scholarly journals DOP50 Recommencement of Inflammatory Bowel Disease medications following colectomy for Ulcerative Colitis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S085-S086
Author(s):  
O Ledder ◽  
R Lujan ◽  
E Orlanski-Meyer ◽  
C Friss ◽  
Y Loewenberg Weisband ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
De Novo ◽  
Large Population ◽  
Medication Use ◽  
Health Maintenance ◽  
True Incidence ◽  
Repeated Surgery ◽  
Clinically Significant ◽  
Acute Severe Colitis

Abstract Background Total colectomy (TC) is often considered a curative procedure for patients with chronic refractory ulcerative colitis (UC) or acute severe colitis. Chronic pouchitis and de novo Crohn’s disease (CD) are well recognized sequelae following TC, yet the true incidence of these are poorly characterized in large population models. We assessed the rate of subsequent utilization of IBD medications as a proxy marker of clinically significant pouchitis or de novo CD following TC for UC. Methods This study utilized data from the Epi-IIRN project, a meta-database incorporating patient data from all four health maintenance organisations (HMO) in Israel, representing 98% of the population. We included all patients identified in the prevalence cohort with an initial diagnosis of UC who underwent TC from January 2000, with ≥ 6 month follow-up. Primary outcome was utilization of IBD medications (including thiopurines, methotrexate, infliximab, adalimumab, vedolizumab, ustekinumab and tofacitinib) following TC. Secondary outcomes were time to commencement of medications, hospitalizations and repeated surgery. Potential predictors of IBD medication use were identified using multivariable models. Results Overall 23,506 patients with UC were identified in the prevalence cohort of whom 456 patients underwent TC for UC and were included in our analysis. 51% of our sample were female, with a median follow up of 8.5 years (IQR 3.8–13.2) and 3956 patient-years. Median age at UC diagnosis was 44.1 (26.5–56.2) years and at TC was 50.2 (34.2–61.7). IBD medications were commenced in 88 (19%) of patients, including 54 (12%) biologics, 56 (12%) immunomodulators and 3 (1%) tofacitinib. A diagnosis of CD was formally assigned to 65 (75%) of these patients. The need for IBD medications was gradual (figure 1). Patients recommenced on IBD medications were younger at diagnosis (30.3 years (18.3–49.7) vs 41.4 (24.2–55.6), p<0.001), at colectomy (34.3 (21.5–54.1) vs 47.5 (30.4–60.6), p<0.001) and with shorter interval from UC diagnosis to TC (2.2 years (1.0–3.3) vs 2.8 (1.4–5.1), p=0.03). TC during childhood was performed in 33 (7%) patients and these had higher utilization of IBD medications post TC (16/33 (49%) vs 72/423 (17%), p=0.001). Conclusion In this nationwide analysis we show that almost 20% of patients require ongoing IBD medications following TC for UC. Younger age is associated with higher rate of subsequent medication use. Patient expectations need be adjusted to account for the potential ongoing requirement of long-term medication following TC.

scholarly journals Arthroscopic Bristow: 12-Year Experience, Assessments of Safety and Effectiveness

2019 ◽  
Author(s):  
Jose Carlos Garcia
Keyword(s):  
Los Angeles ◽  
Shoulder Instability ◽  
De Novo ◽  
Mean Value ◽  
Anterior Shoulder Instability ◽  
Simple Shoulder Test ◽  
The Mean ◽  
Lateral Rotation ◽  
Clinically Significant

