188 Accuracy of Preoperative Serologic Testing in Patients Undergoing Intestinal Resection for Inflammatory Bowel Disease

2009 ◽  
Vol 136 (5) ◽  
pp. A-35
Author(s):  
Nicolas M. Intagliata ◽  
Brian R. Swenson ◽  
Charles M. Friel ◽  
Eugene F. Foley ◽  
Brian W. Behm
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Intestinal Resection ◽  
Serologic Testing ◽  
Inflammatory Bowel

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

2017 ◽  
Vol 35 (1-2) ◽  
pp. 50-55 ◽  
Author(s):  
Jacques Cosnes
Keyword(s):  
Inflammatory Bowel Disease ◽  
Urinary Tract ◽  
High Risk ◽  
Bowel Disease ◽  
Immunosuppressive Treatment ◽  
Intestinal Resection ◽  
Immunosuppressive Drugs ◽  
Inflammatory Bowel ◽  
Risk Of Cancer ◽  
Prior Malignancy

Background: Treatment of inflammatory bowel disease (IBD) in patients with prior malignancy is challenging because therapeutic immunosuppression required for controlling IBD activity may increase the risk of cancer recurrence. Key Messages: Contrary to the observations in the post-transplant population, retrospective observational studies of IBD patients with prior malignancy have not demonstrated that immunosuppressive drugs increased significantly the risk of new or recurrent cancer. However, these studies are highly biased and do not permit the use of these drugs. Factors like the time since treatment completion, severity, and subtype of prior cancer should be weighed along with the current IBD activity before choosing the best therapeutic strategy. In practice, most cases of prior cancer require a delay of at least 2 years before starting or resuming immunosuppressants, including anti-TNF agents. This delay should be extended to 5 years in cancer with a high risk of recurrence including cancer of the urinary tract, gastrointestinal cancer, leukemias, and multiple myeloma. A special attention should be paid to cancers with a high risk of late metastasis (breast, melanoma, renal cell carcinoma). Enteral nutrition, Budesonide, mesalamine, and limited intestinal resection should be considered following the completion of cancer treatment and prior to the safe initiation of immunosuppressive treatment for IBD. Thiopurines should be avoided in case of prior Epstein-Barr virus-related lymphoma, HPV-related carcinomas, and cancer of the urinary tract. Methotrexate and anti-TNF agents seem to be safe except for the risk of recurrent melanoma for the latter. Conclusion: IBD patients with prior malignancy should benefit from individual decisions made on a case-by-case basis.

Serologic testing for inflammatory bowel disease

1999 ◽  
Vol 134 (4) ◽  
pp. 447-452 ◽  
Author(s):  
Edward J. Hoffenberg ◽  
Sara Fidanza ◽  
Angela Sauaia
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Serologic Testing ◽  
Inflammatory Bowel

scholarly journals P255 Predictors of postoperative morbidity in patients with inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S277-S278
Author(s):  
N Imperatore ◽  
L Pellegrini ◽  
L Bucci ◽  
A Rispo ◽  
A D Guarino ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Wound Infection ◽  
Anastomotic Leak ◽  
Bowel Disease ◽  
Disease Duration ◽  
Intestinal Resection ◽  
Operative Morbidity ◽  
Urinary Infections ◽  
Inflammatory Bowel ◽  
Surgery Duration

