected preferences. A prospective, observational, cross-sectional study conducted on IBD patients attending 13 Spanish hospitals during 2008. Patients completed a semi-structured 52-question survey. Survey was adequately completed by 379 of 385 patients (98%), of whom 57% had Crohn's disease and 43% ulcerative colitis. Mean patient age was 37.9 years (range, 16-76 years). Gastroenterologists were the most commonly used resource (98%), followed by the Internet (60%), and general practitioners (50%). More than 90% reported good to excellent satisfaction with gastroenterologists, nurses, and patients' associations. Only 56% considered their information needs to be covered. The Internet was mostly used by young patients and those with a high education level. In the future, 85% of the patients would like to receive information from the gastroenterologists, and 92% by face-to-face interviews. Patients mainly want additional information on treatment (medical and surgical), clinical manifestations, cancer, and mortality risks. They also think that they are poorly informed about their social and work rights, risks of cancer and death, and research trials. Patients with IBD use and prefer gastroenterologists as the main source of information, but only half of them consider their information needs to be covered. Copyright © 2014 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  6. Depression and anxiety levels in therapy-na(i)ve patients with inflammatory bowel disease and cancer of the colon

    Institute of Scientific and Technical Information of China (English)

    Branislav R Filipovi(c); Branka F Filipovi(c); Mirko Kerkez; Nikola Milini(c); Tomislav Ran(d)elovi(c)

    2007-01-01

    AIM: To assess whether depression and anxiety are more expressed in patients with the first episode of inflammatory bowel disease (IBD) than in individuals with newly discovered cancer of the colon (CCa).METHODS: A total of 32 patients with IBD including 13males and 19 females, aged 27 to 74, and 30 patients with CCa including 20 males and 10 females, aged 39-78,underwent a structured interview, which comprised Hamilton's Depression Rating Inventory, Hamilton's Anxiety Rating Inventory and Paykel's Stressful Events Rating Scale.RESULTS: Patients of the IBD group expressed both depression and anxiety. Depressive mood, sense of guilt, psychomotor retardation and somatic anxiety were also more pronounced in IBD patients. The discriminant function analysis revealed the total depressive score was of high importance for the classification of a newly diagnosed patient into one of the groups.CONCLUSION: Newly diagnosed patients with IBD have higher levels of depression and anxiety. Moreover, a psychiatrist in the treatment team is advisable from the beginning.

  7. Patients' knowledge of pregnancy-related issues in inflammatory bowel disease and validation of a novel assessment tool ('CCPKnow').

    Science.gov (United States)

    Selinger, C P; Eaden, J; Selby, W; Jones, D B; Katelaris, P; Chapman, G; McDonald, C; McLaughlin, J; Leong, R W L; Lal, S

    2012-07-01

    Inflammatory bowel diseases (IBD) require complex therapeutic decisions and life choices concerning pregnancy, but little is known about patient's knowledge of IBD and its treatment before and during pregnancy. To develop a novel tool (Crohn's and Colitis Pregnancy Knowledge Score 'CCPKnow') to assess knowledge of pregnancy-related issues in IBD. The validated tool was then applied to determine knowledge in patients. Discriminate ability of 'CCPKnow' was validated in four groups with different levels of IBD knowledge. Reliability and readability were tested by Cronbach-α and Flesch-Kencaid. Construct validity was subsequently assessed against general IBD knowledge (CCKnow) in 145 women with IBD. Associations between patient factors and knowledge were studied. Median CCPKnow scores differed significantly between the validation groups (P disease duration and Crohn's disease. Crohn's and Colitis Pregnancy Knowledge Score, a novel knowledge assessment tool of pregnancy and IBD, demonstrated excellent test characteristics. We found that nearly half of the women with IBD had poor knowledge, identifying a pressing need for better education. © 2012 Blackwell Publishing Ltd.

  8. The effectiveness of cognitive behavioral therapy on the quality of life of patients with inflammatory bowel disease : Multi-center design and study protocol (KL!C- study)

    NARCIS (Netherlands)

    Bennebroek Evertsz', Floor; Bockting, Claudi L H; Stokkers, Pieter C F; Hinnen, Chris; Sanderman, Robbert; Sprangers, Mirjam A G

    2012-01-01

    BACKGROUND: Inflammatory Bowel Disease (IBD) patients report poorer quality of life (QoL) and more anxiety and depressive symptoms than controls from the general population. Cognitive behavioral therapy (CBT) is effective for anxiety and depression, but questionable in case of co-morbidity with IBD.

  9. Effectiveness of Cognitive-Behavioral Therapy on Quality of Life, Anxiety, and Depressive Symptoms Among Patients With Inflammatory Bowel Disease : A Multicenter Randomized Controlled Trial

    NARCIS (Netherlands)

    Evertsz, Floor Bennebroek; Sprangers, Mirjam A. G.; Sitnikova, Kate; Stokkers, Pieter C. F.; Ponsioen, Cyriel Y.; Bartelsman, Joep F. W. M.; van Bodegraven, Ad A.; Fischer, Steven; Depla, Annekatrien C. T. M.; Mallant, Rosalie C.; Sanderman, Robbert; Burger, Huibert; Bockting, Claudi L. H.

    Objective: Inflammatory bowel disease (IBD) is characterized by a low level of quality of life (QoL) and a high prevalence of anxiety and depression, especially in patients with poor QoL. We examined the effect of IBD-specific cognitive-behavioral therapy (CBT) on QoL, anxiety, and depression in IBD

  10. Effectiveness of cognitive-behavioral therapy on quality of life, anxiety, and depressive symptoms among patients with inflammatory bowel disease : A multicenter randomized controlled trial

    NARCIS (Netherlands)

    Bennebroek Evertsz', Floor; Sprangers, Mirjam A. G.; Sitnikova, Kate; Stokkers, Pieter C. F.; Ponsioen, Cyriel Y.; Bartelsman, Joep F W M; van Bodegraven, Ad A.; Fischer, Steven; Depla, Annekatrien C T M; Mallant, Rosalie C; Sanderman, Robbert; Burger, Huibert; Bockting, Claudi L H|info:eu-repo/dai/nl/258267992

    OBJECTIVE: Inflammatory bowel disease (IBD) is characterized by a low level of quality of life (QoL) and a high prevalence of anxiety and depression, especially in patients with poor QoL. We examined the effect of IBD-specific cognitive-behavioral therapy (CBT) on QoL, anxiety, and depression in IBD

  11. Pregnancy outcome in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bortoli, A; Pedersen, N; Duricova, D

    2011-01-01

    Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies.......Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies....

  12. Surgical perspectives on inflammatory bowel disease

    African Journals Online (AJOL)

    VikasC

    J. Inflammatory bowel disease in Towsend: Sabiston. Textbook of Surgery. ... 1998; 44:28991. 19. Xie J, Itzkowitz SH. Cancer in inflammatory bowel disease. World J Gastroenterol 2008;14:37889. 20. Roses RE, Rombeau JL. Recent trends in the surgical ... dyselectrolytemia, anemia, and malnutrition are commonly present.

  13. Childhood Inflammatory Bowel Disease in Libya: Epidemiological ...

    African Journals Online (AJOL)

    Background & Aims: Inflammatory bowel disease is thought to be rare in Libya. The aim is to determine the prevalence of juvenile onset inflammatory bowel disease in Libya. Setting: Al-Fateh childrens' hospital, Benghazi, Libya. Methods: This is a retrospective study of all cases diagnosed over 10 years (1997-2006) with ...

  14. The prevalence of radiographic sacroiliitis in patients affected by inflammatory bowel disease with inflammatory low back pain

    Directory of Open Access Journals (Sweden)

    A. Lo Nigro

    2011-09-01

    Full Text Available Inflammatory bowel diseases (IBD, are Crohn’s disease (CD or ulcerative colitis (UC, are frequently complicated by joint complaints with prevalence that varies between 10 and 28 %. The IBD related arthropathy may be expressed as peripheral arthritis or axial one frequently indistinguishable from the classical ankylosing spondylitis (AS. According to ESSG criteria for spondyloarthropathy, the presence of synovitis or the inflammatory back pain (IBP in IBD patients is diagnostic for spondyloarthropathy, but for diagnosis of as also radiological criteria must be fulfilled. There are few studies regarding the radiological prevalence of sacroiliitis in patients with IBD. We examined, by plain film radiograms of pelvis, 100 sacroiliac joints (SJ of 50 IBD patients with IBP. The New York (1984 SJ radiological score with gradation from 0 to 4 was applied. Total sacroiliac score (SJS was summarized between left and right side (from 0 to 8. Fourteen patients fulfilled New York modified criteria for AS and 8 patients had unilateral 2nd grade sacroiliitis. Only 4 of 14 AS patients (28% were HLA B27 positive. Thirty patients had localized IBP, 10 extended to buttock and 4 extended to sacrum. Sixteen patients had sciatica-like extension of back pain. A difference in SJS between left and right side were observed only in CD patients (1,3± 0,8 e 0,8± 0,9 respectively; p<0,05, but not in UC (1,5± 1,2 vs 1,5± 1,3; p=ns nor in total IBD patients (1,4± 1 vs 1,2± 1,2; p=ns. Total SJS was higher in UC respect CD, but not significantly (2,9± 2,3 vs 2,1± 1,5; p=ns. Our data confirm the importance of these symptoms in patients with IBD, who need to be carefully investigated also for these aspects.

  15. What do changes in inflammatory bowel disease management mean for our patients?

    Science.gov (United States)

    Ghosh, Subrata; D'Haens, Geert; Feagan, Brian G; Silverberg, Mark S; Szigethy, Eva M

    2012-02-01

    Treatment goals in Crohn's disease are evolving beyond the control of symptoms. A treat-to-target approach to management that features earlier initiation of TNF antagonist therapy will enable resolution of objective parameters of inflammation. The decision to initiate anti-TNF therapy should be based on a patient-specific assessment of risks and benefits. This paradigm necessitates a complex process, influenced by multiple factors that include the quality of data available, physicians' and patients' knowledge of the data, and the preferences and values of patients, physicians and society. The potential 'opportunity cost' resulting from a delay in initiation of effective therapy, a consideration that has been neglected in the past, must also enter into the equation. Our evolving approach to the management of Crohn's disease challenges patients to participate in the decision-making process and to become an active partner in their care. Ideally, this evolution should occur within the context of an enduring physician/patient relationship that is based on mutual trust. Motivational communication provides a useful technique to improve dialogue and collaboration between healthcare professionals and patients, and may help to engage and motivate patients to commit to managing their disease. Copyright © 2012 European's Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  16. Decreased bacterial diversity characterizes the altered gut microbiota in patients with psoriatic arthritis, resembling dysbiosis in inflammatory bowel disease.

    Science.gov (United States)

    Scher, Jose U; Ubeda, Carles; Artacho, Alejandro; Attur, Mukundan; Isaac, Sandrine; Reddy, Soumya M; Marmon, Shoshana; Neimann, Andrea; Brusca, Samuel; Patel, Tejas; Manasson, Julia; Pamer, Eric G; Littman, Dan R; Abramson, Steven B

    2015-01-01

    To characterize the diversity and taxonomic relative abundance of the gut microbiota in patients with never-treated, recent-onset psoriatic arthritis (PsA). High-throughput 16S ribosomal RNA pyrosequencing was utilized to compare the community composition of gut microbiota in patients with PsA (n = 16), patients with psoriasis of the skin (n = 15), and healthy, matched control subjects (n = 17). Samples were further assessed for the presence and levels of fecal and serum secretory IgA (sIgA), proinflammatory proteins, and fatty acids. The gut microbiota observed in patients with PsA and patients with skin psoriasis was less diverse when compared to that in healthy controls. This could be attributed to the reduced presence of several taxa. Samples from both patient groups showed a relative decrease in abundance of Coprococcus species, while samples from PsA patients were also characterized by a significant reduction in Akkermansia, Ruminococcus, and Pseudobutyrivibrio. Supernatants of fecal samples from PsA patients revealed an increase in sIgA levels and decrease in RANKL levels. Analysis of fatty acids revealed low fecal quantities of hexanoate and heptanoate in both patients with PsA and patients with psoriasis. Patients with PsA and patients with skin psoriasis had a lower relative abundance of multiple intestinal bacteria. Although some genera were concomitantly decreased in both conditions, PsA samples had a lower abundance of reportedly beneficial taxa. This gut microbiota profile in PsA was similar to that previously described in patients with inflammatory bowel disease and was associated with changes in specific inflammatory proteins unique to this group, and distinct from that in patients with skin psoriasis and healthy controls. Thus, the role of the gut microbiome in the continuum of psoriasis-PsA pathogenesis and the associated immune response merits further study. Copyright © 2015 by the American College of Rheumatology.

  17. [Articular and extraarticular involvement in inflammatory bowel diseases].

    Science.gov (United States)

    Nitsche, A; Tejeda, A; Gallo, J E; Chianello, M

    1993-01-01

    Idiopathic inflammatory bowel disease include basically two disorders: ulcerative colitis and Crohn's disease. Both diseases are chronic and of unknown etiology and extraintestinal manifestations are seen in a high number of these patients. We studied 18 patients (7 female, 11 male) with previous diagnosis of inflammatory bowel disease (14 ulcerative colitis, 2 Crohn's disease, 1 pancolitis, 1 ulcerative proctitis) in order to search for extraintestinal manifestations with emphasis on osteoarticular and ocular involvement. The mean age at the time of diagnosis of the inflammatory bowel disease was 44 years (range 20 to 71 years). Mean time duration of the inflammatory bowel disease was 7 years (range 1 to 24 years) and of the articular manifestations 3.2 years (range 1 to 8 years). The osteoarticular manifestations developed after the diagnosis of the bowel disease in all but one patient (simultaneously) 17/18 patients had artralgias, 7/18 lumbalgia, 3/18 talalgia, 1/18 knee arthritis. (table I) Only six of the 17 patients with orteoarticular involvement has simultaneous activity of the underlying bowel disease. All the 18 patients were taking 2 g/day of sulfasalazine. Radiographic screening in all patients revealed sacroiliitis in 10. (table II) Of the 10 radiographic sacroiliitis 4 were grade I (confirmed by technetium phosphate scans, 2 were grade II and 4 grade III-IV. Three of the ten patients with radiographic sacroiliitis were asymptomatic (table II). Axial computed tomography was performed done in two patients: a) in one case to exclude osteitis condensens ilii, and b) in the other case to exclude septic arthritis. The severity of the sacroiliac damage was related with a longer duration of the inflammatory bowel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Brain involvement in patients with inflammatory bowel disease: a voxel-based morphometry and diffusion tensor imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Zikou, Anastasia K.; Astrakas, Loukas G.; Tzarouchi, Loukia C.; Argyropoulou, Maria I. [University of Ioannina, Department of Radiology, Medical School, Ioannina (Greece); Kosmidou, Maria; Tsianos, Epameinondas [University of Ioannina, 1st Department of Internal Medicine (Hepato-Gastroenterology Unit), Medical School, Ioannina (Greece)

    2014-10-15

    To investigate structural brain changes in inflammatory bowel disease (IBD). Brain magnetic resonance imaging (MRI) was performed on 18 IBD patients (aged 45.16 ± 14.71 years) and 20 aged-matched control subjects. The imaging protocol consisted of a sagittal-FLAIR, a T1-weighted high-resolution three-dimensional spoiled gradient-echo sequence, and a multisession spin-echo echo-planar diffusion-weighted sequence. Differences between patients and controls in brain volume and diffusion indices were evaluated using the voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) methods, respectively. The presence of white-matter hyperintensities (WMHIs) was evaluated on FLAIR images. VBM revealed decreased grey matter (GM) volume in patients in the fusiform and the inferior temporal gyrus bilaterally, the right precentral gyrus, the right supplementary motor area, the right middle frontal gyrus and the left superior parietal gyrus (p < 0.05). TBSS showed decreased axial diffusivity (AD) in the right corticospinal tract and the right superior longitudinal fasciculus in patients compared with controls. A larger number of WMHIs was observed in patients (p < 0.05). Patients with IBD show an increase in WMHIs and GM atrophy, probably related to cerebral vasculitis and ischaemia. Decreased AD in major white matter tracts could be a secondary phenomenon, representing Wallerian degeneration. (orig.)

  19. [Nutritional impact of inflammatory bowel diseases on children and adolescents].