Abstract Objective The open Bristow procedure is a long established and effective method for treating anterior shoulder instability. Following the trends of minimally-invasive surgeries, these procedures were performed arthroscopically, and their outcomes were evaluated. Methods A total of 43 shoulders of patients submitted to Bristow procedures by arthroscopy, using a graft positioned horizontally and a screw, with at least two years of postoperative follow-up, were evaluated regarding quality of life, de novo dislocation index, and loss of lateral rotation. Results The mean follow-up time was of 76 months (range: 129 to 24 months). The University of California at Los Angeles (UCLA) score varied from 25.56 ± 0.50 (standard deviation [SD] = 3.25) to 33.23 ± 0.44 (SD = 2.91) (p < 0.0001). Two or more years after surgery, the mean Rowe score was of 94.25 ± 1.52 (SD = 1.34), whereas the good results standard is 75 (p < 0.0001). The mean value for the simple shoulder test was of 11.35 ± 0.21 (SD = 1.34), while the mean value of the lateral rotation loss was of 10.37° ± 1.36° (SD = 8.58°). There were no de novo dislocations.In total, there were 12 complications, 8 of which had no clinical repercussions. The clinically-significant complications included an infection six months after surgery with a potential hematogenous origin, a coracoid fracture that required an intraoperatively procedure change, and two patients with previous impingement who required synthesis material removal more than six months after surgery. Conclusion Although the arthroscopic Bristow procedure was effective in treating anterior shoulder instability, it is not a complication-free surgery.

scholarly journals P616 Sustainability of thiopurines monotherapy in ulcerative colitis: a nationwide analysis from the epi-IIRN cohort

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S559-S559
Author(s):  
O Atia ◽  
C Friss ◽  
A Mendelovici ◽  
E Shteyer ◽  
E Orlanski-Meyer ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Treatment Duration ◽  
Cox Regression ◽  
Health Maintenance Organizations ◽  
Disease Course ◽  
Aminosalicylic Acid ◽  
Health Maintenance ◽  
Israeli Population ◽  
Pediatric Onset

Abstract Background Thiopurines have been long used to maintain remission in ulcerative colitis (UC) but are also associated with toxicity and therapeutic failure. We aimed to assess the sustainability rate of thiopurines commenced as monotherapy in UC, and to explore predictors of sustainability. Methods This study was performed on data from four Health Maintenance Organizations (HMOs), covering 98% of the Israeli population. We included all biologic-naïve UC patients diagnosed after 2005 and treated with thiopurines monotherapy for at least three months. Treatment with 5- aminosalicylic acid (ASA) was allowed if initiated prior to or during the first three months from initiation of thiopurines. Sustainability was defined as continued thiopurines treatment without switching therapy, adding biologics or requiring surgery. At most one short steroid course was allowed. Cox regression model was used to explore estimated predictors to sustainability. Results A total of 1,897 (370 [20%] pediatric-onset and 1,527 [80%] adults) thiopurines-treated patients were included with a 15,033 person-years of follow-up. The median time from UC diagnosis to initiation of thiopurines was 12.7 months (IQR 4.6–30.9), and the median treatment duration was 13.0 months (6.3–28.4). Sustainability rate was evident in 92% of patients after 6 months from initiation of thiopurines and 83%, 65% and 42% at one, three and five years, thereafter. Sustainability was associated with early initiation of thiopurines during disease course (HR 0.99 [95%CI 0.985–0.995]) and lack of 5-ASA at initiation of thiopurines (HR 0.7 [95%CI 0.6–0.8]). Conclusion As many as two thirds of biologic-naïve UC patients treated with thiopurines monotherapy sustain this treatment after five years, especially when initiated early and without 5-ASA.

Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders

2000 ◽  
Vol 12 (1) ◽  
pp. 15-33 ◽  
Author(s):  
Jürgen Unützer ◽  
Donald L. Patrick ◽  
Paula Diehr ◽  
Greg Simon ◽  
David Grembowski ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Quality Adjusted Life Years ◽  
Health Maintenance ◽  
Medical Disorders ◽  
Life Years ◽  
Clinically Significant ◽  
Quality Adjusted Life

