Epidemiology and clinical course of inflammatory bowel disease in the Central Province of Sri Lanka: A hospital-based study

Abstract Objectives The aim was to examine the clinical course and dietary patterns among patients incorporating autoimmune protocol (AIP) for management of inflammatory bowel disease (IBD). Methods An anonymous online survey was sent through electronic newsletters and support groups utilizing AIP. The survey assessed demographics, IBD disease activity, and medication use. Participants were asked about AIP utilization and food group reintroductions. Abdominal pain (AP), stool frequency (SF), and rectal bleeding (RB) were compared at baseline (BL, prior to starting AIP), week 6 (after starting AIP), and present, for both Crohn's disease (CD) and ulcerative colitis (UC). Results There were 78 respondents. Mean age was 39.4 years, with mean IBD duration 13.2 years. 78% had prior steroid exposure. 35% currently on immunosuppressive agents. 73% perceived achieving clinical remission due to AIP. This was more common among patients not on immunosuppression (76% vs. 24% on immunosuppression, P < 0.001). After starting AIP, 32% reported discontinuing steroids. AIP was initiated according to protocol by 73%, while 27% modified it. Food group reintroductions were started within 0–4 weeks of starting AIP among 8%, while 23% reintroduced within 5–8 weeks, 24% within 2–6 months, 23% within 6–12 months, and 13% after 12 months. Success of food group reintroductions varied (Table 1). Among patients with CD, improvement by ≥1 levels of symptoms by week 6 was reported by 77% for AP, 57% for SF, and 57% for RB. Compared to BL, reported symptoms improved by ≥1 levels in 70% for AP, 53% for SF, and 57% for RB. In contrast, disease worsening by ≥1 levels at week 6 was reported by 7% for AP and none for SF and RB. Among patients with UC, improvement by ≥1 levels by week 6 was reported by 72% for AP, 79% for SF, and 65% for RB. Compared to BL, reported symptoms improved by ≥1 levels in 65% for AP, 67% for SF, and 58% for RB. In contrast, disease worsening by ≥1 levels at week 6 was reported by 2% for AP, 2% for SF, and 5% for RB. Conclusions Patients utilizing AIP for management of IBD report clinical benefit of AIP, reduction of steroid use, and successful food group reintroduction. Dietary interventions could be another form of treatment in patients with IBD to improve symptoms and maintain remission. Funding Sources Not applicable. Supporting Tables, Images and/or Graphs

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Injury Characteristics and Outcomes of Patients With Inflammatory Bowel Disease After Trauma: A Propensity Score Matched Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz254 ◽

2019 ◽

Vol 26 (8) ◽

pp. 1261-1267 ◽

Cited By ~ 1

Author(s):

Bryce E Haac ◽

Amy Nemirovsky ◽

William Teeter ◽

Andrew Geyer ◽

Richard T Birkett ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Pain Management ◽

Propensity Score ◽

Bowel Disease ◽

Brain Injuries ◽

Injury Severity ◽

Clinical Course ◽

Multivariable Analysis ◽

Injury Characteristics ◽

Inflammatory Bowel

Abstract Background The clinical course of patients with inflammatory bowel disease (IBD) after trauma is largely unknown. We sought to compare the clinical course of patients with IBD to those without. Methods We conducted a retrospective case-control study of adult patients admitted to a level-1 trauma center from January 1, 2008, through October 1, 2015. Seventy-five patients with IBD were identified. Cases were matched to controls by age, sex, injury severity, and mechanism using 4:1 propensity score-matching analysis. Injury characteristics, clinical course, and infectious and noninfectious complications were compared using bivariate and multivariate analysis. Results Participants had a mean age of 56 years and mean injury severity score of 15. Of the 75 cases, 44% had ulcerative colitis, 44% had Crohn’s disease, and 12% had undetermined type. More cases were on an immunosuppressant (19% vs 2%, P < 0.01) or steroids (8% vs 2%, P = 0.02) on admission compared with controls. More cases had prior abdominal surgery (P = 0.01). Cases had fewer brain injuries (P = 0.02) and higher admission Glasgow Coma Scale (P < 0.01) but required more neurosurgical intervention (P = 0.03). Cases required more orthopedic surgeries (P < 0.01) and more pain management consultations (P = 0.04). In multivariable analysis, IBD was associated with increased odds of operative intervention, pain management consultation, venous thromboembolism, and longer hospital stay (P < 0.05). Patients on immunosuppressants had increased odds of requiring surgery (P = 0.04), particularly orthopedic surgery (P < 0.01). Conclusions Baseline factors associated with inflammatory bowel disease may place patients at higher risk for surgery and complications after trauma.

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