    Science.gov (United States)

    dos Santos, Gilton Marques; Silva, Luciana Rodrigues; Santana, Genoile Oliveira

    2014-12-01

    To perform a systematic review of the literature about the nutritional impact of inflammatory bowel diseases in children and adolescents. A systematic review was performed using PubMed/MEDLINE, LILACS and SciELo databases, with inclusion of articles in Portuguese and in English with original data, that analyzed nutritional aspects of inflammatory bowel diseases in children and adolescents. The initial search used the terms "inflammatory bowel diseases" and "children" or "adolescents" and "nutritional evaluation" or "nutrition deficiency". The selection of studies was initially performed by reading the titles and abstracts. Review studies and those without data for pediatric patients were excluded. Subsequently, the full reading of the articles considered relevant was performed. 237 studies were identified, and 12 of them were selected according to the inclusion criteria. None of them was performed in South America. During the analysis of the studies, it was observed that nutritional characteristics of patients with inflammatory bowel disease may be altered; the main reports were related to malnutrition, growth stunting, delayed puberty and vitamin D deficiency. There are nutritional consequences of inflammatory bowel diseases in children and adolescents, mainly growth stunting, slower pubertal development, underweight and vitamin deficiencies. Nutritional impairments were more significant in patients with Crohn's disease; overweight and obesity were more common in patients with ulcerative rectocolitis. A detailed nutritional assessment should be performed periodically in children and adolescents with inflammatory bowel disease. Copyright © 2014 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  20. Nutritional impact of inflammatory bowel diseases on children and adolescents

    Directory of Open Access Journals (Sweden)

    Gilton Marques dos Santos

    2014-12-01

    Full Text Available OBJECTIVE: To perform a sistematiy review of the literature about the nutritional impact of inflammatory bowel diseases in children and adolescents.DATA SOURCES: A systematic review was performed using PubMed/MEDLINE, LILACS and SciELO databases, with inclusion of articles in Portuguese and in English with original data, that analyzed nutritional aspects of inflammatory bowel diseases in children and adolescents. The initial search used the terms "inflammatory bowel diseases" and "children" or "adolescents" and "nutritional evaluation" or "nutrition deficiency". The selection of studies was initially performed by reading the titles and abstracts. Review studies and those withouth data for pediatric patients were excluded. Subsequently, the full reading of the articles considered relevant was performed.RESULTS: 237 studies were identified, and 12 of them were selected according to the inclusion criteria. None of them was performed in South America. During the analysis of the studies, it was observed that nutritional characteristics of patients with inflammatory bowel disease may be altered; the main reports were related to malnutrition, growth stunting, delayed puberty and vitamin D deficiency.CONCLUSION: There are nutritional consequences of inflammatory bowel diseases in children and adolescents, mainly growth stunting, slower pubertal development, underweight and vitamin deficiencies. Nutritional impairments were more significant in patients with Crohn's disease; overweight and obesity were more common in patients with ulcerative rectocolitis. A detailed nutritional assessment should be performed periodically in children and adolescents with inflammatory bowel disease.

  1. Colonoscopy surveillance for dysplasia and colorectal cancer in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Aalykke, Claus; Jensen, Michael Dam; Fallingborg, Jan

    2015-01-01

    colitis; and patients with ulcerative colitis as well as Crohn´s disease with a concomitant diagnosis of primary sclerosing cholangitis. A colonoscopy surveillance program is recommended in these subgroups with intervals ranging from every 3-6 months to every 5 years, using chromoendoscopy with targeted...

  2. Histamine release from gut mast cells from patients with inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Nolte, Hendrik; Spjeldnæs, Nikolaj; Kruse, Aksel

    1990-01-01

    of macroscopically inflamed and normal tissue. Mast cells and corresponding basophils were challenged with anti-IgE, anti-IgG, subclass anti-IgG4, and formyl-methionyl-leucyl-phenylalanine (FMLP) and results were compared with those from nine patient control subjects. The mast cell count in patients with ulcerative...... colitis was increased compared with that in control subjects and patients with Crohn's disease, and the mast cell count obtained from inflamed tissue was greater than that of normal tissue. The study also shows the heterogeneity of the responsiveness of the histamine releasing cells to various...

  3. Vertebral fractures in patients with inflammatory bowel disease COMPARED with a healthy population: a prospective case-control study

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    Vázquez Ma

    2012-05-01

    Full Text Available Abstract Background A prospective study was performed to compare the prevalence of morphometric vertebral fractures (MVF between patients with inflammatory bowel disease (IBD and healthy subjects and to identify predictive factors of fracture. Methods A total of 107 patients with IBD (53 with Crohn’s disease and 54 with ulcerative colitis and 51 healthy subjects participated in the study. Information about anthropometric parameters, toxins, previous fractures, and parameters related to this disease were evaluated. The index of vertebral deformity, bone mass density (BMD, and biochemical parameters were calculated. Results A total of 72 fractures were detected in 38.32% of patients with IBD, and 10 fractures were detected in 13.73% of healthy subjects; the risk of fracture in patients with IBD was higher than that in control subjects (OR, 4.03; 95% CI, 1.652–9.847; p p = 0.17 and femoral neck, r = −0.138, p = 0.07. Corticosteroid treatment was not associated with prevalent vertebral fractures nor with taking corticosteroids (r = 0.135, p = 0.14 or the duration for which they were taken (r = 0.08, p = 0.38, whereas this relationship was present in the controls (r = −0.365, p = 0.01. In the multivariate analysis, none of the measured parameters were significantly predictive of fracture, only to manifested IBD. Hypovitaminosis D was observed in 55.14% of patients with IBD. Conclusions The prevalence of morphometric vertebral fractures is higher in patients with IBD than in the healthy population, without association with BMD or corticoid treatment. Simply having IBD was proven to be a predictive factor of fracture. We observed a high incidence of hypovitaminosis D in patients with IBD.

  4. MR enterography for assessment and management of small bowel Crohn disease.

    Science.gov (United States)

    Allen, Brian C; Leyendecker, John R

    2014-07-01

    Magnetic resonance enterography (MRE) utilization has increased for the evaluation of small bowel diseases over the last several years. In addition to performing similarly to computed tomography enterography (CTE) in the evaluation of inflammatory bowel disease, MRE lacks ionizing radiation, can image the small bowel dynamically, and provides excellent soft tissue contrast resolution. This article reviews imaging protocols for MRE, normal MR imaging appearance of small bowel, and the imaging findings of small bowel Crohn disease. The importance of imaging findings for directing management in patients with small bowel Crohn disease is emphasized throughout. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Microbiome, Metabolome and Inflammatory Bowel Disease

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    Ishfaq Ahmed

    2016-06-01

    Full Text Available Inflammatory Bowel Disease (IBD is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn’s Disease (CD or Ulcerative Colitis (UC, two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis.

  6. Does psychological status influence clinical outcomes in patients with inflammatory bowel disease (IBD and other chronic gastroenterological diseases: An observational cohort prospective study

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    Wilson Ian G

    2008-06-01

    Full Text Available Abstract Background Whether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched. Thus, our aims were 1 To observe and compare prospectively clinical outcomes in relation to psychological co-morbidity in patients with inflammatory bowel disease (IBD, irritable bowel syndrome (IBS and chronic hepatitis C (HCV and, 2 To test the hypothesis that patients with psychological co-morbidities are less likely to have a satisfactory response to standard treatment at 12 months. Methods Overall, 139 patients were enrolled in this observational cohort prospective study. Over the ensuing year, physical and psychological measures were made at baseline and after 12 months (HADS, SCL90, SF-12 and disease activity measures. A logistic regression was conducted to observe any relationship between baseline characteristics and patients' clinical outcomes after 12 months. Results Overall, there was no relationship between psychological status and quality of life at baseline and relapse at 12 months (p > 0.05. However, patients with inactive disease at baseline were at lower risk of relapse after 12 months (OR = 0.046, CI: 0.012–0.178. No significant relationship was found between psychological problems such as depression/anxiety and a total number of relapses in the IBD group. However, interestingly, patients with an active disease at baseline tended to have a greater number of relapses (OR = 3.07, CI: 1.650–5.738 and CD participants were found at lower risk of relapse than UC participants (OR = 0.382, CI: 0.198–0.736. Conclusion In contrast to previous investigations, this study suggests that there is no temporal relationship between psychological problems at baseline and clinical outcomes over time. Longer and larger prospective studies are needed to better understand this result.

  7. Management of the Pregnant Inflammatory Bowel Disease Patient on Antitumour Necrosis Factor Therapy: State of the Art and Future Directions

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    Yvette PY Leung

    2014-01-01

    Full Text Available Antitumour necrosis factor (anti-TNF therapy has been a major advance in the treatment of inflammatory bowel disease (IBD by improving rates of mucosal healing, steroid-free remission, and decreasing rates of hospitalization and surgery. Because IBD affects women in their reproductive years, clinicians have and will continue to be asked in the future about the safety profile of these agents and their potential impact on pregnancy, the developing fetus and newborn. Immunoglobulin G transfer from the mother to fetus begins in the second trimester, with an elevation starting at 22 weeks of gestation and the largest amount transferred in the third trimester. Although research investigating the long-term outcomes of children exposed to anti-TNF therapy in utero is limited, there is no known adverse effect on either pregnancy or newborn outcomes including infectious complications with this class of drugs. The World Congress of Gastroenterology consensus statement on biological therapy for IBD considered infliximab and adalimumab to be low risk and compatible with use during conception and during pregnancy in at least the first two trimesters. Based on a clinical algorithm used at the University of Calgary Pregnancy and IBD clinic (Calgary, Alberta, recommendations have been provided on the management of pregnant patients on anti-TNF therapy, particularly with regard to third-trimester dosing, taking into account disease characteristics of individual patients. When educated about the safety of anti-TNF therapy during pregnancy, patients often choose to continue on therapy during the third trimester.

  8. Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease.

    Science.gov (United States)

    Mizrahi, Maya C; Reicher-Atir, Rebecca; Levy, Sigal; Haramati, Sara; Wengrower, Dov; Israeli, Eran; Goldin, Eran

    2012-01-01

    Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention. Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment. Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n = 18) measured results showed a statistically significant improvement as compared to the control group (n = 21) (time by treatment interaction): anxiety levels decreased (p < 0.01), QoL and mood improved (p < 0.05), while levels of pain and stress decreased (p < 0.01). Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.

  9. Consumption of dental treatment in patients with inflammatory bowel disease, a register study.

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    Annsofi Johannsen

    Full Text Available The aim of this study was to compare the consumption of dental treatment among patients with Crohn´s disease (CD or ulcerative colitis (UC compared to age and gender matched control groups.The study group comprised 2085 patients with CD and 3161 with UC from the Uppsala-Örebro region and from the Stockholm region. The patients in the cohort were diagnosed between 1960 and 1989. Patients up to 70 years of age were included in the study. The two patients groups were compared to age- and gender-matched, randomly selected control groups from the same geographic area comprising a corresponding number of participants.CD patients had significantly higher total number of procedures registered (p < 0.000. The difference was most pronounced for removable dentures (+65%, fillings in front teeth (+52% and endodontic treatment (+46% when Crohn's patients were compared to controls (p<0.001. The corresponding figures for UC patients were also a significantly higher total number of procedures (p < 0.005, more clinical examinations (p<0.000, fillings in canines and incisors (p < 0.001 and fillings in bicuspids and molars (p < 0.000.This study demonstrate that CD and UC individuals use more dental treatment compared to an age-gender matched control group, and more caries-related treatments. The difference was most pronounced for restorative treatment in patients with Crohn's.

  10. Small bowel villous atrophy: celiac disease and beyond.

    Science.gov (United States)

    Elli, Luca; Branchi, Federica; Sidhu, Reena; Guandalini, Stefano; Assiri, Asaad; Rinawi, Firas; Shamir, Raanan; Das, Prasenjit; Makharia, Govind K

    2017-02-01

    Small bowel villous atrophy can represent a diagnostic challenge for gastroenterologists and pathologists. In Western countries small bowel atrophy and mild non-atrophic alterations are frequently caused by celiac disease. However, other pathology can mimic celiac disease microscopically, widening the differential diagnosis. The several novelties on this topic and the introduction of the device-assisted enteroscopy in the diagnostic flowchart make an update of the literature necessary. Areas covered: In this review, a description of the different clinical scenarios when facing with small bowel mucosal damage, particularly small bowel atrophy, is described. The published literature on this subject has been summarized and reviewed. Expert commentary: When an intestinal mucosal alteration is histologically demonstrated, the pathology report forms part of a more complex workup including serological data, clinical presentation and clinical history. A multidisciplinary team, including pathologists and enteroscopy-devoted endoscopists, is frequently required to manage patients with small bowel alterations, especially in cases of severe malabsorption syndrome.

  11. Intestinal cytomegalovirus infection in patients hospitalized for exacerbation of inflammatory bowel disease: a 10-year tertiary referral center experience.

    Science.gov (United States)

    Gauss, Annika; Rosenstiel, Simon; Schnitzler, Paul; Hinz, Ulf; Rehlen, Tobias; Kadmon, Martina; Ehehalt, Robert; Stremmel, Wolfgang; Zawierucha, Anna

    2015-06-01

    This 10-year retrospective cohort study aims to determine the prevalence and risk factors of cytomegalovirus (CMV) infection in inpatients with exacerbated inflammatory bowel disease (IBD). All patients admitted to the Department of Gastroenterology of the University Hospital Heidelberg for IBD exacerbation between January 2004 and June 2013 were enrolled. To identify the risk factors of CMV infection, infected individuals were compared with those with excluded infection. Among 297 patients with exacerbated IBD, 21 had confirmed CMV infection and 79 had excluded CMV infection, whereas the remaining patients had not been sufficiently tested for CMV. Taking into account only sufficiently tested individuals, the prevalence of CMV infection was 22.7% in ulcerative colitis and 16.0% in Crohn's disease. The occurrence of CMV infection was associated with the following variables at admission: age of 30 years or more [odds ratio (OR) 14.29; P=0.004], disease duration less than 60 months (OR 7.69; P=0.011), a blood leukocyte count less than 11/nl (OR 4.49; P=0.041), and immunosuppressive therapy (OR 6.73; P=0.0129). CMV-positive patients remained in the hospital longer than noninfected patients (P=0.0009). In the CMV-positive cohort, a 66-year-old woman died of CMV pneumonia and sepsis, whereas there was no death in the CMV-negative cohort. Immunuosuppressive therapy and age older than 30 years were identified as the main risk factors for the development of CMV infection in exacerbated IBD. Because of the risk of death, diagnostics of CMV infection should especially be initiated in older patients on immunosuppressive therapy.

  12. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient

    DEFF Research Database (Denmark)

    Klarskov, Louise; Mogensen, Anne Mellon; Jespersen, Niels

    2011-01-01

    in the inflamed rectum stump. The malignant growth was surrounded by a filiform polyposis, grossly considered as pseudopolyps. The histology disclosed, however, a morphology corresponding to the recently described filiform subset of serrated adenoma (FSA). The clustering of the FSA amounted to a filiform serrated...... lesions of colorectal carcinoma arising in a chronically inflamed bowel as opposed to the generally more monotonous appearance of adenomas in a sporadic context....

  13. A Pooled Analysis of Infections, Malignancy, and Mortality in Infliximab- and Immunomodulator-Treated Adult Patients With Inflammatory Bowel Disease

    Science.gov (United States)

    Lichtenstein, Gary R; Rutgeerts, Paul; Sandborn, William J; Sands, Bruce E; Diamond, Robert H; Blank, Marion; Montello, Jennifer; Tang, Linda; Cornillie, Freddy; Colombel, Jean-Frédéric

    2012-01-01

    OBJECTIVES: The objective of this study was to analyze the safety of long-term infliximab treatment, with/without concomitant immunomodulators, across Crohn's disease (CD) and ulcerative colitis (UC) clinical trials. METHODS: To maximize sample size, we pooled primary safety data across 10 CD or UC trials, including five randomized, controlled trials contributing data from patients who received intravenous infliximab 5 or 10 mg/kg (n=1,713; ±azathioprine) or placebo (n=406; ±azathioprine). Pooled incidences and 95% confidence intervals (CIs) were determined for mortality, infection, and malignancy. Standardized incidence ratios and 95% CIs were also determined for malignancies using the Surveillance, Epidemiology, and End Results database. RESULTS: We observed no increase in infections, serious infections, or malignancy with infliximab vs. placebo in these patients with inflammatory bowel disease (IBD). In patients with UC, but not CD, immunomodulator treatment (vs. treatment without immunomodulator) yielded a higher incidence (95% CI) of infections (120.07 (110.66, 130.08)/100 patient-years (pt-yrs) vs. 92.47 (84.54, 100.94)/100 pt-yrs). Among placebo-treated patients with CD, but not UC, those with immunomodulator use demonstrated a higher incidence (95% CI) of malignancy vs. no immunomodulator treatment (1.84 (0.22, 6.66)/100 pt-yrs vs. 0.00 (0.00, 0.00)/100 pt-yrs). Mortality and infection-related mortality appeared unaffected by infliximab or immunomodulator treatment. CONCLUSIONS: Infliximab treatment of IBD did not appear to affect incidences of infection, mortality, or malignancy. Relative to patients with no immunomodulator use, immunomodulator-treated UC patients demonstrated a higher incidence of infection and immunomodulator-plus-placebo-treated CD patients demonstrated a higher incidence of malignancy. PMID:22613901

  14. Quality of life of patients with irritable bowel syndrome is low compared to others with chronic diseases.

    Science.gov (United States)

    ten Berg, Maarten J; Goettsch, Wim G; van den Boom, Guido; Smout, André J P M; Herings, Ron M C

    2006-05-01

    Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal dysmotility disorder. This study aimed to estimate the burden of illness of a Dutch population of community dwelling patients suffering from IBS. Patients identified at community pharmacies, using mebeverine as a proxy for IBS, were administered a questionnaire regarding (1) the Rome II criteria for IBS, (2) predominant type of stool during complaints, (3) severity of symptoms (abdominal pain and discomfort), (4) generic and disease-specific quality of life, (5) current health status (utilities), and (6) loss of productivity. Three hundred and seventy-five users of mebeverine were identified of which 169 patients met the Rome II criteria for IBS, and were included in the study. More than half (58%) of the IBS patients reported severe abdominal pain and complaints. Generic and disease-specific quality of life outcomes showed impairment on all dimensions. Current health status in IBS patients, calculated on the basis of the EQ-5D VAS, was perceived on 62% of full health (95% CI, 60-66%). A calculation of health status in these patients based on the SF-6D algorithm showed a comparable score of 0.67 (1 is full health; 95% CI, 0.65-0.68). The loss in productivity of IBS patients was 1.8 days (95% CI, 1.1-2.5) per month. This study confirmed that the burden of illness of IBS in the Netherlands is substantial. IBS patients treated with mebeverine experienced low quality of life and suffered from severe pain. Based on these results, more attention for the diagnosis and treatment of IBS seems to be justified.