We used data from a 4-year prospective study of 2,558 primary care patients age 65 and older in a large staff model health maintenance organization to examine the association of clinically significant depressive symptoms and eight other chronic medical conditions with quality adjusted life years (QALYs). We developed linear regression models to examine the association of clinically significant depressive symptoms as defined by a score of 16 or greater on the Center for Epidemiological Studies Depression Scale and eight common chronic medical disorders at baseline with QALYs over the 4-year study period. Estimates of QALYs were derived from Quality of Well-Being Scale scores at baseline, at 2-year follow-up, and at 4-year follow-up. Individuals with clinically significant depressive symptoms at baseline had significantly lower QALYs over the 4-year study period than nondepressed subjects, even after adjusting for differences in age, gender, and the eight other chronic medical conditions. In terms of the entire study population, only arthritis and heart disease were more strongly associated with QALYs than depression.

Headache Medication-Use Among Primary Care Headache Patients in A Health Maintenance Organization

Cephalalgia ◽  
1999 ◽  
Vol 19 (6) ◽  
pp. 575-580 ◽  
Author(s):  
M. Von Korff ◽  
LK Black ◽  
K Saunders ◽  
BS Galer
Keyword(s):  
Primary Care ◽  
International Headache Society ◽  
Puget Sound ◽  
Medication Use ◽  
Self Report ◽  
Health Maintenance ◽  
Before And After ◽  
Subcutaneous Sumatriptan ◽  
Headache Patients

Objective. Medication-use among headache patients 2 and 5 years after a primary care headache visit is assessed, and the pattern of medication-use compared before and after the introduction of subcutaneous sumatriptan among migraineurs. Setting and patients. The study was carried out among headache patients visiting a primary care physician at the Group Health Cooperative of Puget Sound in 1989-90. Methods. We report medication-use patterns 2 and 5 years later for the 530 subjects completing both a 2-year (1991-92) and a 5-year (1994-95) follow-up interview. Medication-use was determined by self-report for the month prior to the interview. Medication-use to control or prevent headache is shown for all headache patients and for those meeting International Headache Society criteria for migraine at the 2-year and the 5-year follow-up. Results. The overall pattern of medication-use was similar at the 2-year and the 5-year follow-up, before and after the introduction of subcutaneous sumatriptan (March, 1993). There was a modest but statistically significant decline in the use of opioid and sedative-hypnotic medications, and in the use of ergotamine. At 5 years, 11% of migraineurs reported use of sumatriptan in the prior month. The large majority of study patients used symptomatic medications, usually non-prescription analgesics, sedativehypnotics, and opiates. Only one-fifth of the migraineurs reported use of a prophylactic medication for headache. Conclusions. Continuing use of symptomatic headache medications was characteristic of patients with migraine and other common forms of headache. The introduction of subcutaneous sumatriptan was not associated with notable change in this pattern, although a modest reduction in use of sedativehypnotics and opiates was observed. Overall, the pattern of use of headache medications was similar before and after the introduction of subcutaneous sumatriptan.

Role of a Doxorubicin-Containing Regimen in Relapsed and Resistant Lymphomas: An 8-Year Follow-Up Study of EPOCH

2000 ◽  
Vol 18 (21) ◽  
pp. 3633-3642 ◽  
Author(s):  
Martin Gutierrez ◽  
Bruce A. Chabner ◽  
Debra Pearson ◽  
Seth M. Steinberg ◽  
Elaine S. Jaffe ◽  
...  
Keyword(s):  
De Novo ◽  
International Prognostic Index ◽  
Oral Prednisone ◽  
Prognostic Index ◽  
Resistant Disease ◽  
Highly Effective ◽  
Clinically Significant ◽  
Hodgkin's Lymphomas