Abstract Background More than half of patients suffering from inflammatory bowel disease (IBD) requires surgery in their lifetime. However, predictors of post-operative morbidity and mortality are poorly investigated. Our aim was to assess the predictors of post-operative mortality and morbidity in IBD. Methods retrospective cohort study enrolling all IBD subjects followed-up and operated at our tertiary IBD Centre from 2015 to 2018. For each patient, we evaluated patient-dependent (comorbidities, smoking, drugs, nutritional status), disease-dependent (disease duration, location, behaviour, extension), surgery-dependent variables (duration, emergency/election, laparoscopy/laparotomy, bowel/colic resection, length of intestinal resection). Results 158 subjects were operated during the period study (males 53.8%, Crohn’s disease 75.3%, mean age 41.9 + 16.2, disease duration 109.5 + 98.3 months); the majority (83%) underwent an elective surgery. No patient died. About morbidity, 40 (25.3%) developed post-operative complications: wound infection (8.9%), respiratory complications (6.9%), prolonged ileum (5.1%), anastomotic leak (3.2%), urinary infections (3.2%), abdominal abscess (3.2%), anastomotic bleeding (3.2%), other infections (2.5%), abdominal bleeding (1.9%), obstruction (1.3%). Two subjects (1.3%) required re-operation within 30 days. A surgery-duration <142 min was predictive for a better post-operative outcome (sensitivity 80%, specificity 42%, PPV 32%, NPV 85.9%). At binary logistic regression, stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6–6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4–9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.4–0.8, p = 0.01), surgery duration <142 min (OR 0.2, 95% CI 0.08–0.7, p = 0.03), were the only predictors for post-operative morbidities. A pre-operative BMI<24 was also predictive for anastomotic leak (OR 4.3, 95% CI 1.8–8.6, p = 0.02); pre-operative hypoalbuminemia was predictive for urinary infections (OR 2.5, 95% CI 1.8–7.9, p = 0.04); pre-operative infliximab was predictive for pneumonia (OR 3.8, 95% CI 2.2–6.3, p = 0.01); diabetes (OR 5.7, 95% CI 2.3–9.8, p < 0.01) and pre-operative steroids (OR 6.1, 95% CI 1.8–11.4, p < 0.01) were predictors of wound infection; need for TPN predicted prolonged ileum (OR 6.1, 95% CI 2.3–15.3, p = 0.03). Conclusion about a quarter of IBD patients undergoing surgery develops a post-operative complication, especially infective. Several patient-related, disease-related and surgery-related factors are predictive for post-operative morbidity. The recognition of these factors, as well the multidisciplinary approach (gastroenterologists, surgeons and nutritionists), and intensive preoperative management could be able to minimise these complications.

scholarly journals P564 Psychological acceptance of surgery in patients with inflammatory bowel disease undergoing intestinal resection

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S475-S476
Author(s):  
Y Hirano ◽  
M Itabashi ◽  
T Saito ◽  
K Uchida ◽  
M Inoue ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Interpersonal Relationships ◽  
Bowel Disease ◽  
Intestinal Resection ◽  
Cross Sectional ◽  
Age At Surgery ◽  
Before And After ◽  
Vas Scores ◽  
Inflammatory Bowel ◽  
Psychological Acceptance

Abstract Background To decision to undergo surgical intestinal resection is among the most difficult that patients with inflammatory bowel disease (IBD) may be required to make during the disease course. Although the clinical outcomes and QoL after intestinal resection are well established, few studies have focused on psychological acceptance of the surgery, that is, how patients feel about the results of intestinal resection. The aim of this study was therefore to evaluate psychological acceptance of the surgical outcome in patients undergoing intestinal resection. Methods We administered a cross-sectional questionnaire survey to patients at five IBD centres in Japan who had undergone intestinal resection at least 1 month before the survey. Patients were asked to complete a visual analogue scale (VAS) questionnaire, consisting of 20 questions related to surgical acceptance and concerns related to IBD (body image, burden of treatment, interpersonal relationships), before and after surgery. The VAS scores before surgery were described by the patient looking back on recollection. Pre- and post-surgical VAS scores were compared using a Wilcoxon’s rank-sum test. Results A total of 64 patients participated in this study (median age at surgery 37.9 (range 12–67) years, median years after surgery 5.0 (range 0.1–21) years). The VAS scores before and after surgery were summarised in the figure. The score for ‘pleased to have surgical resection of my intestine’ improved significantly after the surgery in both UC and CD (p < .0001).Furthermore, the score for ‘burdened with treatment for my IBD’ improved significantly after surgery in UC patients (p < .0001). Conclusion Our findings indicate that surgical intestinal resection outcomes were psychologically well accepted by most IBD patients.

scholarly journals A59 DECREASING HOSPITALIZATIONS AND SURGERIES IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 69-71
Author(s):  
A Dheri ◽  
E Kuenzig ◽  
D Mack ◽  
S Murthy ◽  
G G Kaplan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Health Services ◽  
Bowel Disease ◽  
Intestinal Resection ◽  
Population Based ◽  
Outpatient Basis ◽  
Health Services Use ◽  
Hospitalization Rates ◽  
Inflammatory Bowel ◽  
Services Use