  15. Effect of oral lactulose on clinical and immunohistochemical parameters in patients with inflammatory bowel disease: a pilot study

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    Manns Michael P

    2007-09-01

    Full Text Available Abstract Background The prebiotic potential of lactulose is well established and preclinical studies demonstrated a protective effect of lactulose in murine models of colitis. The aim of the present study was to investigate the clinical and histological efficacy of lactulose in patients with inflammatory bowel disease (IBD, for which probiotic therapy yielded promising results. Methods Patients were treated with standard medication alone or combined with 10 g lactulose daily as adjuvant therapy for 4 months. Clinical efficacy of treatment was assessed using clinical activity indices, a quality of life index (IBDQ, endoscopic scores, defecation frequency and monitoring corticosteroid medication. Orsomucoid, alpha1-antitrypsin and other laboratory parameters were determined. In addition, in some participants colonic biopsies were analyzed with haematoxylin-eosin staining or with antibodies against HLA-DR, CD68, IgA and CD3, and evaluated systematically. All measurements were performed both at enrolment and at the end of the trial. Results 14 patients presenting ulcerative colitis (UC and 17 patients presenting Crohn's disease (CD, most of them in a clinically active state, were enrolled in this pilot study. After 4 month no significant improvement of clinical activity index, endoscopic score or immunohistochemical parameters was observed in CD or UC patients receiving lactulose in comparison to the control group. However, significant improvement of quality of life was observed in UC patients receiving lactulose compared to the control group (p = 0.04. Conclusion The findings of the present pilot study indicate that oral lactulose has no beneficial effects in IBD patients in particular with regard to clinical activity, endoscopic score or immunohistochemical parameters. The importance of the beneficial effect of lactulose in UC patients regarding the quality of life needs further evaluation in larger controlled clinical trials. Trial registration

  16. A national patient and public colorectal research agenda: integration of consumer perspectives in bowel disease through early consultation.

    Science.gov (United States)

    McNair, A G K; Heywood, N; Tiernan, J; Verjee, A; Bach, S P; Fearnhead, N S

    2017-01-01

    There is a recognized need to include the views of patients and the public in prioritizing health research. This study aimed: (i) to explore patients' views on colorectal research; and (ii) to prioritize research topics with patients and the public. In phase 1, 12 charitable organizations and patient groups with an interest in bowel disease were invited to attend a consultation exercise. Participants were briefed on 25 colorectal research topics prioritized by members of the Association of Coloproctology of Great Britain and Ireland. Focus groups were conducted and discussions were recorded with field notes. Analysis was conducted using principles of thematic analysis. In phase 2, a free public consultation was undertaken. Participants were recruited from newspaper advertisements, were briefed on the same research topics and were asked to rate the importance of each on a five-point Likert scale. Descriptive statistics were used to rank the topics. Univariable linear regression compared recorded demographic details with mean topic scores. Focus groups were attended by 12 patients who highlighted the importance of patient-centred information for trial recruitment and when selecting outcome measures. Some 360 people attended the public consultation, of whom 277 (77%) were recruited. Participants rated 'What is the best way to treat early cancer in the back passage?' highest, with 227 (85%) scoring it 4 or 5. There was no correlation between participant demographics and mean topic scores. The present study prioritized a colorectal research agenda with the input of patients and the public. Further research is required to translate this agenda into real improvements in patient care. © 2016 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

  17. Inflammatory bowel disease and novel endoscopic technologies.

    Science.gov (United States)

    Naganuma, Makoto; Hosoe, Naoki; Ogata, Haruhiko

    2014-01-01

    Conventional ileocolonoscopy and barium small bowel follow-through are useful techniques for assessing the extension and severity of disease in patients with inflammatory bowel disease (IBD). More recently, novel techniques to enable IBD diagnosis have been developed, such as capsule endoscopy (CE), balloon enteroscopy (BE), computed tomography enterography (CTE) and magnetic resonance enterography (MRE). The advantages of CE and BE are that they enable mucosal assessment directly whereas the usefulness of CTE/MRE is in its ability to enable detection of transmural inflammation, stenosis, and extraintestinal lesions including abscesses and fistulas. In ulcerative colitis (UC), colitis-associated dysplasia/cancer is one of the critical complications in patients with chronic disease. Detection of colitis-associated cancer is difficult in cases with inflammation. Magnification colonoscopy has been used to detect dysplasia in patients with chronic UC. Furthermore, colon CE and endocytoscopy have also developed and these might be used for selected patients in the near future. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  18. Use of thiopurines in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Frei, Pascal; Biedermann, Luc; Nielsen, Ole Haagen

    2013-01-01

    The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine...

  19. A family study of asymptomatic small bowel Crohn's disease.

    Science.gov (United States)

    Biancone, Livia; Calabrese, Emma; Petruzziello, Carmelina; Capanna, Alessandra; Zorzi, Francesca; Onali, Sara; Condino, Giovanna; Lolli, Elisabetta; Ciccacci, Cinzia; Borgiani, Paola; Pallone, Francesco

    2014-03-01

    Discrepancies between severity of lesions and symptoms may be observed in Crohn's disease. We prospectively assessed whether Crohn's disease may be diagnosed among asymptomatic relatives of patients, using Small Bowel Contrast Ultrasonography. Diagnosis of asymptomatic Crohn's disease relatives was defined ultrasonographically as: bowel wall thickness >3mm, bowel dilation/stricture, lumen diameter >2.5 cm. Diagnosis was confirmed by ileocolonoscopy. Subjects were also screened for the Leu3020insC mutation. Consent was given by 35 asymptomatic first-degree relatives of 18 Crohn's disease patients. Ultrasonography indicated increased bowel wall thickness (5mm) compatible with ileal Crohn's disease in 1 relative (2.8%), a 42 year-old male. Ileocolonoscopy, histology, and radiology confirmed the diagnosis of stricturing ileal Crohn's disease. Gallbladder stones were detected in 7/35 (20%) relatives and Leu3020insC mutation in 3/35 (8.5%). Small Bowel Contrast Ultrasonography may be a useful tool to diagnose asymptomatic small bowel Crohn's disease among first-degree relatives of patients. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  20. The role of fecal calprotectin in investigating inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Mustafa Erbayrak

    2009-05-01

    Full Text Available INTRODUCTION: Invasive and non-invasive tests can be used to evaluate the activity of inflammatory bowel diseases. OBJECTIVE: The aim of the present study was to investigate the role of fecal calprotectin in evaluating inflammatory bowel disease activity and the correlation of fecal calprotectin with the erythrocyte sedimentation rate and C reactive protein values in inflammatory bowel disease. METHOD: Sixty-five patients affected with inflammatory bowel disease were enrolled. Twenty outpatients diagnosed with inflammatory bowel disease comprised the control group. RESULTS: In the present study, all patients in the control group had an fecal calprotectin value lower than the cut-off point (50 mg/kg. CONCLUSION: In conclusion, fecal calprotectin was found to be strongly associated with colorectal inflammation indicating organic disease. Fecal calprotectin is a simple and non-invasive method for assessing excretion of macrophages into the gut lumen. Fecal calprotectin values can be used to evaluate the response to treatment, to screen asymptomatic patients, and to predict inflammatory bowel disease relapses.

  1. Hospitalizations for vaccine preventable pneumonias in patients with inflammatory bowel disease: a 6-year analysis of the Nationwide Inpatient Sample

    Directory of Open Access Journals (Sweden)

    Stobaugh DJ

    2013-05-01

    Full Text Available Derrick J Stobaugh,1,2 Parakkal Deepak,1,2 Eli D Ehrenpreis1,21Center for the Study of Complex Diseases, Research Institute, NorthShore University HealthSystem, Evanston, IL, USA; 2Gastroenterology Department, NorthShore University HealthSystem, Highland Park, IL, USABackground: Pneumonias are among the most common causes of hospitalization among inflammatory bowel disease (IBD patients. Guidelines published in 2004 advocate vaccination against Streptococcus pneumoniae and influenza virus. We sought to examine trends in hospitalizations for vaccine preventable pneumonias among IBD patients since the availability of published guidelines, and to identify whether Haemophilus influenzae is a causative organism for pneumonia hospitalizations among IBD patients.Methods: This cross-sectional study on the Nationwide Inpatient Sample was used to identify admissions for pneumonias in patients with IBD between 2004 and 2009. A multivariate logistic regression analysis was performed comparing IBD patients to controls, accounting for potential confounders.Results: There were more admissions for S. pneumoniae pneumonia than influenza virus or H. influenzae (787, 393, and 183 respectively. Crohn’s disease (CD as well as ulcerative colitis (UC patients did not demonstrate increased adjusted odds of hospitalization for S. pneumoniae pneumonia (1.08; confidence interval [CI] 0.99–1.17 compared to 0.93; CI 0.82–1.06 respectively. Increased adjusted odds for hospitalization for pneumonias due to influenza virus were seen among UC patients in the bottom quartile of income (1.86; CI 1.46–2.37. Adjusted odds for H. influenzae pneumonia admission in patients with UC and CD patients were increased compared to controls (1.42; CI 1.13–1.79 and 1.28; CI 1.06–1.54, respectively.Conclusion: The study identified lowest income UC patients as having higher adjusted odds, and these patients should be targeted for influenza virus vaccination. Additionally, H

  2. Dietary fortificant iron intake is negatively associated with quality of life in patients with mildly active inflammatory bowel disease.

    Science.gov (United States)

    Powell, Jonathan J; Cook, William B; Hutchinson, Carol; Tolkien, Zoe; Chatfield, Mark; Pereira, Dora Ia; Lomer, Miranda Ce

    2013-01-15

    Iron deficiency anaemia and oral iron supplementation have been associated negatively with quality of life, and with adverse effects, respectively, in subjects with inflammatory bowel disease (IBD). Hence, the risk-benefit ratio of oral iron is not understood in this patient group. The present case-control study investigated whether dietary iron intake impacts on quality of life in IBD patients. Quality of life, habitual dietary iron intakes and iron requirements were assessed in 29 patients with inactive or mildly active IBD as well as in 28 healthy control subjects. As expected, quality of life was worse in IBD patients as a whole in comparison to healthy controls according to EuroQol score and EuroQol VAS percentage (6.9 ± 1.6 vs 5.3 ± 0.6; p< 0.0001 and 77 ± 14% vs 88 ± 12%; p=0.004 respectively). For IBD subjects, 21/29 were iron deplete based upon serum iron responses to oral iron but, overall, were non-anaemic with mean haemoglobin of 13.3 ± 1.5 g/dL, and there was no difference in their quality of life compared to 8/29 iron replete subjects (Hb 14.0 ± 0.8 g/dL). Interestingly, total dietary iron intake was significantly negatively associated with quality of life in IBD patients, specifically for non-haem iron and, more specifically, for fortificant iron. Moreover, for total non-haem iron the negative association disappeared when fortificant iron values were subtracted. Finally, further sub-analysis indicated that the negative association between (fortificant) dietary iron intake and quality of life in IBD patients is driven by findings in patients with mildly active disease rather than in patients with quiescent disease. Iron deficiency per se (i.e. without concomitant anaemia) does not appear to further affect quality of life in IBD patients with inactive or mildly active disease. However, in this preliminary study, dietary iron intake, particularly fortificant iron, appears to be significantly negatively associated with quality of life in patients

  3. Dietary fortificant iron intake is negatively associated with quality of life in patients with mildly active inflammatory bowel disease

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    Powell Jonathan J

    2013-01-01

    Full Text Available Abstract Background Iron deficiency anaemia and oral iron supplementation have been associated negatively with quality of life, and with adverse effects, respectively, in subjects with inflammatory bowel disease (IBD. Hence, the risk-benefit ratio of oral iron is not understood in this patient group. The present case–control study investigated whether dietary iron intake impacts on quality of life in IBD patients. Methods Quality of life, habitual dietary iron intakes and iron requirements were assessed in 29 patients with inactive or mildly active IBD as well as in 28 healthy control subjects. Results As expected, quality of life was worse in IBD patients as a whole in comparison to healthy controls according to EuroQol score and EuroQol VAS percentage (6.9 ± 1.6 vs 5.3 ± 0.6; pvs 88 ± 12%; p=0.004 respectively. For IBD subjects, 21/29 were iron deplete based upon serum iron responses to oral iron but, overall, were non-anaemic with mean haemoglobin of 13.3 ± 1.5 g/dL, and there was no difference in their quality of life compared to 8/29 iron replete subjects (Hb 14.0 ± 0.8 g/dL. Interestingly, total dietary iron intake was significantly negatively associated with quality of life in IBD patients, specifically for non-haem iron and, more specifically, for fortificant iron. Moreover, for total non-haem iron the negative association disappeared when fortificant iron values were subtracted. Finally, further sub-analysis indicated that the negative association between (fortificant dietary iron intake and quality of life in IBD patients is driven by findings in patients with mildly active disease rather than in patients with quiescent disease. Conclusions Iron deficiency per se (i.e. without concomitant anaemia does not appear to further affect quality of life in IBD patients with inactive or mildly active disease. However, in this preliminary study, dietary iron intake, particularly fortificant iron, appears to be significantly negatively

  4. Distinct inflammatory and cytopathic characteristics of Escherichia coli isolates from inflammatory bowel disease patients

    DEFF Research Database (Denmark)

    Jensen, Stina Rikke; Mirsepasi-Lauridsen, Hengameh Chloé; Thysen, Anna Hammerich

    2015-01-01

    Escherichia coli (E. coli) may be implicated in the pathogenesis of inflammatory bowel disease (IBD), as implied from a higher prevalence of mucosa-associated E. coli in the gut of IBD-affected individuals. However, it is unclear whether different non-diarrheagenic E. coli spp. segregate from eac...

  5. A prospective study of the safety of lower gastrointestinal endoscopy during pregnancy in patients with inflammatory bowel disease

    NARCIS (Netherlands)

    A. de Lima (Alison); Z. Zelinkova (Zuzana); C.J. van der Woude (Janneke)

    2015-01-01

    textabstractIntroduction: Women with inflammatory bowel disease [IBD] have a higher risk of undergoing gastrointestinal [GI] endoscopy during pregnancy than healthy women. Data on endoscopic procedures during pregnancy in IBD women are limited. The aim of this study was to investigate the safety of

  6. Association between tumor necrosis factor-α antagonists and risk of cancer in patients with inflammatory bowel disease

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    Nyboe Andersen, Nynne; Pasternak, Björn; Basit, Saima

    2014-01-01

    to evaluate these effects. OBJECTIVE: To investigate whether patients with inflammatory bowel disease (IBD) exposed to TNF-α antagonists were at increased risk of developing cancer. DESIGN, SETTING, AND PARTICIPANTS: Nationwide register-based cohort study in Denmark, 1999-2012. Participants were 56......,146 patients 15 years or older with IBD identified in the National Patient Registry, of whom 4553 (8.1%) were exposed to TNF-α antagonists. Cancer cases were identified in the Danish Cancer Registry. MAIN OUTCOMES AND MEASURES: Rate ratios (RRs) for incident cancer (overall and site-specific) comparing TNF......-α antagonists (1.8%) (median follow-up, 3.7 years [interquartile range, 1.8-6.0]) and 3465 of 51,593 unexposed patients (6.7%) developed cancer, yielding a fully adjusted RR of 1.07 (95% CI, 0.85-1.36). There was no significantly increased risk of cancer in analyses according to time since first TNF...

  7. Coping Strategies and Psychological Outcomes of Patients with Inflammatory Bowel Disease in the First 6 Months After Diagnosis.

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    McCombie, Andrew M; Mulder, Roger T; Gearry, Richard B

    2015-10-01

    Inflammatory bowel disease (IBD) is associated with reduced physical and mental well-being. The first 6 months after diagnosis is an important time in a patient's life with IBD. On top of the physical symptoms, psychological characteristics, such as coping strategies and personality, may contribute to impaired or improved health-related quality of life (HRQOL), anxiety, and depression. This study aimed to measure the stability of coping strategies and personality over the first 6 months after diagnosis and identify the associations of coping strategies and personality traits with the level of HRQOL and degree of anxiety and depression. This study aimed to measure HRQOL, anxiety, depression, IBD symptoms, coping, and personality at baseline and 6 months. Questionnaires about HRQOL, anxiety, depression, IBD symptoms, coping, personality, and demographic information were administered to patients at baseline and 6 months after diagnosis. Personality characteristics were stable over the first 6 months but coping strategies were not. Maladaptive coping strategies were associated with worse outcomes but adaptive coping strategies were not associated with better outcomes. All measures of HRQOL improved. Neuroticism was associated with worse psychological anxiety, depression, and HRQOL outcomes. This is the first study to psychologically test patients with IBD during the first 6 months after diagnosis. Generally, the HRQOL of patients with IBD improves over this time. Maladaptive coping is associated with worse psychological anxiety, depression, and HRQOL physical outcomes; although until an interventional study is performed, reverse causation cannot be ruled out.

