scholarly journals P630 Inflammatory bowel disease in immigrants to Spain: results of the EIIMIGRA study from GETECCU (ENEIDA registry)

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S567-S568
Author(s):  
A Gutiérrez Casbas ◽  
P Zapater ◽  
E Ricart ◽  
M González-Vivó ◽  
J Gordillo ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Latin American ◽  
Bowel Disease ◽  
Disease Duration ◽  
Universal Access ◽  
Disease Onset ◽  
Migrant Group ◽  
Phenotypic Differences ◽  
Disease Extension ◽  
Inflammatory Bowel

Abstract Background Previous studies comparing inflammatory bowel disease(IBD) features between migrant and native patients have shown clinical phenotype differences. To date, no study has focused on IBD immigrants(MP) in Spain. The aim of this study was to explore the features of MP in Spain and to compare age of disease onset, IBD phenotype and therapeutic requirements with native-born IBD patients(NP). Methods This was an observational, multicentric and case-control study of the nationwide ENEIDA registry. We selected all IBD patients who were born outside of Spain and compared with a control cohort of NP. All included patients were diagnosed with IBD before 2015. Results A total of 13,524 patients were included(1864 MP and 11660 NP).The most prevalent ethnic migrant group was Caucasian(771, 41%), followed by Latin American(572, 31%) and Arabian(341,18%), whereas Asian represented only 6%. Table 1 summarizes the demographic and phenotypic features. 71% of MP were diagnosed with IBD in Spain. There was not a gender predisposition to IBD in the overall migrant group, however more female UC MP were detected compared to UC NP(52 % vs 45%, p<0.001). MP were younger at the onset of the disease and had a shorter disease duration compared to NP, in both UC and CD patients. Significantly more CD patients were diagnosed under 16 years(A1) among MP, and more patients over 40 years(A3) among NB. More NB patients had CD stricturing phenotype(24% vs 19%, p=0,002) compared to MP. Disease extension in CD and UC did not differ between groups. The overall proportion of abdominal or perianal surgery was similar in both groups but the use of biologic therapy was more common in MP(36% vs 30%, p=0,001). Conclusion In the largest cohort of migrant IBD patients in Spain, immigrants were younger, had a shorter disease duration and required a higher use of biologics than natives, pointing phenotypic differences in this population and a universal access to the healthcare system all over the country.

Milder multiple sclerosis course in patients with concomitant inflammatory bowel disease

2013 ◽  
Vol 20 (8) ◽  
pp. 1135-1139 ◽  
Author(s):  
Hélène Zéphir ◽  
Corinne Gower-Rousseau ◽  
Julia Salleron ◽  
Olivier Simon ◽  
Marc Debouverie ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Duration ◽  
Disease Course ◽  
Expanded Disability Status Scale ◽  
Disability Status ◽  
Disease Extension ◽  
Inflammatory Bowel ◽  
Extent Of Disease

An association between multiple sclerosis (MS) and inflammatory bowel disease (IBD) has been suggested. The purpose of this study was to compare the disease course of patients with both MS and IBD with that of patients with isolated MS or isolated IBD. Sixty-six MS-IBD patients were identified and were matched with 251 isolated MS and 257 isolated IBD controls. Main outcomes were scores using the Expanded Disability Status Scale (EDSS) in MS and extent of disease extension in IBD at last clinical evaluation. After a median 12 years of disease duration, the median EDSS and the percentages of patients reaching an EDSS of 3.0 and 4.0 were significantly lower in MS-IBD patients than in controls. MS had no impact on IBD. MS course appears to be milder in patients with concomitant IBD.

scholarly journals Efficacy of biological drugs in short-duration versus long-duration inflammatory bowel disease: a protocol for a systematic review and an individual-patient level meta-analysis of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024222 ◽  
Author(s):  
Shomron Ben-Horin ◽  
Yue Zhao ◽  
Jing Guo ◽  
Ren Mao ◽  
Lena Novack ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Duration ◽  
Meta Analysis ◽  
Disease Onset ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Individual Patient Level ◽  
Patient Level ◽  
Inflammatory Bowel

