scholarly journals P438 Maladaptive decision-making is associated with psychological morbidity in people with Inflammatory Bowel Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S438-S439
Author(s):  
L Grinsted Tate ◽  
L Johnson ◽  
G Jones ◽  
A Lobo
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Bowel Disease ◽  
Demographic Data ◽  
Psychological Morbidity ◽  
Decision Making Styles ◽  
Inflammatory Bowel ◽  
The Impact ◽  
Buck Passing

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic relapsing-remitting inflammatory condition. Due to its long-term, multifaceted nature, patients will need to make many complex decisions during their treatment. The Melbourne Decision Making Questionnaire (MDMQ) assesses the use of four decision-making styles. Vigilance is the only style considered adaptive, with a thorough, analytical approach. Buck-passing (avoiding responsibility), procrastination and hypervigilance (a hurried, anxious approach) are considered maladaptive. This study aimed to assess the impact of psychological morbidity, health-related quality of life (HRQoL) and demographic/disease factors on decision-making in IBD. Methods People over the age of 16 with IBD completed the MDMQ. Psychological morbidity was assessed by the DASS-21 questionnaire, and HRQoL by the EQ-5D-3L/EQ-5D-Y. Demographic data included age, gender, ethnicity, Index of Multiple Deprivation quintile, educational level and employment status. Diagnosis, disease duration and age at diagnosis were also recorded. Exploratory analysis of all variables against scores for each of the four decision-making styles was conducted. Significant results were used to perform multivariate analysis. All statistical analysis was performed using IBM SPSS Statistics software (v26). Results 172 patients were studied (94 CD, 75 UC, 3 IBD-U, 68 (39.5%) male), median age 46.5 (16-83). Median MDMQ scores for vigilance, buck-passing, procrastination and hypervigilance were 10/12, 3/12, 2/10 and 3/10 respectively. Multivariate analysis showed strong positive associations between psychological morbidity scores and all three maladaptive decision-making styles: buck-passing (F(1, 95)=12.512, p=0.001), procrastination (F(1, 115)=35.009, p<0.001) and hypervigilance (F(1, 114)=34.342, p<0.001). Age and duration of disease were not associated with decision making style. Current employment and higher HRQoL scores were significantly associated with greater degrees of buck-passing (F(3,95)=5.100, p=0.003; and F(1, 95)=6.351, p=0.013 respectively). A diagnosis of CD was associated with lower vigilance score (F(2, 133)=3.224, p=0.043). Conclusion People with IBD are likely to have an adaptive decision-making style, demonstrated by a high median vigilance score. However, psychological morbidity is associated with maladaptive decision-making – an important consideration for clinicians and in shared decision making. Further studies are required to determine whether interventions for psychological morbidity can improve maladaptive decision-making.

scholarly journals P312 Introduction of bowel ultrasonography for follow-up of paediatric inflammatory bowel disease: A single-centre experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S310-S310
Author(s):  
R Lev Zion ◽  
G Focht ◽  
N Asayag ◽  
D Turner
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Wall Thickness ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Wall Thickening ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Bowel ultrasonography (BUS) for imaging of inflammatory bowel disease (IBD) is increasingly recognised as a prominent non-invasive tool to supplement, and in some cases replace traditional endoscopic and imaging modalities, with high sensitivity and specificity. The increasing number of gastroenterologists trained to perform BUS has transformed BUS into a bedside tool to guide routine clinical decision making and accurately monitor response to treatment. However, this process is still in its infancy in paediatric IBD. We present here data on the first 2 years of implementation of BUS performed by a paediatric gastroenterologist (RLT) at the paediatric IBD centre at Shaare Zedek Medical Center in Jerusalem. We aim to describe trends, results and clinical implications of the US studies performed during this period. Methods The electronic medical record system was searched for all BUS studies performed on IBD patients by RLT as part of his weekly IBD clinic between 2017–2019. Studies performed on other caregivers’ patients were excluded to ensure uniform documentation and nomenclature. Findings were classified as normal (wall thickness <3 mm), mild (wall thickening 3–4 mm and blood flow < Limberg 3) or significant signs of inflammation (wall thickness ≥4 mm or 3–4 mm with Limberg ≥3). Charts were reviewed to assess the impact of BUS findings on clinical management. Results A total of 83 bedside BUS studies were performed on 55 IBD patients (42 with Crohn’s – CD) during the study period, with a mean age of 15.1 ± 3.7 years. Thirty-four had one study (23 with CD), 15 had two (13 with CD) and 6 had three or more (all with CD). Overall, 32 studies were normal, 20 showed mild findings and 30 showed significant inflammation. Four studies found stenosis and one showed an abscess. Follow-up studies of initially active disease showed 10/16 (63%) with improvement, including 9/16 (56%) with sonographic remission. 22/83 (27%) studies were felt upon review to have had a direct impact on clinical decision-making. These included decisions not to switch therapy due to normal BUS despite symptoms, admission due to discovery of an abscess, decision to escalate therapy due to lack of sonographic improvement, and decision to continue adalimumab in the presence of a stricture due to favourable prognostic characteristics as per the CREOLE study. Conclusion Bedside BUS is a practical and useful tool that can be integrated into a paediatric IBD clinic, with the ability to provide relevant information in real-time and thus impact on day-to-day patient management.