  8. Over-reaching beyond disease activity: the influence of anxiety and medical economic burden on health-related quality of life in patients with inflammatory bowel disease

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    Luo XP

    2016-12-01

    Full Text Available Xia-peng Luo,1,* Ren Mao,1,* Bai-li Chen,1 Yun Qiu,1 Sheng-hong Zhang,1 Yao He,1 Jie Chen,1 Zhi-rong Zeng,1 Shomron Ben-Horin,2 Min-hu Chen1 1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; 2Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors contributed equally to this work Purpose: Many patients with inflammatory bowel disease (IBD have impaired health-related quality of life (HRQOL. The influence of psychological and economic factors on HRQOL has not been fully elucidated in IBD. Therefore, we aimed to identify the predictors of HRQOL in an IBD cohort. Patients and methods: This was a cross-sectional cohort study of patients presenting to our tertiary IBD center. HRQOL was measured using the 36-item Short Form Health Survey (SF-36 and the Inflammatory Bowel Disease Questionnaire (IBDQ. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS. Perceived stress and perceived social support were also assessed by standardized scales. Demographic, socioeconomic and clinical data were obtained from a prespecified questionnaire and patients’ medical records. Univariate analyses and multiple regression analysis were performed to identify predictors of HRQOL. Results: A total of 242 IBD patients were recruited, and the questionnaire return rate was 90.5% (219/242. The prevalence rates of anxiety and depression were 24.7% and 17.4%, respectively. In all, 30.6% of the patients spent over half of their income to cover medical costs. Multivariate analysis revealed that anxiety symptoms (P<0.001, active disease (P<0.001 and higher medical expenditures (P=0.001 were strong and independent predictors of reduced HRQOL. Conclusion: Psychological factors and costs of medical care strongly impair HRQOL in IBD, independent of the disease activity. Psychological counseling and socioeconomic

  9. Prevalence of hepatitis B, hepatitis C and human immunodeficiency viral infections in patients with inflammatory bowel disease in north India

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    Parnita Harsh

    2017-01-01

    Full Text Available Background/Aims: Patients with inflammatory bowel disease (IBD often require immunosuppressive therapy and blood transfusions and therefore are at a high risk of contracting infections due to hepatitis B (HBV and hepatitis C (HCV and human immunodeficiency virus (HIV. In the present study, we assessed the prevalence of these infections in patients with IBD.Methods: This retrospective study included 908 consecutive patients with IBD (ulcerative colitis [UC], n=581; Crohn's disease [CD], n=327 who were receiving care at a tertiary care center. Ninety-five patients with intestinal tuberculosis (ITB were recruited as disease controls. Prospectively maintained patient databases were reviewed for the prevalence of HBV surface antigen, anti-HCV antibodies, and HIV (enzyme-linked immunosorbent assay method. HCV RNA was examined in patients who tested positive for anti-HCV antibodies. Prevalence data of the study were compared with that of the general Indian population (HBV, 3.7%; HCV, 1%; HIV, 0.3%.Results: The prevalence of HBV, HCV, and HIV was 2.4%, 1.4%, and 0.1%, respectively, in the 908 patients with IBD. Among the 581 patients with UC, 2.2% (12/541 had HBV, 1.7% (9/517 had HCV, and 0.2% (1/499 had HIV. Among the 327 patients with CD, 2.8% (8/288 had HBV, 0.7% (2/273 had HCV, and 0% (0/277 had HIV. One patient with CD had HBV and HCV coinfection. The prevalence of HBV, HCV, and HIV in patients with ITB was 5.9% (4/67, 1.8% (1/57, and 1.2% (1/84, respectively.Conclusions: The prevalence of HBV, HCV, and HIV in north Indian patients with IBD is similar to the prevalence of these viruses in the general community. Nonetheless, the high risk of flare after immunosuppressive therapy mandates routine screening of patients with IBD for viral markers.

  10. Impact of Bariatric Surgery on Outcomes of Patients with Inflammatory Bowel Disease: a Nationwide Inpatient Sample Analysis, 2004-2014.

    Science.gov (United States)

    Sharma, Prabin; McCarty, Thomas R; Njei, Basile

    2017-10-18

    There is a paucity of data regarding the benefits of bariatric surgery in patients with inflammatory bowel disease (IBD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized patients with IBD. The United States (US) National Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and IBD. Hospitalizations with a history of prior-bariatric surgery were also identified. The primary outcome was in-hospital mortality. Secondary outcomes included renal failure, under-nutrition, thromboembolic events, strictures, fistulae, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery. Among 15,319 patients with a discharge diagnosis of IBD and morbid obesity, 493 patients (3.2%) had bariatric surgery. From 2004 to 2014, the proportion of obese IBD patients that underwent bariatric surgery declined (5.2 versus 3.1%). In a multivariable analysis, prior-bariatric surgery was associated with decreased IRR for renal failure, under-nutrition, and fistulae formation in morbidly obese IBD patients [(IRR 0.1; 95% CI 0.02-0.3; P Bariatric surgery did not influence mortality (P = 0.99). Despite a gradual increase in morbid obesity among patients with IBD, there has been a decrease in proportion of overall bariatric surgeries. Bariatric surgery appears to reduce morbidity in obese patients with IBD.

  11. eHealth for inflammatory bowel disease self-management - the patient perspective.

    Science.gov (United States)

    Con, Danny; Jackson, Belinda; Gray, Kathleen; De Cruz, Peter

    2017-09-01

    Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients' attitudes towards the use of eHealth solutions in IBD is lacking. The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management. A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken. Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management. This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management.

  12. Outcome Following Infliximab Therapy for Pediatric Patients Hospitalized with Refractory Colitis-Predominant Inflammatory Bowel Disease

    Science.gov (United States)

    Falaiye, Tolulope O.; Mitchell, Keisha R.; Lu, Zengqi; Saville, Benjamin R.; Horst, Sara N.; Moulton, Dedrick E.; Schwartz, David A.; Wilson, Keith T.; Rosen, Michael J.

    2013-01-01

    Objectives While randomized trials demonstrated efficacy of infliximab for both pediatric Crohn’s disease (CD) and ulcerative colitis (UC), few patients in these studies exhibited colitis requiring hospitalization. The aims of this study were to determine the rate of subsequent infliximab failure and dose escalation in pediatric patients started on infliximab during hospitalization for colitis-predominant IBD, and to identify potential predictors of these endpoints. Methods Single center retrospective cohort study of patients admitted from 2005 to 2010 with Crohn’s colitis, UC, or IBD-unspecified (IBD-U) and initiated on infliximab. Results We identified 29 patients (12 Crohn’s colitis, 15 UC, and 2 IBD-U; median age 14 years) with a median follow-up of 923 days. 18 patients (62%) required infliximab dose escalation (increased dose or decreased infusion interval). Infliximab failure occurred in 18 patients (62%), due to ineffectiveness in 12 (67%) and adverse reactions in 6 (33%). 12 patients (41%) underwent colectomy. Subsequent need for infliximab dose escalation was associated with lower body mass index (BMI) z-score (P=0.01), lower serum albumin (P=0.03), and higher ESR (P=0.002) at baseline. ESR predicted subsequent infliximab dose escalation with an area under the curve of 0.89 (95% CI 0.72–1.00) and a sensitivity and specificity at a cutoff of 38 mm/hr of 0.79 (95% CI 0.49–0.95) and 0.88 (95% CI 0.47–0.99), respectively. Conclusions Most hospitalized pediatric patients with colitis treated with infliximab require early dose escalation and fail the drug long term. Low BMI and albumin, and high ESR may identify patients who would benefit from a higher infliximab starting dose. PMID:24048170

  13. Efficacy of intravenous iron in treating iron deficiency anaemia in patients with inflammatory bowel disease: Are there predictors of response?

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    Rocío Ferreiro Iglesias

    Full Text Available Introduction: in inflammatory bowel disease (IBD iron deficiency anaemia (IDA is a very common disorder. Until recently, oral iron has been the mainstay therapy, nevertheless it has been associated with intolerance and noncompliance. Therefore, the goal of our study was to evaluate the efficacy of intravenous iron in IDA in IBD patients and the secondary aim was to investigate whether other potential factors could influence in the response to the treatment. Design: an open-label, prospective, consecutive, single centre study. Material and methods: we performed our study in patients with ulcerative colitis (UC or Crohn's disease (CD with severe anaemia or intolerance with oral iron. All of them received intravenous sacarose iron and did biochemistry profile with haemoglobin (Hb. Moreover, the correlation with other variables was studied: age, sex, smoking habit, IBD type, previous surgery and type of surgery and other treatments. Response was defined as Hb increase of ≥ 2 g/dL or normalization of the levels. Results: fifty-four patients were included into the study, 34 (63% with UC y 20 (37% with CD, 18 (33.3% men and 36 women (66.6% and the average was 48 ± 14 years. The total proportion of responders was 52% (SD ± 05; 43% of the patients reached Hb ≥ 2 g/dl and y 9% of them normalized Hb. Only the utilization of 5-ASA was associated with low response to iron treatment (p < 0.05. Conclusions: our study suggests that response to intravenous iron is achievable in the majority of patients with IBD and severe IDA or intolerance treatment with oral iron. Moreover, the patients with consumption of 5-ASA could had less response to the treatment.

  14. Smell and taste in inflammatory bowel disease.

    Science.gov (United States)

    Steinbach, Silke; Reindl, Wolfgang; Dempfle, Astrid; Schuster, Anna; Wolf, Petra; Hundt, Walter; Huber, Wolfgang

    2013-01-01

    To investigate the olfactory/gustatory functions of patients with inflammatory bowel disease (IBD) by smell/taste tests, and to determine if disease activity or medication might influence the olfactory/gustatory functions of patients. In total, 59 IBD patients (37 Crohn's disease (CD) and 22 ulcerative colitis (UC) patients) were studied using "Sniffin' sticks" and "taste strips" for olfactory and gustatory tests, respectively, and compared to healthy controls and published normative data. Among IBD (CD and UC) patients, the values for odor threshold, but not for odor identification or discrimination, were significantly lower than that of the normative data. Further, these patients showed lower values than the normative taste values and the control group for all tastes, except sour; 57.6% of the IBD patients were hyposmic, while 30.5% were hypogeusic. Subjective self-assessments showed that the patients were not aware of their reduced olfactory/gustatory functions. There were no relevant differences in taste and smell abilities between the CD and UC patients. Disease activity and treatment did not influence the olfactory/gustatory functions. IBD (CD and UC) patients exhibited significant reductions in the olfactory and gustatory functions. Therefore, patients should be tested by smell/taste tests, in order to be adequately informed of their olfactory/gustatory functions and provided an understanding of how to overcome their limitations, and thus improve their quality of life.

  15. Genetic polymorphism of ABCB1 gene (C3435T) in patients with inflammatory bowel diseases. Is there any gender dependency?

    Science.gov (United States)

    Jaźwińska-Tarnawska, Ewa; Jęśkowiak, Izabela; Waszczuk, Ewa; Mulak, Agata; Głowacka, Krystyna; Hurkacz, Magdalena; Paradowski, Leszek; Zaleska, Zofia; Wiela-Hojeńska, Anna

    2015-04-01

    In recent years, an increasing incidence of inflammatory bowel disease (IBD) has been reported, mainly as Crohn's disease (CD) and ulcerative colitis (UC). The individual susceptibility, the disease's course and response to the applied therapy is likely due to genetic factors such as ABCB1 gene mutations, exemplified by C3435T polymorphism. The aim of the study was to evaluate the distribution of C3435T polymorphism regarding the gender in IBD patients and control subjects from Lower Silesia region and its possible association with IBD susceptibility. The research was conducted in groups of 61 IBD patients and 101 healthy subjects from the Lower Silesia region. Polymorphism of C3435T was determined using PCR-RFLP method. Frequency distributions of C3435T genotype and of 3435T or 3435C gene alleles of IBD, CD or UC patients were compared to control group; each treated as a whole or split further by gender. The statistically significant correlation was discovered between gender and C3435T genotype both for IBD and CD patients, with 3435CT heterozygote prevailing in IBD and CD males. Odds ratio calculations revealed statistically significant difference for the 3435CT genotype between control and: IBD group considered as a whole; IBD males; CD males; and for 3435TT variant between control and IBD males. Conclusions. The 3435CT genotype could be a risk factor for IBD and CD in men. The 3435TT genotype in males seems to be associated with the lower chance of IBD presence. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  16. Fecal Calprotectin Measured By Patients at Home Using Smartphones—A New Clinical Tool in Monitoring Patients with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Vinding, Kristoffer Kofod; Elsberg, Henriette; Thorkilgaard, Tine

    2016-01-01

    in clinical practice. Our aim was to evaluate CalproSmart, a new rapid test for fecal calprotectin performed by patients themselves at home, and compare it to gold standard ELISA. METHODS: A total of 221 patients with inflammatory bowel disease (115 ulcerative colitis and 106 Crohn's disease) were included...... CalproSmart at home, patients also sent in 2 fecal samples to be analyzed by ELISA. RESULTS: Totally, 894 fecal calprotectin results were obtained by ELISA, and 632 of them from CalproSmart. The correlation coefficient was 0.685, higher for academics than nonacademics (0.768 versus 0.637; P = 0....... The CalproSmart test involves extraction of feces, application to the lateral flow device, and taking a picture with a smartphone after 10 minutes of incubation. Results appear on the screen within seconds. Patients were instructed at inclusion and had a video guide of the procedure as support. When using...

  17. Management of Inflammatory Bowel Disease During Pregnancy.

    Science.gov (United States)

    Bar-Gil Shitrit, Ariella; Grisaru-Granovsky, Sorina; Ben Ya'acov, Ami; Goldin, Eran

    2016-08-01

    Inflammatory bowel disease (IBD) usually affects women during their reproductive years and many concerns arise among these young patients. Pre-pregnancy consultation with a multi-disciplinary team is very important. The team should make patients aware of the critical importance of ensuring that conception occurs during a period of disease remission. Conception during an IBD flare-up results in disease activity or even exacerbates disease in two-thirds of women. Exacerbation of the disease is associated with increased frequency of maternal and fetal complications. Drug therapy constitutes a considerable source of patient anxiety but most drugs used for treating IBD are considered safe. Therefore, continuing pharmacological therapy during pregnancy is necessary to maintain disease control. Optimization of pre-conception nutritional status and smoking cessation are also emphasized. The general guideline for most patients, except for active perianal disease patients, is to aim for vaginal delivery in the absence of obstetric contraindications. Consistent, ongoing follow-up, as detailed in this review, should allay the anxieties and fears surrounding continuing immunosuppressive drugs during pregnancy, allowing each patient to attain the optimal conditions for achieving her goal of holding a healthy baby.

  18. Multidisciplinary management of patients with coexisting inflammatory bowel disease and spondyloarthritis: A Delphi consensus among Italian experts.

    Science.gov (United States)

    Armuzzi, Alessandro; Felice, Carla; Lubrano, Ennio; Cantini, Fabrizio; Castiglione, Fabiana; Gionchetti, Paolo; Orlando, Ambrogio; Salvarani, Carlo; Scarpa, Raffaele; Marchesoni, Antonio; Vecchi, Maurizio; Olivieri, Ignazio

    2017-06-23

    Treatment of patients with coexisting spondyloarthritis (SpA) and inflammatory bowel disease (IBD) often requires multidisciplinary collaboration between gastroenterologists and rheumatologists. To describe the results of the first Delphi consensus to define shared therapeutic strategies for the best management of patients with coexisting SpA and IBD. A scientific steering committee of 10 Italian experts in the field of SpA and IBD developed 27 statements on 5 possible clinical scenarios and selected 40 specialists from across Italy, both gastroenterologists and rheumatologists, to vote them using a Delphi method. Each participant expressed a level of agreement on each statement using a 5-point scale (1="absolutely disagree"; 5="absolutely agree"). Total cumulative agreement was defined as the sum of the percentage of responses to items 4 ("agree") and 5 ("absolutely agree"). Total cumulative agreement ≥70% defined consensus for each statement. After the first round, positive consensus was reached for 22 statements. Statements without consensus were discussed in a plenary session before the second vote. Positive consensus was then reached in all statements, with final total cumulative agreement ranging from 80% to 100%. This is the first Delphi consensus defining specific treatment algorithms for patients with coexisting SpA and IBD. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  19. Risk of inflammatory bowel disease in patients with rosacea: Results from a nationwide cohort study in Taiwan.

    Science.gov (United States)

    Wu, Chun-Ying; Chang, Yun-Ting; Juan, Chao-Keui; Shieh, Jeng-Jer; Lin, Yu-Pu; Liu, Han-Nan; Lin, Jaw-Town; Chen, Yi-Ju

    2017-05-01

    A link between rosacea and inflammatory bowel disease (IBD) has been proposed with unknown mechanisms. Epidemiologic evidence of this association needs to be examined. In this nationwide cohort study, a total of 89,356 patients with rosacea and 178,712 matched patients without rosacea between 1997 and 2013 were identified in the Taiwanese National Health Insurance Research Database. Cumulative incidences of IBD were compared between these 2 cohorts. Frailty Cox proportional hazard model was used and subgroup analyses were conducted to examine the risk factors for IBD. The 15-year cumulative incidences of IBD were 0.036% (95% confidence interval [CI] 0.00%-1.57%) and 0.019% (95% CI 0.00%-0.83%) in rosacea and nonrosacea cohorts, respectively (P = .05). Rosacea (adjusted hazard ratio 1.94, 95% CI 1.04-3.63, P = .04) and male gender (adjusted hazard ratio 3.52, 95% CI 2.03-6.11, P rosacea, but without statistical significance. Information related to lifestyle, diet, alcohol, and smoking was not included in the database. Patients with rosacea may have an increased risk of IBD. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review.