Abstract Background Health services use in inflammatory bowel disease (IBD) patients cost the Canadian healthcare system $1.3 billion per year, but recent changes to care in children with IBD may have altered trends in health services use. Characterization of these trends would aid health policy makers plan for the healthcare needs of IBD children. Aims To quantify time trends in IBD health services use in children and all-cause health services use in children with and without IBD using a population-based cohort. Methods Using the Ontario Crohn’s and Colitis Cohort, children <18y with IBD diagnosed between 1994–2012 in Ontario were identified using validated algorithms from health administrative data, and matched on age, sex, rurality, and income to children without IBD. We evaluated trends in the number of IBD-specific and all-cause outpatient visits, emergency department (ED) visits, and hospitalizations using negative binomial regression. Cox proportional hazards regression models were used to describe changes in the hazard of intestinal resection (Crohn’s disease; CD) and colectomy (ulcerative colitis; UC) over time. Results are reported as annual percentage change (with 95%CI) for events within 5 years from the diagnosis/index date. Results IBD-specific hospitalization rates decreased by 2.5% (95%CI 1.8–3.2%) per year, but all-cause hospitalization rates in children without IBD decreased faster (APC, 95%CI: 4.3%, 3.5–5.1%, difference in rates p-value=0.0028). The hazard of intestinal resection for CD decreased by 6.0% (95%CI 4.6–7.3%) per year and the hazard of colectomy for UC decreased by 3.0% (95%CI 0.7–5.2%) per year. IBD-specific outpatient visit rates increased after 2005 by 4.0% (95%CI 3.1–4.9%) per year. Similar trends were not observed in children without IBD. Conclusions Decreasing hazards of intestinal resection and colectomy in children with IBD suggest changes in disease management, including more care being provided on an outpatient basis. Decreased hospitalization rates in IBD were mirrored by similar decreases in non-IBD children, indicating universal care changes. Understanding why these trends are occurring may help us better understand how to provide optimal care to children with IBD. Funding Agencies CIHRCanGIEC

scholarly journals A65 VARIATION IN THE CARE OF CHILDREN WITH INFLAMMATORY BOWEL DISEASE: A CANGIEC POPULATION-BASED STUDY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 78-79
Author(s):  
E Kuenzig ◽  
H Singh ◽  
A Bitton ◽  
G G Kaplan ◽  
M W Carroll ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Quality Care ◽  
Intestinal Resection ◽  
Specialist Care ◽  
High Quality ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
Incident Cases ◽  
Pediatric Ibd

Abstract Background Inflammatory bowel disease (IBD) is rising rapidly in Canadian children. These children require consistent high-quality specialized care to prevent long-term complications. Aims Evaluate variation in health services utilization and surgery rates across pediatric IBD centres in Ontario. Methods Incident cases of IBD <16y (1999–2010), identified from health administrative data using a validated algorithm, were assigned to pediatric IBD centres based on location of IBD hospitalization, endoscopy and outpatient care. Children receiving IBD-specific care outside pediatric centres were also grouped. Frailty models, median hazard ratios (MHR), and Kendall’s t described variation in IBD-related ED visits, hospitalizations, and surgery 6–60 months after diagnosis, adjusting for age, sex, rural/urban household, and income. Mean diagnostic lag (time from first health system contact for an IBD symptom to final IBD diagnosis) and proportion of children with IBD care by gastroenterologists (GIs) at each centre were evaluated as centre-level predictors of variation. Results Of 2584 IBD cases, 73.4% were treated in a pediatric IBD centre. Between-centre differences accounted for 0.18% (MHR 1.06) and 0.41% (MHR 1.09) of variation in hospitalizations and ED visits, respectively. Children treated at centres where a higher proportion of children were cared for by GIs were more likely to be hospitalized (HR 2.09, 95% CI 1.26–3.45). Children treated at centres with a longer mean diagnostic lag were also more likely to be hospitalized (HR 1.01, 95% CI 1.003–1.02). ED visits were not associated with the proportion of children cared for by gastroenterologists or diagnostic lag. Among 1529 CD cases, 14.1% required intestinal resection; 1.79% of variation in the risk of surgery resulted from between-centre differences (MHR 1.20). Surgery was less common among patients at centres where more children were cared for by GIs (HR 0.24, 95% CI 0.07–0.84) and with a longer mean diagnostic lag (HR 0.98, 95% CI 0.97–0.99). After adjusting for these, between-centre differences accounted for 0.005% (MHR 1.01) of variation in care. Minimal variation was observed among the 11.0% of 872 UC cases requiring colectomy, with 0.37% of variation due to between-centre differences (MOR 1.09). Colectomy risk was not associated with GI care or diagnostic lag. Conclusions Variation in ED visits, hospitalizations, and surgery among children with IBD is small; however, centre-level differences in GI specialist care use and time to diagnosis were associated with hospitalization and surgery. It is essential to understand between-centre differences to reduce variation and ensure high-quality care. Funding Agencies CCC

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