scholarly journals Predicting the development of psychological morbidity in inflammatory bowel disease: a systematic review

2020 ◽  
pp. flgastro-2019-101353
Author(s):  
Anna B Hoogkamer ◽  
Alenka J Brooks ◽  
Georgina Rowse ◽  
Alan J Lobo
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
English Language ◽  
Psychological Morbidity ◽  
Physical Factors ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Inflammatory Bowel ◽  
The Impact

BackgroundPsychological morbidity in inflammatory bowel disease is common with significant impact on quality of life and health outcomes, but factors which predict the development of psychological morbidity are unclear.AimTo undertake a systematic literature review of the predictors of psychological morbidity in patients with inflammatory bowel disease.MethodsElectronic searches for English-language articles were performed with keywords relating to psychological morbidity according to the Diagnostic and Statistical Manual of Mental Disorders IV and subsequent criteria, and inflammatory bowel disease; in MEDLINE, PsychInfo, Web of Science and EMBASE for studies published from January 1997 to 25 January 2019.ResultsOf 660 studies identified, seven met the inclusion criteria. All measured depression, with three also measuring anxiety. Follow-up duration was variable (median of 18 months range 6–96 months). Risk factors identified for development of psychological morbidity included physical factors: aggressive disease (HR 5.77, 95% CI 1.89 to 17.7) and greater comorbidity burden (OR 4.31, 95% CI 2.83 to 6.57) and psychological risk factors: degree of gratitude (r=−0.43, p<0.01) and parenting stress (R-change=0.03, F(1,58)=35.6, p<0.05). Age-specific risk was identified with young people (13–17 years) at increased risk.ConclusionsIdentifiable risks for the development of psychological morbidity in inflammatory bowel disease include physical and psychological factors. Further research is required from large prospective studies to enable early interventions in those at risk and reduce the impact of psychological morbidity.

scholarly journals P440 Polimedication in patients with inflammatory bowel disease: prevalence and outcomes in a retrospective unicentric series

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S398-S398
Author(s):  
F Mesonero Gismero ◽  
C Fernández ◽  
E Sánchez-Rodríguez ◽  
A García-García de Paredes ◽  
A Albillos ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
High Risk ◽  
Bowel Disease ◽  
Demographic Data ◽  
Inappropriate Medication ◽  
Univariate Analysis ◽  
Disease Outcomes ◽  
Clinical Series ◽  
Inflammatory Bowel

Abstract Background Polymedication (PM) can complicate course and management of chronic diseases, and is currently a poorly explored issue in patients with inflammatory bowel disease (IBD). Our aims were to determine the prevalences of PM, and of inappropriate and high-risk drugs use (APINCH) in a clinical series of IBD patients, describing epidemiological factors associated with PM, and evaluating a possible association of PM with poor disease outcomes. Methods A retrospective observational study of a unicentric series, including patients with IBD visited at our Unit (September-October 2018). Prescriptions, demographic data, and clinical features were collected reviewing clinical files and electronic drug prescriptions. PM was defined as the simultaneous use of more than 5 drugs (Gnjidic D, J Clin Epidemiol. 2012). APINCH drugs included insulin, antibiotics, anticoagulants, chemotherapies, narcotics, and potassium supplements (Clinical Excellence Australian Commission 2017). Disease outcomes (flares, hospitalisations, surgeries), non-adherence to treatment and undertreatment were evaluated 12 months after the index visit. Results We included 407 patients (56% males, median age 48 yo, range 17–92, 60.2% Crohn′s disease, 38.8% ulcerative colitis). Chronic comorbidity was present in 54% (29% metabolic, 25.5% cardiovascular, 12.8% psychiatric), and 27% presented multiple comorbidities (≥3). Median patient number of prescriptions was 3 (r 0–15); 14.3% were on more than three drugs, and 15.7% between four and five drugs. Most frequent prescriptions are represented in Figure 1. PM was identified in 18.4% of cases, inappropriate medication in 8.8%, and high-risk drugs in 6.1% (mainly opioids). In multivariate analysis, factors significantly associated with PM were chronic comorbidity (OR 11, CI 2.3-51,2, p˂0.002), multiple comorbidities (OR 4.02, CI 1.93–8.38, p˂0.001), and age &gt;62 years (OR 3.66, CI 1.7–7.7, p˂0.001). In univariate analysis, both undertreatment (54% vs. 16%, p˂0.01) and non-adherence (26% vs. 12%, p˂0.02) were associated with PM after 12 months. No association of PM with poor disease outcomes was found. In multivariate analysis, only undertreatment was significantly associated with PM (OR 5.9, CI 1.4–29.4, p˂0.014). Conclusion PM occurs in around one of the five patients with IBD, mainly in the elderly and in those with comorbidity. This scenario could interfere with appropriate IBD treatment and therapeutic success.