    Science.gov (United States)

    Zhan, Yong-le; Zhan, Yong-An; Dai, Shi-Xue

    2017-05-24

    To assess the current evidence regarding the benefit of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol (FODMAP) diet in the treatment of patients with inflammatory bowel disease (IBD). Databases such as PubMed, Web of Science, Medline were comprehensively searched for relevant studies through January 2017. The pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were used to analyze the dichotomous variables (diarrhea response, abdominal pain and bloating, etc.) and the continuous variables. Random- and fixed-effects models were chosen according to heterogeneity. Two RCTs and four before-after studies with a total of 319 patients (96% in remission) were identified. Except for the constipation response, there was a significant improvement in other symptoms: diarrhea response (OR: 0.24, 95% CI: 0.11-0.52, p = 0.0003), satisfaction with gut symptoms (OR: 26.84, 95% CI: 4.6-156.54, p FODMAP diet is beneficial for reducing gastrointestinal symptoms in patients with quiescent IBD. With the inherent limitations, the findings of this analysis remain to be confirmed and updated by further high-volume, well-designed and long-term follow-up studies. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  1. Bone Loss Prevention of Bisphosphonates in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

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    Yan Hu

    2017-01-01

    Full Text Available Objective. The purpose of this study was to evaluate the effect of bisphosphonates in improving bone mineral density (BMD and decreasing the occurrence rate of fractures and adverse events in patients with inflammatory bowel disease (IBD. Methods. Randomized controlled trials (RCTs which use bisphosphonates in IBD patients were identified in PubMed, MEDLINE database, EMBASE database, Web of Knowledge, and the Cochrane Databases between 1990 and June 2016. People received bisphosphonate or placebos with a follow-up of at least one year were also considered. STATA 12.0 software was used for the meta-analysis. Results. Eleven randomized clinical trials were included in the meta-analysis. The data indicated that the percentage change in the increased BMD in the bisphosphonates groups was superior to that of the control groups at the lumbar spine and total hip. At the femoral neck, there was no significant difference between the two groups. The incidence of new fractures during follow-up showed significant reduction. The adverse event analysis revealed no significant difference between the two groups. Conclusion. Our results demonstrate that bisphosphonates therapy has an effect on bone loss in patients with IBD but show no evident efficiency at increasing the incidence of adverse events.

  2. Safety of herpes zoster vaccination among inflammatory bowel disease patients being treated with anti-TNF medications.

    Science.gov (United States)

    Khan, N; Shah, Y; Trivedi, C; Lewis, J D

    2017-10-01

    The risk of herpes zoster (HZ) is elevated in inflammatory bowel disease (IBD) patients treated with anti-TNF medications. While it is optimal to give herpes zoster vaccine prior to initiation of therapy clinical circumstances may not always allow this. To determine the safety of giving herpes zoster vaccine while patients are on anti-TNF therapy. We conducted a retrospective cohort study involving IBD patients who were followed in the Veterans Affairs (VA) healthcare system between 2001 and 2016. Patients who received herpes zoster vaccine while on anti-TNF medication were identified through vaccination codes and confirmed through individual chart review. Our outcome of interest was development of HZ between 0 and 42 days after herpes zoster vaccine administration. Fifty-six thousand four hundred and seventeen patients with IBD were followed in the VA healthcare system. A total of 59 individuals were on anti-TNF medication when they were given herpes zoster vaccine, and amongst them, 12 (20%) were also taking a thiopurine. Median age at the time of herpes zoster vaccine was 64.9 years and 95% of patients had a Charlson Comorbidity Index of ≥2. Median number of encounters within 42 days after receiving herpes zoster vaccine was two. No case of HZ was found within 0-42 days of HZV administration. Our data suggest that co-administering the herpes zoster vaccine to patients who are taking anti-TNF medications is relatively safe. This study significantly expands the evidence supporting the use of herpes zoster vaccine in this population, having included an elderly group of patients with a high Charlson Comorbidity Index who are likely at a much higher risk of developing HZ. © 2017 John Wiley & Sons Ltd.

  3. Exaggerated inflammatory response of primary human myeloid dendritic cells to lipopolysaccharide in patients with inflammatory bowel disease.

    Science.gov (United States)

    Baumgart, D C; Thomas, S; Przesdzing, I; Metzke, D; Bielecki, C; Lehmann, S M; Lehnardt, S; Dörffel, Y; Sturm, A; Scheffold, A; Schmitz, J; Radbruch, A

    2009-09-01

    Inflammatory bowel disease (IBD) results from a breakdown of tolerance towards the indigenous flora in genetically susceptible hosts. Failure of dendritic cells (DC) to interpret molecular microbial patterns appropriately when directing innate and adaptive immune responses is conceivable. Primary (conventional, non-monocyte generated) CD1c(+)CD11c(+)CD14(-)CD16(-)CD19(-) myeloid blood or mucosal dendritic cells (mDC) from 76 patients with Crohn's disease (CD) or ulcerative colitis (UC) in remission, during flare-ups (FU) and 76 healthy or non-IBD controls were analysed by fluorescence activated cell sorter (FACS) flow cytometry and real-time polymerase chain reaction. Cytokine secretion of freshly isolated, cultured and lipopolysaccharide (LPS)-stimulated highly purified mDC (purity >95%) was assessed using cytometric bead arrays (CBA). More cultured and stimulated circulating mDC express CD40 in IBD patients. Stimulated circulating mDC from IBD patients secrete significantly more tumour necrosis factor (TNF)-alpha and interleukin (IL)-8. Toll-like receptor (TLR)-4 expression by mDC was higher in remission and increased significantly in flaring UC and CD patients compared with remission (P up more LPS and the uptake begins earlier compared with controls (P expressing mucosal mDC is significantly greater in UC and CD compared with non-IBD controls (P < 0.001 versus P < 0.01, respectively). Our data suggest an aberrant LPS response of mDC in IBD patients, resulting in an inflammatory phenotype and possibly intestinal homing in acute flares.

  4. Inflammatory bowel diseases, celiac disease, and bone.

    Science.gov (United States)

    Bianchi, Maria Luisa

    2010-11-01

    The article summarizes the current knowledge on the pathogenesis, clinical aspects and treatment of bone problems in the major inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and celiac disease. It presents the physiological relationship between intestine and bone as well as the alterations determined by disease-disrupted intestinal integrity. Two hypotheses about the pathogenetic mechanisms of bone metabolism derangements and bone loss are discussed: the classical one, that indicates calcium malabsorption as the main culprit, and the new one, that emphasizes the role of inflammation. The article summarizes the available epidemiological data about osteopenia/osteoporosis and fragility fractures in these chronic intestinal diseases and presents the state-of-the-art treatment options. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH FUNCTIONAL DYSPEPSIA AND CONSTIPATION PREDOMINANT IRRITABLE BOWEL SYNDROME: CLINICAL FEATURES AND EFFICACY OF LACTULOSE AND ITOPRIDE HYDROCHLORIDE

    OpenAIRE

    O. V. Krapivnaya; S. A. Alekseenko

    2014-01-01

    Background: The frequent coexistence of gastroesophageal reflux disease (GERD) with functional dyspepsia (FD) and an irritable bowel syndrome (IBS) has been described in the literature. Aim: To study the specific features of GERD clinical course and diagnosis in patients with GERD in combination with FD and constipation predominant IBS (IBS-C) in comparison to patients with isolated GERD; to assess the efficacy of lactulose and itopride hydrochloride. Materials and methods: A total of 60 pati...

  6. Inflammatory bowel disease and colon cancer.

    Science.gov (United States)

    Jawad, Noor; Direkze, Natalie; Leedham, Simon J

    2011-01-01

    The inflammatory bowel diseases (IBD); Crohn's and Ulcerative colitis, result from an altered host response to intestinal flora. Recurrent inflammation with ulceration and tissue restitution confers an increased risk of cancer in both UC and Crohns, and genome wide searches have identified a number of disease susceptibility alleles. The carcinogenesis pathway in colitis-associated colorectal cancer (CACRC) is less clearly understood than it's sporadic counterpart. Clonal ordering experiments have indicated the order and timing of chromosomal instability and common genetic mutations. Epigenetic changes such as DNA methylation and histone modification are thought to play an increasingly important role in inflammation induced carcinogenesis. Clonal expansion of procarcinogenic mutations can lead to large fields of mutant tissue from which colitis associated cancers can arise (field cancerisation). Endoscopic screening is the mainstay of surveillance in high-risk patients although the development of appropriate, clinically applicable biomarkers remains a research priority. Despite the expanding field of biological therapy in inflammatory bowel disease the ASA compounds remain the best-studied and most efficacious chemopreventive agents. Colitis associated CRC appears to have a different aetiology, carcinogenesis pathway and clinical course to its sporadic counterpart. Further research including long-term follow up of patient cohorts taking biological therapies will improve the detection and treatment of these important, inflammation-induced malignancies.

  7. Management of inflammatory bowel disease in pregnancy.

    Science.gov (United States)

    Vermeire, Séverine; Carbonnel, Franck; Coulie, Pierre G; Geenen, Vincent; Hazes, Johanna M W; Masson, Pierre L; De Keyser, Filip; Louis, Edouard

    2012-09-01

    Inflammatory bowel disease (IBD) is a chronic disease affecting mainly young people in their reproductive years. IBD therefore has a major impact on patients' family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal disease control and drug safety considerations. This article aims to provide a framework for clinical decision making in IBD based on review of the literature on pregnancy-related topics. Medline searches with search terms 'IBD', 'Crohn's disease' or 'ulcerative colitis' in combination with keywords for the topics fertility, pregnancy, congenital abnormalities and drugs names of drugs used for treatment of IBD. IBD patients have normal fertility, except for women after ileal pouch-anal anastomosis (IPAA) and men under sulfasalazine treatment. Achieving and maintaining disease remission is a key factor for successful pregnancy outcomes in this population, as active disease at conception carries an increased risk of preterm delivery and low birth weight. Clinicians should discuss the need for drug therapy to maintain remission with their patients in order to ensure therapy compliance. Most IBD drugs are compatible with pregnancy, except for methotrexate and thalidomide. If possible, anti-TNF therapy should be stopped by the end of the second trimester and the choice of delivery route should be discussed with the patient. Disease control prior to conception and throughout pregnancy is the cornerstone of successful pregnancy management in IBD patients. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  8. Role of vitamin D derivatives in intestinal tissue of patients with inflammatory bowel diseases.

    Science.gov (United States)

    Martinesi, Maria; Ambrosini, Stefano; Treves, Cristina; Zuegel, Ulrich; Steinmeyer, Andreas; Vito, Annese; Milla, Monica; Bonanomi, Andrea G; Stio, Maria

    2014-09-01

    The adhesion molecule expression and matrix metalloproteinases (MMPs) are proposed to be major factors for intestinal injury mediated by T cells in (IBD) and are up-regulated in intestinal mucosa of IBD patients. To investigate the effect of vitamin D derivatives on adhesion molecules and MMPs in colonic biopsies of IBD patients. Biopsies from inflamed and non-inflamed tract of terminal ileum and colon and PBMC from the same IBD patients were cultured with or without vitamin D derivatives. MMP activity and adhesion molecule levels were determined. 1,25(OH)2D3 and ZK 191784 significantly decrease ICAM-1 protein levels in the biopsies obtained only from the inflamed region of intestine of UC patients, while MAdCAM-1 levels decrease in the presence of 1,25(OH)2D3 in the non-inflamed region, and, in the presence of ZK, in the inflamed one. In CD patients 1,25(OH)2D3 and ZK decrease ICAM-1 and MAdCAM-1 in the biopsies obtained from the non-inflamed and inflamed regions, with the exception of ICAM-1 in the inflamed region in the presence of 1,25(OH)2D3. The expression of MMP-9, MMP-2, and MMP-3 decreases in the presence of vitamin D derivatives in UC and CD with the exception of 1,25(OH)2D3 that does not affect the levels of MMP-9 and MMP-2 in CD. Vitamin D derivatives always affect MMP-9, MMP-2 and ICAM-1 in PBMC of UC and CD patients. Based on the increased expression of ICAM-1, MAdCAM-1 and MMP-2,-9,-3 in IBD, our study suggests that vitamin D derivatives may be effective in the management of these diseases. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  9. [Two-year incidence of new immune-mediated inflammatory diseases in patients with inflammatory bowel disease: A study in the AQUILES cohort].

    Science.gov (United States)

    Marín-Jiménez, Ignacio; Gisbert, Javier P; Pérez-Calle, José L; García-Sánchez, Valle; Tabernero, Susana; García-Vicuña, Rosario; Romero, Cristina; Juliá, Berta; Vanaclocha, Francisco; Cea-Calvo, Luis

    2015-12-01

    To describe the 2-year incidence of new immune-mediated inflammatory diseases (spondylarthritis, uveitis, psoriasis) in the cohort of patients with inflammatory bowel disease (IBD) included in the AQUILES study. Over a 2-year period, 341 patients with IBD (53% women, mean age 40 years) diagnosed with Crohn's disease (60.5%), ulcerative colitis (38.1%) and indeterminate colitis (1.4%) were followed up. New diagnoses made during follow-up were based on reports of the corresponding specialists (rheumatologists, ophthalmologists, and dermatologists). A total of 22 new diagnoses of immune-mediated inflammatory diseases were established in 21 patients (cumulative incidence of 6.5%, 95% confidence interval [CI] 3.7-9.2, incidence rate of 26 cases per 10,000 patient-years). Most diagnoses were new cases of spondylarthritis (n=15). The cumulative incidence of new diagnoses of immune-mediated inflammatory diseases was similar in patients with Crohn's disease (5.8%, 95% CI 3.4-9.9) and in patients with ulcerative colitis (7.7%, 95% CI 4.2-13.6). On multivariate analysis, the incidence of new immune-mediated inflammatory diseases was significantly associated with a family history of IBD (odds ratio=3.6, 95% CI 1.4-9.4) and the presence of extraintestinal manifestations of IBD (odds ratio=1.8, 95% CI .7-5.2). In patients with IBD, the incidence of new immune-mediated inflammatory diseases at 2 years of follow-up was 6.5%. These diseases were more frequent in patients with extraintestinal manifestations of IBD and a family history of IBD. Copyright © 2015 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  10. Selenium and inflammatory bowel disease.

    Science.gov (United States)

    Kudva, Avinash K; Shay, Ashley E; Prabhu, K Sandeep

    2015-07-15

    Dietary intake of the micronutrient selenium is essential for normal immune functions. Selenium is cotranslationally incorporated as the 21st amino acid, selenocysteine, into selenoproteins that function to modulate pathways involved in inflammation. Epidemiological studies have suggested an inverse association between selenium levels and inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis that can potentially progress to colon cancer. However, the underlying mechanisms are not well understood. Here we summarize the current literature on the pathophysiology of IBD, which is multifactorial in origin with unknown etiology. We have focused on a few selenoproteins that mediate gastrointestinal inflammation and activate the host immune response, wherein macrophages play a pivotal role. Changes in cellular oxidative state coupled with altered expression of selenoproteins in macrophages drive the switch from a proinflammatory phenotype to an anti-inflammatory phenotype to efficiently resolve inflammation in the gut and restore epithelial barrier integrity. Such a phenotypic plasticity is accompanied by changes in cytokines, chemokines, and bioactive metabolites, including eicosanoids that not only mitigate inflammation but also partake in restoring gut homeostasis through diverse pathways involving differential regulation of transcription factors such as nuclear factor-κB and peroxisome proliferator-activated receptor-γ. The role of the intestinal microbiome in modulating inflammation and aiding in selenium-dependent resolution of gut injury is highlighted to provide novel insights into the beneficial effects of selenium in IBD. Copyright © 2015 the American Physiological Society.

  11. Understanding Microbial Sensing in Inflammatory Bowel Disease Using Click Chemistry

    Science.gov (United States)

    2016-10-01

    AWARD NUMBER: W81XWH-15-1-0368 TITLE: Understanding Microbial Sensing in Inflammatory Bowel Disease Using Click Chemistry PRINCIPAL...AND SUBTITLE with Click Chemistry : : Understanding Microbial Sensing in Inflammatory Bowel Disease with Click Chemistry Understanding Microbial...Sensing in Inflammatory Bowel Disease with Click Chemistry 5a. CONTRACT NUMBER Understanding Microbial Sensing in Inflammatory Bowel Disease Using Click

  12. Presence of Mycobacterium avium subsp. paratuberculosis (MAP in Brazilian patients with inflammatory bowel diseases and in controls

    Directory of Open Access Journals (Sweden)

    Isabel Azevedo Carvalho

    Full Text Available CONTEXT AND OBJECTIVE: Mycobacterium avium subsp. paratuberculosis (MAP has attracted the interest of researchers because of similarities between paratuberculosis and Crohn's disease (CD. The aim of this study was to evaluate the frequency of MAP through cultures, histology and polymerase chain reaction (PCR on intestinal biopsies from Brazilian CD patients. Quantitative real time PCR (qRT-PCR was performed on positive samples. DESIGN AND SETTING: Analytical cross-sectional study with control group at two federal universities. METHODS: Fresh samples were collected from 25 patients; five with CD, eight with ulcerative colitis (UC and 12 controls with non-inflammatory bowel disease (nIBD. Formalin-fixed paraffin-embedded (FFPE samples from 143 patients were also collected: 44 CD, 49 UC and 56 nIBD. RESULTS: None of the fresh samples was positive for MAP. Five FFPE samples (one CD, two UC and two nIBD and three fresh samples (one in each group were positive through IS900-PCR. qRT-PCR was performed on these eight samples. Among the FFPE samples, there were 192.12 copies/μl in the CD group, 72.28 copies/μl in UC and 81.43 copies/μl in nIBD. Among the fresh samples, there were 432.99 copies/μl, 167.92 copies/μl and 249.73 copies/μl in the CD, UC and nIBD groups, respectively. The highest bacterial load was in the CD group. CONCLUSION: This study does not provide evidence for a role of MAP in the etiology of CD, although MAP DNA was detected in all three patient groups. This is the first report of MAP presence in human intestinal biopsies in Brazil.