PURPOSE: Curative up-front regimens for non-Hodgkin’s lymphomas contain doxorubicin, vincristine, and cyclophosphamide, whereas salvage regimens generally contain non–cross-resistant agents. We hypothesized that up-front agents may be highly effective for salvage and developed an infusional regimen based on in vitro evidence of increased efficacy. PATIENTS AND METHODS: A prospective phase II study of etoposide, vincristine, and doxorubicin over 96 hours with bolus cyclophosphamide and oral prednisone (EPOCH) was performed in 131 patients with relapsed or resistant lymphoma. RESULTS: Seventy-nine percent of patients had aggressive histologies, 46% were considered high risk by the International Prognostic Index, and 34% had resistant disease. Eighty-eight percent of patients had received at least four of the agents in EPOCH, and 94% had received doxorubicin. In 125 assessable patients, 29 (24%) achieved complete responses and 60 (50%) achieved partial responses. Among 42 patients with resistant disease, 57% responded, and in 28 patients with relapsed aggressive de novo lymphomas, 89% responded with 54% complete responses. With a median follow-up of 76 months, the overall and event-free survivals (EFS) were 17.5 and 7 months, respectively. In 33 patients with sensitive aggressive disease who did not receive stem-cell transplantation, EFS was 19% at 36 months. Toxicity was primarily hematologic, with an 18% incidence of febrile neutropenia. No clinically significant cardiac toxicity was observed, despite no maximum cumulative doxorubicin dose. CONCLUSION: EPOCH is highly effective in patients who had previously received most/all of the same drugs and produces durable remissions in curable subtypes. Salvage regimens need not contain non–cross-resistant agents, and infusional schedules may partially reverse drug resistance and reduce toxicity.

scholarly journals Hepatobiliary Manifestations of Inflammatory Bowel Disease

HPB Surgery ◽  
2000 ◽  
Vol 11 (6) ◽  
pp. 363-371 ◽  
Author(s):  
Mohammed Iqbal Memon ◽  
Breda Memon ◽  
Muhammed Ashraf Memon
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Chronic Ulcerative Colitis ◽  
Bowel Disease ◽  
Present Moment ◽  
True Incidence ◽  
Inflammatory Bowel ◽  
Systemic Manifestations ◽  
Clinically Significant ◽  
Considerable Morbidity

Hepatobiliary manifestations occur quite frequently in patients suffering from chronic ulcerative colitis and Crohn's disease and carry with them considerable morbidity and mortality. Although the true incidence is difficult to determine, clinically, significant hepatobiliary disease occurs in 5%–10% of patients. At the present moment, the aetiology and pathogenesis of inflammatory bowel disease and its systemic manifestations remains speculative. For those hepatobiliary manifestations that respond to therapy of the underlying bowel disease, medical and/or surgical therapy must be aggressively pursued. More urgent research is required towards understanding the underlying cause(s) of the primary bowel disease and its systemic manifestations in order to improve the overall management of this condition.

scholarly journals 509Healthy-lifestyle-scores associated with lower subsequent fatigue risk in multiple sclerosis using inverse probability treatment weighting

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Tracey Weiland ◽  
Steve Simpson-Yap ◽  
Nupur Nag ◽  
George Jelinek ◽  
Keryn Taylor ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lower Risk ◽  
Healthy Lifestyle ◽  
Medication Use ◽  
Lifestyle Factors ◽  
Inverse Probability ◽  
Fatigue Severity ◽  
Clinically Significant ◽  
Doubly Robust