scholarly journals P490 The impact of the COVID-19 pandemic on gastroenterologists providing care to inflammatory bowel disease patients in Canada: preliminary data of a cross-sectional survey

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S475-S476
Author(s):  
M Mikail ◽  
G Malhi ◽  
A Wilson ◽  
R Khanna
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Time Interval ◽  
Cross Sectional Survey ◽  
Inflammatory Bowel ◽  
Laboratory Investigations ◽  
The Impact

Abstract Background We aim to explore the impact of COVID-19 pandemic-related restrictions on gastroenterologists providing care to inflammatory bowel disease (IBD) patients in Canada. Methods We invited 28 Canadian gastroenterology societies, 14 academic centres and 101 community hospitals and private clinics to have their gastroenterologists engage in an online mixed methods survey from December 2020 - March 2021. The survey explored the impact of pandemic-related restrictions on gastroenterologists managing IBD patients and the impact on clinical decision-making, rates of consultation, investigations and endoscopies conducted before and during the pandemic. Results 59 gastroenterologists (59.3% male) participated in our study with 40.7% having completed additional training in IBD. Respondents mean age was 43.7 years with 30.5% practising independently for a duration of less than or equal to 5 years. The majority of respondents were from Ontario (43.1%), Quebec (31%) and British Columbia (13.8%) with 62.7% practising primarily at an academic centre. 93.2% of respondents reported that their practice was affected by the pandemic. 44.6% note a reduction in the number of total consultations completed. Only 60% were able to arrange endoscopies for patients in an active IBD flare at an appropriate time interval compared to their pre-COVID practice. During the pandemic, 87.3% reported a reduction in the total endoscopies performed, with 43.8% of those individuals noting a minimum reduction of 25% of previous volumes. The following barriers attributed to the decrease in endoscopies performed during the pandemic: institutional-imposed restriction on daily allowed endoscopies (97.9%), indication for endoscopy was non-urgent (68.8%) and patient-requested cancellation due to a fear of contracting COVID-19 (87.5%). 63.6% of respondents were able to arrange outpatient laboratory investigations in less than 1-week prior to the pandemic vs. 41.8% arranging similar tests in 1–2 weeks during the pandemic. 50.9% were able to arrange diagnostic investigations in 1–2 months before the pandemic vs. 65% arranging similar tests in 3-months or more during the pandemic. When advancing drug therapy in IBD patients before versus during the pandemic, respondents reported the following factors as playing a crucial role in clinical decision making: patient symptomatology (87% vs. 79.3%), laboratory investigations (94.8% vs. 96.6%), diagnostic imaging (89.7% vs. 81%) and endoscopy findings (89.7% vs 72.4%). Conclusion We illustrate that Canadian gastroenterologists have been affected by the pandemic, with decreases in endoscopy performance related to access and patient preference and less decision-making guided by endoscopy. Outpatient access to urgent investigations was reduced.

scholarly journals Exploitation of Marine-Derived Robust Biological Molecules to Manage Inflammatory Bowel Disease

Marine Drugs ◽  
2021 ◽  
Vol 19 (4) ◽  
pp. 196
Author(s):  
Muhammad Bilal ◽  
Leonardo Vieira Nunes ◽  
Marco Thúlio Saviatto Duarte ◽  
Luiz Fernando Romanholo Ferreira ◽  
Renato Nery Soriano ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bioactive Compounds ◽  
Bowel Disease ◽  
Clinical Translation ◽  
Biologically Active ◽  
Naturally Occurring ◽  
Inflammatory Bowel ◽  
Functional Features ◽  
Biological Entities ◽  
The Impact