  13. Exome Sequencing Analysis Reveals Variants in Primary Immunodeficiency Genes in Patients With Very Early Onset Inflammatory Bowel Disease

    Science.gov (United States)

    Kelsen, Judith R.; Dawany, Noor; Moran, Christopher J.; Petersen, Britt-Sabina; Sarmady, Mahdi; Sasson, Ariella; Pauly-Hubbard, Helen; Martinez, Alejandro; Maurer, Kelly; Soong, Joanne; Rappaport, Eric; Franke, Andre; Keller, Andreas; Winter, Harland S.; Mamula, Petar; Piccoli, David; Artis, David; Sonnenberg, Gregory F.; Daly, Mark; Sullivan, Kathleen E.; Baldassano, Robert N.; Devoto, Marcella

    2016-01-01

    Background & Aims Very early onset inflammatory bowel disease (VEO-IBD), IBD diagnosed ≤5 y of age, frequently presents with a different and more severe phenotype than older-onset IBD. We investigated whether patients with VEO-IBD carry rare or novel variants in genes associated with immunodeficiencies that might contribute to disease development. Methods Patients with VEO-IBD and parents (when available) were recruited from the Children's Hospital of Philadelphia from March 2013 through July 2014. We analyzed DNA from 125 patients with VEO-IBD (ages 3 weeks to 4 y) and 19 parents, 4 of whom also had IBD. Exome capture was performed by Agilent SureSelect V4, and sequencing was performed using the Illumina HiSeq platform. Alignment to human genome GRCh37 was achieved followed by post-processing and variant calling. Following functional annotation, candidate variants were analyzed for change in protein function, minor allele frequency 1 Mbp of coding sequence, were selected from the whole exome data. Our analysis revealed novel and rare variants within these genes that could contribute to the development of VEO-IBD, including rare heterozygous missense variants in IL10RA and previously unidentified variants in MSH5 and CD19. Conclusions In an exome sequence analysis of patients with VEO-IBD and their parents, we identified variants in genes that regulate B- and T-cell functions and could contribute to pathogenesis. Our analysis could lead to the identification of previously unidentified IBD-associated variants. PMID:26193622

  14. Predictive factors of impaired quality of life in Korean patients with inactive inflammatory bowel disease: association with functional gastrointestinal disorders and mood disorders.

    Science.gov (United States)

    Kim, Eun S; Cho, Kwang B; Park, Kyung S; Jang, Byung I; Kim, Kyeong O; Jeon, Seong W; Jung, Min K; Kim, Eun Y; Yang, Chang H

    2013-04-01

    Inflammatory bowel disease is a chronic and relapsing inflammatory disorder of the intestine and has a great effect on patients' health-related quality of life (HRQOL). Some patients in remission are known to show functional gastrointestinal disorders (FGIDs) and mood disorders (MDs), which may also negatively impact HRQOL. The aim of this study was to evaluate predictors of impaired HRQOL in inactive inflammatory bowel disease (IBD) patients. Patients presenting a long-standing remission during the previous year completed questionnaires of EuroQol, Rome III criteria for FGID, and Hospital Anxiety and Depression Survey. Demographic data including age, sex, employment status, education, smoking, and location of residence were also collected. Among the 513 patients with IBD, 226 (Crohn's disease 107 and ulcerative colitis 119, age 39.01±15.63, male 141) defined in remission were enrolled. Overall, 147 (65.0%) had at least 1 FGID with irritable bowel syndrome being the most common disorder (36.3%). Anxiety and depression were identified in 27.4% and 33.6%, respectively. Participants with FGID or MD had a significantly lower HRQOL status than those without disorders (P<0.01). Among various demographic and clinical variables, aged 40 or older [odds ratio (OR), 2.342; 95% confidence interval (CI), 1.195-4.590; P=0.01], irritable bowel syndrome (OR, 3.932; 95% CI, 1.937-7.982; P<0.01), and anxiety (OR, 2.423; 95% CI, 1.067-5.502; P=0.03) were significant independent predictors of impaired HRQOL in inactive IBD patients. FGID and MD are common in Korean quiescent IBD patients. Appropriate management should be administered according to age of patients and presence of concomitant FGID and MD to improve patients' HRQOL.

  15. Risk factors for thiopurine-induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype.

    Science.gov (United States)

    Broekman, M M T J; Coenen, M J H; Wanten, G J; van Marrewijk, C J; Klungel, O H; Verbeek, A L M; Hooymans, P M; Guchelaar, H-J; Scheffer, H; Derijks, L J J; Wong, D R; de Jong, D J

    2017-11-01

    Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S-methyltransferase (TPMT) gene are the best-known risk factor, but only explain up to 25% of leucopenia cases. To identify the clinical risk factors for thiopurine-induced leucopenia in patients without a common TPMT variant, and explore if these patients are at increased risk for infections. Post hoc analysis of the Thiopurine response Optimisation by Pharmacogenetic testing in Inflammatory bowel disease Clinics (TOPIC) trial. For this analysis, patients without a variant in TPMT (*2, *3A or*3C) were included. Uni- and multivariate Cox-proportional hazard models were used to identify risk factors for leucopenia and infections. Leucopenia was defined as a white blood cell (WBC) count <3.0 × 109 /L and infections were classified according to the Common Terminology Criteria for Adverse Events. Sixty hundred and ninety-five patients (90.6%) included in the TOPIC-trial had no variant in TPMT, of which 45 (6.5%) developed leucopenia. Median time to leucopenia was 56 (29-112) days. Multivariate analysis showed that use of mercaptopurine compared to azathioprine was associated with leucopenia (hazard ratio [HR] 2.61 [95% CIs, 1.39-4.88; P < .01]) and a higher baseline WBC count was protective (HR 0.80 [95% CIs, 0.71-0.89; P < .01]). Risk factors for infections were older age (per 10 year; HR 2.07 [95% CIs, 1.18-3.63; P = .01]) and concomitant use of biologic drugs (HR 2.15 [95% CIs, 1.14-4.07; P = .02]). Low baseline WBC count and mercaptopurine, due to a relatively higher dose, were risk factors for thiopurine-induced leucopenia in patients without a TPMT variant. © 2017 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

  16. [Obstetrical and gynecological relevance of inflammatory bowel disease].

    Science.gov (United States)

    Kálmán, Judit; Bajor, Judit; Gáll, János; Harsányi, László; Horváth, Henrik Csaba; Kerékgyártó, Olga; László, Adám; Novák, János; Salamon, Agnes; Wacha, Judit

    2012-11-18

    Inflammatory bowel disease may show a life long persistence, while female fertility is time-limited. The aim of the authors was to obtain more knowledge about the obstetrical-gynecological aspects of this disorder. The authors evaluated 100 patients with inflammatory bowel disease and 100 healthy women with a self-composed questionnaire. Menarche occurred significantly earlier in patients than in controls (p = 0,03). Either the activity of the disease, or the therapy itself may initiate irregularities in the menstrual cycle. Patients used contraceptives less frequently than controls (p = 0,002), and the time from family-planning to conception was longer in patients. Symptoms of bowel disease during pregnancy were not as severe as before and after pregnancy (ppregnancy (p = 0,042) and on the frequency of complications. Preterm birth and low birth weight were more frequent in newborns of patients (p = 0,019). Pregnancy has positive effect on the symptoms of inflammatory bowel disease in case gestation occurs in a stable period of the inflammatory bowel disease.

  17. [Inflammatory bowel disease during pregnancy and childbirth].

    Science.gov (United States)

    Závorová, K

    2017-01-01

    The aim is to give basic information about inflammatory bowel disease (IBD) during pregnancy, to highlight the importance of treatment in pregnancy and also show our own experience with the issue. Original work - a retrospective study. Department of Obstetrics and Gynecology, Hospital Hořovice. We provide basic overview information about inheritance, fertility, mutual influence of IBD and pregnancy therapy in pregnancy and childbirth options for patients with IBD. We present also the results of the group of 17 patients with varying degrees of disability IBD (including patients after previous surgeries - bowel resection, hemicolectomy, ileostomy or with a pouch) that gave birth to our workplace. A crucial factor for good results is the degree of inflammation at the time of conception and during pregnancy. If the disease is inactive and nutrition of the diseased sufficient, there is no decrease in fertility, course of pregnancy is seamless, there is no greater risk of deterioration of disease in pregnancy and pregnancy do not differ from the normal population. The opposite situation occurs if there is a pregnancy at the time of disease activity. Then up to 75% pregnancy courses with big problems, fertility is declining, inflammation is also worsening and the risk of exacerbations increases during pregnancy, which aggravates the course of pregnancy and childbirth and has a negative effect on the fetus. Pregnancy is therefore necessary to plan for a longer period of disease stabilization and continue chronic medication and not discontinue drugs for fear of negative impact of medications on fetal development. On the contrary, active inflammation of the mother during pregnancy poses a greater risk to the fetus than adequate treatment. Commonly used drugs-aminosalicylates, corticosteroids, immunosuppressants and biological therapy appears to be safe and well tolerated during pregnancy. Method of delivery is individual and depends on the form and location of the

  18. Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Severs, M.; Mangen, M.J.; Fidder, H.H.; Valk, M.E. van der; Have, M. van der; Bodegraven, A.A. van; Clemens, C.H.; Dijkstra, G.; Jansen, J.M.; Jong, D.J. de; Mahmmod, N.; Meeberg, P.C. van de; Jong, A E F de; Pierik, M.; Ponsioen, C.Y.; Romberg-Camps, M.J.; Siersema, P.D.; Jharap, B.; Woude, J.C. van der; Zuithoff, N.P.; Oldenburg, B.

    2017-01-01

    BACKGROUND: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD. METHODS: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and

  19. Stem cell therapy for inflammatory bowel disease

    NARCIS (Netherlands)

    Duijvestein, Marjolijn

    2012-01-01

    Hematopoietic stem cell transplantation (HSCT) and mesenchymal stromal (MSC) cell therapy are currently under investigation as novel therapies for inflammatory bowel diseases (IBD). Hematopoietic stem cells are thought to repopulate the immune system and reset the immunological response to luminal

  20. An Assessment of the AGA and CCFA Quality Indicators in a Sample of Patients Diagnosed with Inflammatory Bowel Disease.

    Science.gov (United States)

    Tkacz, Joseph; Brady, Brenna L; Meyer, Roxanne; Lofland, Jennifer H; Ruetsch, Charles; Coelho-Prabhu, Nayantara

    2015-11-01

    Inflammatory bowel disease (IBD) is a chronic relapsing disease characterized by activation of the mucosal immune system and inflammation of the gastrointestinal tract. Management of IBD places a significant burden on the health care system because of the complexity of treatment, variability in patient outcomes, and chronic nature of the disease.  To investigate the American Gastroenterological Association (AGA) and Crohn's and Colitis Foundation of America's (CCFA) quality measurement sets in a sample of IBD patients. Fourteen quality measures were restated for application to a claims database and calculated using Optum Clinformatics DataMart database. Selected measures were calculated over calendar year 2011. Performance measures ranged from 0.4% for AGA measure 9, prophylaxis for venous thromboembolism, to 66.9% for AGA measure 8, testing for Clostridium difficile. CCFA outcome measures ranged from 0.6% qualifying for CCFA O10, report of fecal incontinence, to 32.9% for CCFA O1, prednisone usage. In addition to Clostridium difficile testing, the use of appropriate corticosteroid-sparing therapy (51.1%) and testing for latent tuberculosis before initiating anti-tumor necrosis factor therapy (45.0%) were the highest achieved measures. This is the first examination of IBD quality measures using administrative claims. Rates of achievement across measures were variable and likely affected by the ability to calculate certain measures with claims data. Future studies should further examine measurement of IBD quality indicators in claims data to assess the validity of claims-based analyses and to ascertain whether measure attainment translates into better overall health or IBD-related outcomes.

  1. A prospective study of the safety of lower gastrointestinal endoscopy during pregnancy in patients with inflammatory bowel disease.

    Science.gov (United States)

    de Lima, A; Zelinkova, Z; van der Woude, C J

    2015-07-01

    Women with inflammatory bowel disease [IBD] have a higher risk of undergoing gastrointestinal [GI] endoscopy during pregnancy than healthy women. Data on endoscopic procedures during pregnancy in IBD women are limited. The aim of this study was to investigate the safety of lower GI endoscopy during pregnancy in IBD women. All consecutive IBD women who underwent endoscopy during pregnancy [cases] from 2008-2014 were prospectively included. Cases were matched 1:1 on age, IBD medication, and disease activity with pregnant IBD patients without endoscopy during pregnancy [controls]. Maternal and neonatal outcomes were compared between the cases and controls. Adverse events [AEs] were assessed for a temporal relation and for an aetiological relation with the endoscopy. In total, 42 pregnant IBD patients [19 Crohn's disease, 23 ulcerative colitis] underwent 47 lower GI endoscopies [12 colonoscopies/35 sigmoidoscopies]. Median maternal age was 30 years [interquartile range: 28-32]. Two spontaneous abortions were temporally and probably related to endoscopy; however, spontaneous abortion did not occur more often in cases than in controls (2 [4.8%] vs 10 [23.8%], p 0.01). Median birthweight was significantly lower in the cases compared with controls [3017g vs 3495g, p 0.01]. There were no significant differences in terms of gestational age at birth, congenital abnormalities, or APGAR scores. Although lower GI endoscopy in pregnant IBD women should only be performed when strongly indicated, we report no increased adverse outcomes for the mother or the newborn related to endoscopy in any of the three trimesters of pregnancy compared with controls. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  2. Potential Human Models of Infammatory Bowel Disease

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    Stephen B Hanauer

    1995-01-01

    Full Text Available Similar to animal models of inflammatory bowel disease (IBD, there is no single human model representative of ulcerative colitis or Crohn's disease. An optimal human model awaits etiopathogenetic definitions and further reclassification or depiction of clinicopathological scenarios. Current human models can be classified into models depicting risk of disease; preclinical disease; acute inflammation; and miscellaneous IBD. Family studies are the best means of pursuing patients at risk. Evolving genetic and serological markers may further identify subgroups to assess with permeability probes, leukocyte scans or endoscopy for preclinical disease. Provocation with nonsteroidal anti-inflammatory drugs (NSAIDs may be useful in selected patients because NSAID mucosal damage may induce or mimic IBD. Alternative natural history or interventional studies in patients with human leukocyte antigen (HLA-B27 spondylarthropathy may be useful. The disease margin and pouchitis are models within the disease state of ulcerative colitis as are the aphthous ulcer, anastomotic margin and diverted fecal stream for Crohn's disease. Newly defined colitides, such as microscopic and collagenous colitis and diversion colitis, also provide potential comparative models to evaluate mucosal immune, inflammatory, reparative, secretory and absorptive regulation.

  3. The Customer Quality of Delivered Care to Patients with Inflammatory Bowel Disease in Tabriz City, Iran, 2012

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2015-08-01

    Full Text Available Abstract Background and purpose: Customer quality (CQ refers to knowledge, attitude, and skills of service-user in treatment process and this study aims to assess it in delivered care to patients with inflammatory bowel disease (IBD in Tabriz city, Iran, 2012. Materials and Methods: This is a cross-sectional investigation in which the target population includes 94 patients with IBD, who had medical care files in Imam Reza Hospital and Tabriz Golgasht Specialized Clinic. A 19-question inventory is the tool for data collection that its validity was approve by 10 experts and its reliability was examined and verified by conducting a pilot study and with calculation of internal consistency (α = 0.78. SPSS software was employed to analyze data. Results: The mean score of the variable of CQ was derived (70.63 ± 9.67 in patients with IBD disease. All participants had acquired the scores of self-management at the first phase. However, at last 11.7% of them had reported the highest scores in variable of CQ and they could continue their own medical care trend under variable conditions like stress and financial problems. Similarly, there was a significant relationship among CQ with an educational degree in the participants (P = 0.050 so that as the educational level was higher, the score of CQ was also increased. Conclusion: The acquired results signify that CQ is relatively acceptable in the studied population but major problems are visible in some areas, and this may imply the necessity for consideration by healthcare directors.

  4. Prior colorectal neoplasia is associated with increased risk of ileoanal pouch neoplasia in patients with inflammatory bowel disease.