Abstract Background Several lifestyle factors have been associated with the onset and progression of multiple sclerosis (MS). Combining these lifestyle factors into scoring indices is an efficient way to assess their collective relationship with clinical outcomes. We examined the association of two lifestyle scores with clinically significant fatigue and change thereof over two years’ follow-up. Methods Data on sociodemographic, lifestyle and clinical characteristics surveyed from the international HOLISM cohort of people with MS at baseline and 2.5-year follow-up. Fatigue was defined by Fatigue Severity Scale (FSS), and healthy lifestyle by the Healthy Lifestyle Index Score (HLIS), and SNAP (Smoking, Nutrition, Alcohol, Physical Activity) score. Analyses by standard logistic and inverse probability treatment weighting (IPTW) models adjusted for age, sex, MS type, disability, comorbidity number, immunomodulatory medication use, prescription antifatigue medication use, and ongoing relapse symptoms; change in fatigue models also adjusted for baseline fatigue. Results 1,160 participants completed the FSS questionnaire at both timepoints, and roughly 62% had fatigue at each timepoint. By logistic regression, baseline HLIS and SNAP were each associated with lower risk of being fatigued at follow-up, persisting on adjustment. Using doubly-robust IPTW these associations were attenuated but high HLIS (OR = 0.89, 95% CI = 0.81-0.97) and SNAP (OR = 0.82, 95% CI = 0.73-0.90) were each associated with lower risk of fatigue at follow-up. Evaluating change in fatigue, however, there was no consistent association of either HLIS or SNAP score by either statistical method. Conclusions In this sample of people with MS, healthy lifestyle scores were associated with less fatigue 2.5 years later, though not with change in fatigue over this interval.

scholarly journals De novo lupus-like glomerulonephritis after pediatric non-kidney organ transplantation

2021 ◽  
Author(s):  
Cristina M. Farkas-Skiles ◽  
Robert B. Ettenger ◽  
Jonathan E. Zuckerman ◽  
Meghan Pearl ◽  
Robert S. Venick ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Kidney Biopsy ◽  
De Novo ◽  
Solid Organ ◽  
Significant Finding ◽  
Clinically Significant ◽  
Pediatric Recipients ◽  
Pediatric Liver Transplant ◽  
Active Lupus

Abstract Background We propose a novel clinically significant finding, de novo lupus-like glomerulonephritis (DNLLGN), in patients with autoantibodies and kidney abnormalities in pediatric liver transplant (LT) and intestinal inclusive transplants (ITx). Methods We describe the clinical, serologic, and histopathologic presentation and kidney outcomes in eight patients from our center found to have DNLLGN on kidney biopsy. Results Pediatric recipients of non-kidney solid organ transplants developed an unusual de novo immune complex glomerulonephritis with morphologic similarity to lupus nephritis. Six had isolated LT (0.9% of all pediatric LT at our center) and two had ITx (2.1% of all ITx). Five (63%) presented with nephrotic syndrome. Five patients had autoantibodies. Patients underwent kidney biopsy at a mean of 11.5 years in LT and 2.8 years in ITx after the index transplant. Biopsies demonstrated changes similar to focal or diffuse active lupus. Follow-up eGFR at a mean of 6 years after biopsy showed a mean decrease of 30 ml/min/1.73 m2 in all patients (p = 0.11). Conclusions DNLLGN has not been previously recognized in this clinical setting, yet 8 kidney biopsies from pediatric recipients of LT and ITx at our center in 25 years demonstrated this finding. DNLLGN appears to be an under-reported phenomenon of clinical significance. Graphical abstract

De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

2016 ◽  
Vol 82 (10) ◽  
pp. 977-981 ◽  
Author(s):  
Karen Zaghiyan ◽  
Jan P. Kaminski ◽  
Galinos Barmparas ◽  
Phillip Fleshner
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Ileal Pouch ◽  
De Novo ◽  
Anal Anastomosis ◽  
Long Term Follow Up ◽  
Inflammatory Bowel

The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8–81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively. After a median follow-up of 76 months (range: 3–236), 63 patients (19%) developed CD within a median of 22 months (range: 1–213) from ileostomy closure compared with the previously published 40 patients (12%) with 26-month follow-up ( P = 0.01). The development of de novo CD was similar for patients undergoing IPAA for UC (n = 40; 17%), IBDU (n = 21; 22%) or those classified as having UC (n = 42; 18%) or IC (n = 19; 19%) postoperatively; P > 0.05. Thus, patients with IBDU and IC can expect equivalent long-term outcome to patients with UC after IPAA. Pouch failure occurred in 13 (4%) study patients and was equal among all four groups.

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