Naturally occurring biological entities with extractable and tunable structural and functional characteristics, along with therapeutic attributes, are of supreme interest for strengthening the twenty-first-century biomedical settings. Irrespective of ongoing technological and clinical advancement, traditional medicinal practices to address and manage inflammatory bowel disease (IBD) are inefficient and the effect of the administered therapeutic cues is limited. The reasonable immune response or invasion should also be circumvented for successful clinical translation of engineered cues as highly efficient and robust bioactive entities. In this context, research is underway worldwide, and researchers have redirected or regained their interests in valorizing the naturally occurring biological entities/resources, for example, algal biome so-called “treasure of untouched or underexploited sources”. Algal biome from the marine environment is an immense source of excellence that has also been demonstrated as a source of bioactive compounds with unique chemical, structural, and functional features. Moreover, the molecular modeling and synthesis of new drugs based on marine-derived therapeutic and biological cues can show greater efficacy and specificity for the therapeutics. Herein, an effort has been made to cover the existing literature gap on the exploitation of naturally occurring biological entities/resources to address and efficiently manage IBD. Following a brief background study, a focus was given to design characteristics, performance evaluation of engineered cues, and point-of-care IBD therapeutics of diverse bioactive compounds from the algal biome. Noteworthy potentialities of marine-derived biologically active compounds have also been spotlighted to underlying the impact role of bio-active elements with the related pathways. The current review is also focused on the applied standpoint and clinical translation of marine-derived bioactive compounds. Furthermore, a detailed overview of clinical applications and future perspectives are also given in this review.

scholarly journals Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

2020 ◽  
Vol 4 (1) ◽  
pp. e000786
Author(s):  
Abbie Maclean ◽  
James J Ashton ◽  
Vikki Garrick ◽  
R Mark Beattie ◽  
Richard Hansen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
High Standard ◽  
Current Evidence ◽  
Faecal Calprotectin ◽  
Paediatric Patients ◽  
Inflammatory Bowel ◽  
Working Practices ◽  
The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

scholarly journals The Impact of Inflammatory Bowel Disease in Canada 2018: IBD in Seniors

2018 ◽  
Vol 2 (Supplement_1) ◽  
pp. S68-S72 ◽  
Author(s):  
Geoffrey C Nguyen ◽  
Laura E Targownik ◽  
Harminder Singh ◽  
Eric I Benchimol ◽  
Alain Bitton ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Inflammatory Bowel ◽  
The Impact

scholarly journals P725 Trends in biologic use prior to resective surgery for inflammatory bowel disease: A Canadian population-based study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S583-S584
Author(s):  
D Chopra ◽  
E Kennedy ◽  
A V Weizman ◽  
A Tennakoon ◽  
L E Targownik
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Duration ◽  
Biologic Therapy ◽  
Demographic Data ◽  
Biologic Agent ◽  
Primary Role ◽  
Resective Surgery ◽  
Inflammatory Bowel ◽  
Incident Cases

Abstract Background Despite advances in medical therapy for inflammatory bowel disease (IBD), surgery is required in 50–80% of patients with Crohn’s disease (CD) and 20–30% of patients with ulcerative colitis (UC). Given that fibrostenotic disease may be playing a primary role in patients undergoing resective surgery, practices around biologic administration in this setting need to be clarified. We aimed to describe the pre-operative trends in biologic utilisation for IBD patients undergoing resective surgery. Methods The University of Manitoba IBD Epidemiology Database was used to identify all persons with IBD who underwent resective surgery between April 2005 and 2018. Demographic data were extracted to explore the baseline characteristics of persons on biologic therapy prior to IBD resective surgery. Proportion calculations were used to assess how often a new biologic agent was initiated within 3, 6, and 12 months prior to resective surgery. Results were stratified by type of IBD (UC vs. CD) and disease duration (&lt;3 or ≥3 years) for incident cases. Results A total of 1412 IBD-related resective surgeries were identified from April 2005 to 2018. 67.1% of resective surgeries were performed for CD and 32.9% for UC. Results of analysis are presented below: Conclusion Overall, in Manitoba, rates of biologic initiation or re-start in the pre-operative period for IBD resective surgery are relatively small. Biologic therapy was initiated or re-started more frequently for CD than UC, and when disease duration was less than 3 years. This is reassuring and suggests that physicians are rarely choosing to initiate biologic therapy in futile situations. Work should be performed to see if these findings can be replicated in other practice settings.

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