    Science.gov (United States)

    Derikx, Lauranne A A P; Kievit, Wietske; Drenth, Joost P H; de Jong, Dirk J; Ponsioen, Cyriel Y; Oldenburg, Bas; van der Meulen-de Jong, Andrea E; Dijkstra, Gerard; Grubben, Marina J A L; van Laarhoven, Cornelis J H M; Nagtegaal, Iris D; Hoentjen, Frank

    2014-01-01

    Although restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) substantially reduces the risk of colorectal cancer in patients with inflammatory bowel disease (IBD), subsequent pouch neoplasia can develop. There are few data on the incidence of and risk factors for neoplasia, so there is no consensus on the need for pouch surveillance. We aimed to determine the cumulative incidence of pouch neoplasia in patients with IBD and identify risk factors for developing pouch neoplasia. We searched the Dutch Pathology Registry (PALGA) to identify all patients with IBD and IPAA in The Netherlands from January 1991 to May 2012. We calculated the cumulative incidence of pouch neoplasia and performed a case-control study to identify risk factors. Demographic and clinical variables were analyzed with univariable and multivariable Cox regression analyses. We identified 1200 patients with IBD and IPAA; 25 (1.83%) developed pouch neoplasia, including 16 adenocarcinomas. Respective cumulative incidences at 5, 10, 15, and 20 years were 1.0%, 2.0%, 3.7%, and 6.9% for pouch neoplasia and 0.6%, 1.4%, 2.1%, and 3.3% for pouch carcinoma. A history of colorectal neoplasia was the only risk factor associated with pouch neoplasia. Hazard ratios were 3.76 (95% confidence interval, 1.39-10.19) for prior dysplasia and 24.69 (95% confidence interval, 9.61-63.42) for prior carcinoma. The incidence of pouch neoplasia in patients with IBD without a history of colorectal neoplasia is relatively low. Prior dysplasia or colon cancer is associated with an approximate 4- and 25-fold increase in risk, respectively, of developing pouch neoplasia. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  5. The Immunological Basis of Inflammatory Bowel Disease

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    Francesca A. R. Silva

    2016-01-01

    Full Text Available Inflammatory bowel diseases (IBDs are chronic ailments, Crohn’s disease and ulcerative colitis being the most important. These diseases present an inflammatory profile and they differ according to pathophysiology, the affected area in the gastrointestinal tract, and the depth of the inflammation in the intestinal wall. The immune characteristics of IBD arise from abnormal responses of the innate and adaptive immune system. The number of Th17 cells increases in the peripheral blood of IBD patients, while Treg cells decrease, suggesting that the Th17/Treg proportion plays an important role in the development and maintenance of inflammation. The purpose of this review was to determine the current state of knowledge on the immunological basis of IBD. Many studies have shown the need for further explanation of the development and maintenance of the inflammatory process.

  6. Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn′s disease

    Directory of Open Access Journals (Sweden)

    Francesca Fornasa

    2011-01-01

    Full Text Available Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn′s disease (CD. Materials and Methods: A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged present if a small bowel segment had >80% lumen reduction as compared to an adjacent normal loop and mural thickening of >3 mm. At the level of the stenosis, both T2 signal intensity and post-gadolinium T1 enhancement were quantified using a 5-point scale (0: very low; 1: low; 2: moderate; 3: high; and 4: very high. A stenosis was considered fibrotic if the sum of the two values (activity score: AS did not exceed 1. Results: A small bowel stenosis was identified in 48 out of 111 patients. Fibrosis was confirmed at histology in all of the 23 patients with AS of 0 or 1, who underwent surgery within 3 days of the MRI examination. In the remaining 25 patients (AS: 2-8, an active inflammatory stenosis was suspected and remission of the obstructive symptoms was obtained by means of medical treatment. One of these patients (AS: 2, however, underwent surgery after 14 days, due to recurrence. MRI had 95.8% sensitivity, 100% specificity, and 97.9% accuracy in the diagnosis of fibrotic stenosis. Conclusion: MRI is reliable in differentiating fibrotic from inflammatory small bowel stenosis in CD.

  7. Immunopathology of inflammatory bowel disease.

    Science.gov (United States)

    Wallace, Kori L; Zheng, Li-Bo; Kanazawa, Yoshitake; Shih, David Q

    2014-01-07

    Inflammatory bowel disease (IBD) results from a complex series of interactions between susceptibility genes, the environment, and the immune system. The host microbiome, as well as viruses and fungi, play important roles in the development of IBD either by causing inflammation directly or indirectly through an altered immune system. New technologies have allowed researchers to be able to quantify the various components of the microbiome, which will allow for future developments in the etiology of IBD. Various components of the mucosal immune system are implicated in the pathogenesis of IBD and include intestinal epithelial cells, innate lymphoid cells, cells of the innate (macrophages/monocytes, neutrophils, and dendritic cells) and adaptive (T-cells and B-cells) immune system, and their secreted mediators (cytokines and chemokines). Either a mucosal susceptibility or defect in sampling of gut luminal antigen, possibly through the process of autophagy, leads to activation of innate immune response that may be mediated by enhanced toll-like receptor activity. The antigen presenting cells then mediate the differentiation of naïve T-cells into effector T helper (Th) cells, including Th1, Th2, and Th17, which alter gut homeostasis and lead to IBD. In this review, the effects of these components in the immunopathogenesis of IBD will be discussed.

  8. Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting.

    Science.gov (United States)

    Afzali, Anita; Ogden, Kristine; Friedman, Michael L; Chao, Jingdong; Wang, Anthony

    2017-04-01

    Inflammatory bowel disease (IBD) (e.g. ulcerative colitis [UC] and Crohn's disease [CD]) severely impacts patient quality-of-life. Moderate-to-severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy. A model was developed, estimating annual costs of providing monitored infusions using an activity-based costing framework approach. Multiple sources (published literature, treatment product inserts) informed base-case model input estimates. The total modeled per patient infusion therapy costs in Year 1 with infliximab and vedolizumab was $38,782 and $41,320, respectively, and Year 2+, $49,897 and $36,197, respectively. Drug acquisition cost was the largest total costs driver (90-93%), followed by costs associated with hospital-based infusion provision: labor (53-56%, non-drug costs), allocated overhead (23%, non-drug costs), non-labor (23%, non-drug costs), and laboratory (7-10%, non-drug costs). Limitations included reliance on published estimates, base-case cost estimates infusion drug, and supplies, not accounting for volume pricing, assumption of a small hospital infusion center, and that, given the model adopts the hospital perspective, costs to the patient were not included in infusion administration cost base-case estimates. This model is an early step towards a framework to fully analyze infusion therapies' associated costs. Given the lack of published data, it would be beneficial for hospital administrators to assess total costs and trade-offs with alternative means of providing biologic therapies. This analysis highlights the value to hospital administrators of assessing cost associated with infusion patient mix to make more informed resource allocation decisions. As the landscape for reimbursement changes, tools for evaluating the costs of infusion therapy

  9. A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy.

    Science.gov (United States)

    Bar-Gil Shitrit, Ariella; Koslowsky, Benjamin; Livovsky, Dan M; Shitrit, David; Paz, Kalman; Adar, Tomer; Adler, Samuel N; Goldin, Eran

    2017-03-01

    Capsule endoscopy (CE) is often used to investigate small bowel Crohn's disease (CD). The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings. Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD. Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p = .048). Median calprotectin and lactoferrin in the CD group and in the control group were 169 mg/kg vs. 40 (p = .004) and 6.6 mg/kg vs. 1 (p = .051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95 mg/kg and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD. Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE. ClinicalTrials.gov Identifier: NCT01266629.

  10. Hyposplenism in inflammatory bowel disease.

    Science.gov (United States)

    Ryan, F P; Smart, R C; Holdsworth, C D; Preston, F E

    1978-01-01

    Splenic function was assessed in 35 patients with ulcerative colitis and 20 patients with Crohn's disease. Hyposplenism was diagnosed if there were Howell-Jolly bodies in the peripheral blood film or if there was prolongation of clearance from the peripheral blood of injected 51-Cr-labelled heat-damaged red blood cells. Thirteen of the patients with ulcerative colitis had hyposplenism as compared with only one patient with Crohn's disease. Conversely, heat-damaged red cell clearance values faster than the normal range were found in six out of the 20 patients with Crohn's disease. Four patients with hyposplenism and ulcerative colitis developed life-threatening septicaemia in the early postcolectomy period, two of these being further complicated by disseminated intravascular coagulation. Images Fig. 2 PMID:624506

  11. Exome sequencing analysis reveals variants in primary immunodeficiency genes in patients with very early onset inflammatory bowel disease.

    Science.gov (United States)

    Kelsen, Judith R; Dawany, Noor; Moran, Christopher J; Petersen, Britt-Sabina; Sarmady, Mahdi; Sasson, Ariella; Pauly-Hubbard, Helen; Martinez, Alejandro; Maurer, Kelly; Soong, Joanne; Rappaport, Eric; Franke, Andre; Keller, Andreas; Winter, Harland S; Mamula, Petar; Piccoli, David; Artis, David; Sonnenberg, Gregory F; Daly, Mark; Sullivan, Kathleen E; Baldassano, Robert N; Devoto, Marcella

    2015-11-01

    Very early onset inflammatory bowel disease (VEO-IBD), IBD diagnosed at 5 years of age or younger, frequently presents with a different and more severe phenotype than older-onset IBD. We investigated whether patients with VEO-IBD carry rare or novel variants in genes associated with immunodeficiencies that might contribute to disease development. Patients with VEO-IBD and parents (when available) were recruited from the Children's Hospital of Philadelphia from March 2013 through July 2014. We analyzed DNA from 125 patients with VEO-IBD (age, 3 wk to 4 y) and 19 parents, 4 of whom also had IBD. Exome capture was performed by Agilent SureSelect V4, and sequencing was performed using the Illumina HiSeq platform. Alignment to human genome GRCh37 was achieved followed by postprocessing and variant calling. After functional annotation, candidate variants were analyzed for change in protein function, minor allele frequency less than 0.1%, and scaled combined annotation-dependent depletion scores of 10 or less. We focused on genes associated with primary immunodeficiencies and related pathways. An additional 210 exome samples from patients with pediatric IBD (n = 45) or adult-onset Crohn's disease (n = 20) and healthy individuals (controls, n = 145) were obtained from the University of Kiel, Germany, and used as control groups. Four hundred genes and regions associated with primary immunodeficiency, covering approximately 6500 coding exons totaling more than 1 Mbp of coding sequence, were selected from the whole-exome data. Our analysis showed novel and rare variants within these genes that could contribute to the development of VEO-IBD, including rare heterozygous missense variants in IL10RA and previously unidentified variants in MSH5 and CD19. In an exome sequence analysis of patients with VEO-IBD and their parents, we identified variants in genes that regulate B- and T-cell functions and could contribute to pathogenesis. Our analysis could lead to the

  12. Reproductive Planning and Contraception for Women with Inflammatory Bowel Diseases.

    Science.gov (United States)

    Gawron, Lori M; Sanders, Jessica; Steele, Katelyn P; Flynn, Ann D

    2016-02-01

    Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk for adverse pregnancy outcomes. Pregnancy outcomes for these conditions are best during stable disease remission. Unfortunately, women with inflammatory bowel disease are equally as likely as the general population to have unintended pregnancies. Patients look to their gastroenterologist for contraceptive counseling; however, the current standards for disease management do not prioritize this topic. Guidelines based on available evidence and expert opinion, such as the Centers for Disease Control U.S. Medical Eligibility Criteria for Contraceptive Use, exist to help practitioners provide safe and effective contraception to women with chronic medical conditions. If health care providers were to educate themselves and screen women with inflammatory bowel disease for risk of unintended pregnancy, there would be a reduction in the number of unintended pregnancies and subsequent adverse neonatal and maternal outcomes.

  13. Caring for Women with Inflammatory Bowel Disease.

    Science.gov (United States)

    Feagins, Linda A; Kane, Sunanda V

    2016-06-01

    Ulcerative colitis and Crohn disease are chronic inflammatory diseases with typical onset in early adulthood. These diseases, therefore, can affect a woman throughout the many stages of her life, including menstruation, sexuality, pregnancy, and menopause. Unique health issues face women during these stages and can affect the course of their inflammatory bowel disease as well as treatment strategies and health maintenance. This article covers the non-pregnancy-related issues that are important in caring for women with inflammatory bowel disease. The topics of pregnancy and fertility are covered in a separate review. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Qualidade de vida em pacientes portadores de doença inflamatória intestinal: tradução para o português e validação do questionário "Inflammatory Bowel Disease Questionnaire" (IBDQ Quality of life in patients with inflammatory bowel diseases: translation to Portuguese language and validation of the "Inflammatory Bowel Disease Questionnaire" (IBDQ

    Directory of Open Access Journals (Sweden)

    Rose Meire Albuquerque Pontes

    2004-06-01

    ser utilizada na avaliação da qualidade de vida de pacientes brasileiros portadores de doenças inflamatórias intestinais.BACKGROUND: Crohn's disease comprises, together with ulcerative colitis, the inflammatory bowel diseases, which because their morbidity and chronic evolution have a considerable impact on the patient's quality of life. The measurement of quality of life requires the determination of the degree of subjective well-being attributed to the lack of symptoms, to psychological state and daily activity, and is useful as an instrument of evaluation, both in clinical trials and health programs. Inflammatory Bowel Disease Questionnaire is an instrument developed by North-American investigators of McMaster University which reproducibility and validity has been determined in several countries studies, and has shown its use in the measurement of the quality of life of patients with inflammatory bowel diseases. AIMS: Our purpose was to translate that instrument into Portuguese language, its adaptation to Brazilian culture and verify its psychometric properties (validity and reproducibility. METHODS: It was applied to a population of 50 inflammatory bowel diseases patients (24 with Crohn's disease, 26 with ulcerative colitis. To test the criteria and construction validity of the instrument's, it was compared with SF-36, a general questionnaire for establishing quality of life, and the Crohn's Disease Activity Index and Lichtiger's Index. RESULTS: The correlations obtained were mostly moderate. About the intestinal diseases activity index, Lichtiger's index showed better correlations than Crohn's Disease Activity Index. To evaluate its reproducibility, the instrument was applied on three occasions, twice by the same observer (12 days average between applications and once by a second observer, resulting in a high degree of intra- and interobserver correlation. CONCLUSIONS: Portuguese version of Inflammatory Bowel Disease Questionnaire is a valid and reproducible

  15. Coping with Stress in Patients with Inflammatory Bowel Disease and Its Relationship with Disease Activity, Psychological Disorders, and Quality of Life

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    Manizheh Danesh

    2015-09-01

    Full Text Available Background: Inflammatory bowel diseases (IBD are chronic diseases with significant impact on patients’ well-being. The aim of this study was the determination of stress coping strategies in IBD patients and their correlation with disease activity, psychological health, and quality of life (QOL. Methods: This cross-sectional study was conducted on IBD patients referred to a gastroenterology clinic in Isfahan city (Iran. Disease activity, severity of anxiety and depression symptoms, stress coping strategies, and QOL were assessed using standard questionnaires. Coping strategies in IBD patients were compared to an unaffected control group. Results: 80 patients with mean age of 52.9 years (57.5% female and mean disease duration of 6.5 years were studied. Compared to the controls, IBD patients had higher scores in the maladaptive coping styles (evasive and palliative (P < 0.05. Association between coping strategies and disease activity was not significant. Severity of anxiety and depression was directly correlated with the maladaptive strategies (fatalistic and emotional (r = 0.283 to 0.468 and inversely correlated with the adaptive strategies (confrontive, optimistic, and self-reliant (r = -0.320 to -0.534. In addition, QOL was inversely correlated with the maladaptive strategies (fatalistic and emotional (r = -0.278 to -0.327 and directly correlated with the adaptive strategies (confrontive and optimistic (r = 0.262 to 0.355. Conclusion: Patients with IBD use more maladaptive and less adaptive stress coping strategies which are associated with their psychological health and QOL. Larger and prospective studies on the dynamic and interactive network of biopsychosocial factors in IBD patients are required.

  16. Efficacy of duloxetine add on in treatment of inflammatory bowel disease patients: A double-blind controlled study

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    Hamed Daghaghzadeh

    2015-01-01

    Full Text Available Background: Treating inflammatory bowel disease (IBD with antidepressants might be of utility to improve patient′s condition. The aim of this study was to assess the efficacy of Duloxetine on depression, anxiety, severity of symptoms, and quality of life (QOL in IBD patients. Materials and Methods: In a randomized, double-blind, controlled clinical trial on 2013-2014, in Alzahra Hospital (Isfahan, Iran, 44 IBD patients were chosen to receive either duloxetine (60 mg/day or placebo. They were treated in a 12 weeks program, and all of the participants also received mesalazine, 2-4 g daily. We assessed anxiety and depression with Hospital Anxiety and Depression Scale, the severity of symptoms with Lichtiger Colitis Activity Index and QOL with World Health Organization Quality of Life Instruments, before and just after the treatment. The data were analyzed using Paired sample t-test and ANCOVA. Results: In 35 subjects who completed the study, the mean (standard error [SE] scores of depression and anxiety were reduced in duloxetine more than placebo group, significantly (P = 0.041 and P = 0.049, respectively. The mean (SE scores of severity of symptom were also reduced in duloxetine more than the placebo group, significantly (P = 0.02. The mean (SE scores of physical, psychological, and social dimensions of QOL were increased after treatment with duloxetine more than placebo group, significantly (P = 0.001, P = 0.038, and P = 0.015, respectively. The environmental QOL was not increased significantly (P = 0.260. Conclusion: Duloxetine is probably effective and safe for reducing depression, anxiety and severity of physical symptoms. It also could increase physical, psychological, and social QOL in patients.

  17. Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment.

    Science.gov (United States)

    Wauters, Lucas; Billiet, Thomas; Papamichael, Konstantinos; Ballet, Vera; Joniau, Steven; Verschueren, Patrick; Silversmit, Geert; Van Assche, Gert; Vermeire, Séverine; Ferrante, Marc

    2017-01-01

    We aimed to study the risk of renal cell carcinoma (RCC) with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease (IBD) and rheumatic diseases (RD) and calculate standardized incidence ratios (SIRs) in IBD. This was a retrospective case-control and cohort study spanning 25 years, including IBD and RD patients with a diagnosis of RCC (1990-2014) identified through the electronic database of a tertiary referral center. RCC was confirmed in seven anti-TNF-exposed (TNF+) and 21 anti-TNF-naive (TNF-) IBD and one TNF+ and 26 TNF- RD patients. In IBD-RCC, younger age at RCC diagnosis [median (interquartile range) 46 (42-58) vs. 63 (52-75) years; P=0.02], immunosuppressive therapy (100 vs. 24%; P<0.0004), partial nephrectomy (86 vs. 33%; P=0.02), and surgery less than 1 month after diagnosis of RCC (71 vs. 14%; P=0.004) were associated with anti-TNF. Compared with IBD, RD patients were older at RCC diagnosis [70 (60-77) vs. 59 (47-69) years; P=0.02] with less nephron-sparing surgery (26 vs. 54%; P=0.04) and more symptomatic (44 vs. 14%; P=0.02) and advanced tumors (30 vs. 7%; P=0.04). SIRs in IBD-RCC TNF- and TNF+ were 5.4 (95% confidence interval 2.9-9.2) and 7.1 (2.3-16.5) in male patients and 8.5 (3.7-16.8) and 4.8 (0.6-17.3) in female patients, respectively. The risk for RCC associated with anti-TNF in IBD was 0.8 (0.3-2.5) in men and 1.4 (0.2-5.5) in women. The favorable patient and tumor profiles in IBD with anti-TNF may suggest incidentally discovered RCC on abdominal imaging. SIRs for IBD-RCC were not increased after anti-TNF exposure.

  18. Gastric emptying and disease activity in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Keller, Jutta; Binnewies, Ulrich; Rösch, Marie

    2015-01-01

    BACKGROUND: Gastric emptying (GE) is delayed in a subset of patients with inflammatory bowel disease (IBD). We have shown before that altered release of gastrointestinal hormones may contribute to GE disturbances, but overall effects of disease activity remain unclear. Thus, we aimed to evaluate GE...... in patients with IBD during active disease and following therapy. DESIGN: A total of 20 healthy subjects (HC) and 26 patients with IBD hospitalized because of an acute episode of their disease (Crohn's disease (CD) n = 13, ulcerative colitis (UC) n = 13) underwent a standardized (13) C-octanoic acid GE breath...... pathologically delayed GE half-time (T½ > 150 min) (P = 0·028 vs. HC). Moreover, T½ was significantly longer in the total group of patients with IBD than in HC (129 ± 12 min vs. 96 ± 7, P = 0·030). Postprandial GLP-1 responses were elevated in IBD (P = 0·002 vs. HC) and correlated with T½ (P = 0·05). Following...

  19. Re-phrasing the question: A simple tool for evaluation of adherence to therapy in patients with inflammatory bowel disease.

    Science.gov (United States)

    Engel, T; Ungar, B; Ben-Haim, G; Levhar, N; Eliakim, R; Ben-Horin, S

    2017-10-01

    Non-adherence to medication in patients with inflammatory bowel disease (IBD) is a challenging problem which is often overlooked or under-estimated by the physician or denied by the patient. We aimed to examine if re-phrasing the wording of the question used by the physician could help in revealing more patients who are non-adherent, and for whom appropriate counseling may be instituted. A cross-sectional questionnaire-based study of IBD patients treated in a tertiary center was conducted. Patients received a questionnaire detailing their treatments and disease course, as well as their perceptions about disease. Two forms of questions about adherence were deliberately placed in two separate parts of the questionnaire: One was 'are you taking your medications regularly as prescribed?' (Standard question), and the second, more emphatic question, was 'how often does it happen that you miss a drug dosing?' (Re-phrased question). The rate of non-adherence disclosed by each of these questions was compared. Sensitivity, specificity and predicative values were computed for each question against the conventional definition of non-adherence as taking of less than 80% of prescribed medication doses disclosed by any of the methods. Predictors of non-compliance and of denying non-compliance were also explored. Overall, 165 patients were included (49% female, mean age 33.7 ± 12.7 SD, median age 30 years, 29.6% with ulcerative colitis, 62.4% with Crohn's disease). Upon questioning, 50 (30.3%) of the patients admitted to non-adherence in the last month when asked by the emphatic re-phrased question format, compared with only 10 patients (6%) reporting non-adherence when asked directly by the standard question (OR 7.4, 95%CI 3.6-15.2, p question format disclosed only 20% of genuinely non-compliant patients and had 16% sensitivity and 98.2% specificity for revealing non-adherence (PPV 80%, NPV 72.9%) compared with the reference re-phrased question. The leading cause for non

  20. Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease.

    Science.gov (United States)

    Ehrenpreis, Eli D; Zhou, Ying

    2017-07-14

    To examined the prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease (IBD) by comparing the diagnostic codes for these procedures in patients with IBD and a control group of patients. The National Inpatient Sample database (NIS) is part of the Healthcare Cost and Utilization Project (HCUP), the largest publicly available inpatient healthcare database in the United States. The NIS samples about 20% of discharges from all community hospitals participating in HCUP, representative of more than 95% of the United States population, with approximately 7000000 hospitalizations reported annually. NIS contains data on diagnoses, procedures, demographics, length of stay (LOS), co-morbidities and outcomes. ICD-9-CM diagnostic codes for primary hospitalizations for arthroplasty of the hip or knee with a co-diagnosis of IBD [combining both Crohn's disease (CD) and ulcerative colitis (UC)] were used to identify study subjects for cost and LOS analysis for NIS from 1999-2012. Statistical analysis: 1: 2 propensity score matching between IBD vs a control group based on following factors: Patient age, gender, race, total co-morbidities, # of procedures, admission type, insurance, income quartiles, and hospital bed size, location and hospital teaching status. Categorical variables were reported as frequency and compared by χ 2 tests or Fisher's exact tests. Individual 1:3 matching was also performed for patients carrying diagnostic codes for CD and for patients with the diagnostic code for UC. After matching, continuous variables were rcompared with Wilcoxon signed rank or Paired T-tests. Binary outcomes were compared with the McNemar's test. This process was performed for the diagnosis of hip or knee arthroplasty and IBD (CD and UC combined). Prevalence of the primary or secondary diagnostic codes for these procedures in patients with IBD was determined from NIS 2007. Costs and mortality were similar for patients with IBD and controls, but LOS was

  1. Outcome after discontinuation of infliximab in patients with inflammatory bowel disease in clinical remission

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Molazahi, Akbar; Ainsworth, Mark Andrew

    2012-01-01

    -center, retrospective study of all patients with a primary response to IFX who discontinued IFX therapy while in steroid-free remission. Relapse was defined as reintroduction of treatment with a biologic, systemic steroid or surgery. Results. Of 219, 53 (24%) CD patients, and 28 of 97 (30%) UC patients discontinued IFX...

  2. Skin Manifestations of Inflammatory Bowel Disease

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    Brian L Huang

    2012-02-01

    Full Text Available Inflammatory bowel disease (IBD is a disease that affects the intestinal tract via an inflammatory process. Patients who suffer from IBD often have diseases that affect multiple other organ systems as well. These are called extraintestinal manifestations (EIMs and can be just as, if not more, debilitating than the intestinal inflammation itself. The skin is one of the most commonly affected organ system in patients who suffer from IBD. The scientific literature suggests that a disturbance of the equilibrium between host defense and tolerance, and subsequent over-activity of certain immune pathways, are responsible for the cutaneous disorders seen so frequently in IBD patients. The purpose of this review article is to give an overview of the types of skin diseases that are typically seen with IBD and their respective pathogenesis, proposed mechanisms, and treatments. These cutaneous disorders can manifest as a metastatic lesion, reactive process to the intestinal inflammation, association by genetic linkage and autoimmune processes, complication of IBD itself, as side effects from IBD treatments, and from other mechanisms that will be discussed in this article. Ultimately, it is important for healthcare providers to understand that skin manifestations should always be checked and evaluated for in patients with IBD.

  3. Inflammatory Bowel Disease. Medical and psychological aspects

    NARCIS (Netherlands)

    Albersnagel, Frans; Dijkstra, Gerard

    A review is presented in which the state of the art of behavioural-scientific research on inflammatory bowel disease (BID) is sorted out. After a short introduction on medical aspects of the two diseases that constitute IBD, i.e. Crohn's disease and ulcerative colitis, the factors that may have an

  4. Recent advances using immunomodulators for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Bjerrum, Jacob Tveiten; Herfarth, Hans

    2013-01-01

    Use of the immunomodulators thiopurines and methotrexate (MTX) in the treatment of inflammatory bowel disease (IBD), i.e., Crohn's disease and ulcerative colitis (UC), is considered to be good clinical practice. However, despite being administered to a considerable number of IBD patients over...

  5. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet

    DEFF Research Database (Denmark)

    Maagaard, Louise; Ankersen, Dorit Vedel; Callaerts-Vegh, Zsuzsanna

    2016-01-01

    AIM: To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease. METHODS: Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS...... deviations. Wheat, dairy products, and onions were the foods most often not reintroduced by patients. CONCLUSION: These data suggest that a diet low in FODMAPs is an efficacious treatment solution in the management of functional bowel symptoms for IBS and IBD patients....

  6. Prevalence of hepatobiliary dysfunction in a regional group of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Wewer, V; Gluud, C; Schlichting, P

    1991-01-01

    -22%) had at least 1 abnormal laboratory value. Serum bilirubin was elevated in 5%, alkaline phosphatases in 8%, aspartate aminotransferases in 4%, and alanine aminotransferases in 8% of the patients. Two per cent had decreased plasma coagulation factors (2.7 and 10) and serum albumin. Further diagnositc...... laboratory value. Serum bilirubin was elevated in 2%, alkaline phosphatases in 18%, asparetate aminotransferases in 3%, and alanine aminotransferases in 10% of the patients. One per cent had decreased plasma coagulation factors (2.7 and 10) and serum albumin concentrations. Three patients (2%) fulfilled...... evaluation consisting of ultrasonography, liver biopsy, and endoscopic retrograde cholangiography was performed in patients who had biochemical values more than twice the upper normal limit in two consecutive blood tests within a fortnight. Six patients (1%) fulfilled this criterion. Three patients had...

  7. Risk of cerebrovascular accidents and ischemic heart disease in patients with inflammatory bowel disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Singh, Siddharth; Singh, Harkirat; Loftus, Edward V; Pardi, Darrell S

    2014-03-01

    Inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolic disease. However, it is unclear whether IBD modifies the risk of arterial thromboembolic events, including cerebrovascular accidents (CVA) and ischemic heart disease (IHD). We performed a systematic review and meta-analysis of cohort and case-control studies that reported incident cases of CVA and/or IHD in patients with IBD and a non-IBD control population (or compared with a standardized population). We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs). We analyzed data from 9 studies (2424 CVA events in 5 studies, 6478 IHD events in 6 studies). IBD was associated with a modest increase in the risk of CVA (5 studies; OR, 1.18; 95% CI, 1.09-1.27), especially among women (4 studies; OR, 1.28; 95% CI, 1.17-1.41) compared with men (OR, 1.11; 95% CI, 0.98-1.25), and in young patients (<40-50 y old). The increase in risk was observed for patients with Crohn's disease and in those with ulcerative colitis. IBD also was associated with a 19% increase in the risk of IHD (6 studies; OR, 1.19; 95% CI, 1.08-1.31), both in patients with Crohn's disease and ulcerative colitis. This risk increase was seen primarily in women (4 studies; OR, 1.26; 95% CI, 1.18-1.35) compared with men (OR, 1.05; 95% CI, 0.92-1.21), in young and old patients. IBD was not associated with an increased risk of peripheral arterial thromboembolic events. Considerable heterogeneity was observed in the overall analysis. IBD is associated with a modest increase in the risk of cardiovascular morbidity (from CVA and IHD)-particularly in women. These patients should be counseled routinely on aggressive risk factor modification. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  8. A comprehensive analysis of 12 thrombophilic mutations and related parameters in patients with inflammatory bowel disease: data from Turkey.

    Science.gov (United States)

    Yilmaz, Serif; Bayan, Kadim; Tüzün, Yekta; Batun, Sabri; Altintaş, Abdullah

    2006-12-01

    Possible association of inflammatory bowel disease (IBD) with the most common inherited prothrombotic conditions has been the focus of many investigations. Advance in modern molecular biology is expanding the thrombophilia evaluation steadily. We tried to put forward a comprehensive thrombophilic profile in IBD and to see the probable role of this profile in pathogenesis. A total of 60 adults (33 patients and 27 healthy controls) were included. We used the CVD-StripAssay which is based on the reverse-hybridization principle to identify a total of 12 thrombophilic gene mutations: Factor V R506Q, Factor V H1299R, prothrombin G20210A, Factor XIII V34L, beta-Fibrinogen-455 G-A, PAI-1 4G/5G, platelet GPIIIa L33P, MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q and Apo E2/E3/E4, respectively. Besides, we evaluated many related blood parameters such as protein C, protein S, AT-III, IL-6, TNF-alpha, Apo-A1, Apo-B100, homocysteine (tHcy) etc. using commercially available assays. The frequencies of genetic polymorphisms were found to be statistically insignificant among patients and controls, except for three: Beta-Fibrinogen-455G-A, MTHFR A1298C and ACE-I/D. Two patients with a history of deep venous thrombosis had more than one polymorphism. Patients with MTHFR C677T and MTHFR A1298C gene mutations had a similar mean tHcy levels with controls. Patients with Apolipoprotein B R3500Q and Apolipoprotein E4 gene mutations had similar mean LDL-cholesterol levels. Mean total cholesterol and triglyceride levels were similar in patients and controls of Apo E2, E3, E4 alleles. Predominantly, the presence of genetic mutations that predispose to hypercoagulable states does not appear to be in correlation with IBD. There was a statistical difference between the proportions of the mutated allele frequencies of Beta-Fibrinogen-455G-A, MTHFR A1298C and ACE-I/D in IBD.

  9. Two-year incidence of psoriasis, uveitis and inflammatory bowel disease in patients with spondyloarthritis: A study in the AQUILES cohort.

    Science.gov (United States)

    García-Vicuña, Rosario; Zarco, Pedro; González, Carlos M; Vanaclocha, Francisco; Marín-Jiménez, Ignacio; Cea-Calvo, Luis

    2016-01-01

    To describe the 2-year incidence of new extra-articular manifestations (uveitis, psoriasis, inflammatory bowel disease) in a cohort of patients with spondyloarthritis included in the AQUILES study. Over a period of 2 years, 513 patients with spondyloarthritis (62.5% males, mean age 48 years) diagnosed with ankylosing spondylitis (AS) (55.6%), psoriatic arthritis (25.3%), undifferentiated spondyloarthritis (16.2%), enteropathic arthritis (2.5%), and other diseases (0.4%) were followed. New diagnoses were based on reports of the corresponding specialists (ophthalmologists, dermatologists, gastroenterologists). During the 2-year follow-up, 22 new diagnoses of the extra-articular manifestations were established, with a cumulative incidence of 4.3% (95% confidence interval 2.4-6.1) and an incidence rate of 17 cases per 10,000 patient-year. Uveitis was the most frequent diagnosis (cumulative incidence 3.1%), predominantly in patients with AS. In the multivariate analysis, the diagnosis of AS was the only predictive variable associated to the development of new extra-articular disease. In patients with spondyloarthritis, the 2-year global incidence of uveitis, psoriasis and inflammatory bowel disease (IMID) was 4.3%, particularly due to new diagnoses of uveitis in patients with AS. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  10. Correlation between morphological expansion and impairment of intra- and prelesionary motility in inflammatory small bowel lesions in patients with Crohn's disease – Preliminary data

    Energy Technology Data Exchange (ETDEWEB)

    Bickelhaupt, Sebastian; Wurnig, Moritz; Boss, Andreas [University Hospital Zürich, Department of Radiology, Rämistrasse 100, 8091 Zürich (Switzerland); Patak, Michael A., E-mail: Michael.Patak@patak.ch [University Hospital Zürich, Department of Radiology, Rämistrasse 100, 8091 Zürich (Switzerland); Hirslanden Clinic, Radiology, Witellikerstrasse 40, 8032 Zürich (Switzerland)

    2014-07-15

    Introduction: The aim of this study is to investigate if alterations of intra- and prelesionary motility in inflamed small-bowel segments correlate with length, wall-thickness and prelesionary dilatation of inflammatory small bowel lesions in patients suffering from Crohn's disease assessed with MRI. Methods and materials: This retrospective IRB approved study included 25 patients (12 males, 18–77y) with inflammatory lesions examined using (MRE) magnetic resonance imaging enterography. Cine MRE was performed using a coronal 2D steady-state free precession sequence (TR 2.9, TE 1.25) on a 1.5T MRI scanner. Small bowel motility was examined using a dedicated MR-motility assessment software (Motasso, Vers. 1.0, Sohard AG, Bern, Switzerland). Motility patterns (contraction frequency, relative occlusion rate and mean diameter) were assessed in correlation to wall thickness, length and prelesionary dilatation of the lesions. Stati