IntroductionCrohn’s disease (CD) and ulcerative colitis (UC) are remitting–relapsing inflammatory diseases often culminating in disease complications and/or need for surgery. Biologic monoclonal antibody drugs (‘Biologics’) are efficacious for both diseases, but there are no systematic assessments of their efficacy if administered early after disease onset (‘top-down’ strategy) vis-à-vis later in the course of disease (‘step-up’ approach).Methods and analysisElectronic databases (MEDLINE, EMBASE/EMBASE classic Cochrane CENTRAL register of controlled trials, the Cochrane IBD Group Specialised Trials Register and Clinicaltrials.gov registry) will be searched to identify all randomised placebo-controlled clinical trials of food and drug administration (FDA)-approved biologics for CD and UC (by March 2016). Two independent reviewers will screen identified papers, extract data and assess the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. Individual-patient-level data (IPD) will be extracted from the identified trials through data-sharing platforms for pharmaceutical companies’ sponsored trials and by contacting principal investigators of independent investigator-initiated trials. We will analyse induction of remission in patients with early-disease (<18 months since disease onset) versus patients with longer disease duration, using a generalised linear mixed effect model and by a two-stage approach using coefficient for the treatment-by-subgroup interaction within each trial. We will perform receiver operator curve analysis of optimal disease duration for response. Analyses will be separate for CD and UC. This first-of-its-kind meta-analysis at IPD level of interaction of disease duration with the response to biologics in UC and CD may elucidate the impact of early initiation of biologics, which is of paramount importance for clinical practice and management strategies of inflammatory bowel disease.Ethics and disseminationThis meta-analysis was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University. Findings will be published in peer-reviewed journal and disseminated via scientific meetings and links with organisations.PROSPERO registration numberCRD42018041961.

Ethnic Differences in the Smoking-Related Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Daniele Piovani ◽  
Claudia Pansieri ◽  
Soumya R R Kotha ◽  
Amanda C Piazza ◽  
Celia-Louise Comberg ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Latin American ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Study Data ◽  
Future Research ◽  
Related Risk ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background and aims The association between smoking and inflammatory bowel disease (IBD) relies on old meta-analyses including exclusively non-Jewish White populations. Uncertainty persists regarding the role of smoking in other ethnicities. Methods We systematically searched Medline/PubMed, Embase and Scopus for studies examining tobacco smoking and the risk of developing IBD, i.e., Crohn’s disease (CD) or ulcerative colitis (UC). Two authors independently extracted study data and assessed each study’s risk-of-bias. We examined heterogeneity and small-study effect, and calculated summary estimates using random-effects models. Stratified analyses and meta-regression were employed to study the association between study-level characteristics and effect estimates. The strength of epidemiological evidence was assessed through prespecified criteria. Results We synthesized 57 studies examining the smoking-related risk of developing CD and UC. Non-Jewish White smokers were at increased risk of CD (29 studies; RR: 1.95, 95% CI: 1.69‒2.24; moderate evidence). No association was observed in Asian, Jewish and Latin-American populations (11 studies; RR: 0.97; 95% CI: 0.83–1.13), with no evidence of heterogeneity across these ethnicities. Smokers were at reduced risk of UC (51 studies; RR: 0.55, 95% CI: 0.48–0.64; weak evidence) irrespectively of ethnicity; however, cohort studies, large studies and those recently published showed attenuated associations. Conclusions This meta-analysis did not identify any increased risk of CD in smokers in ethnicities other than non-Jewish Whites, and confirmed the protective effect of smoking on UC occurrence. Future research should characterize the genetic background of CD patients across different ethnicities to improve our understanding on the role of smoking in CD pathogenesis.

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.

scholarly journals FOXP3+T Regulatory Cell Modifications in Inflammatory Bowel Disease Patients Treated with Anti-TNFαAgents

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Luisa Guidi ◽  
Carla Felice ◽  
Annabella Procoli ◽  
Giuseppina Bonanno ◽  
Enrica Martinelli ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Bowel Disease ◽  
Flow Cytometry ◽  
Bowel Disease ◽  
Peripheral Blood ◽  
Disease Duration ◽  
Healthy Controls ◽  
T Regulatory Cell ◽  
Inflammatory Bowel ◽  
Necrosis Factor

Treg modulation has been hypothesized as one of the mechanisms by which antitumor necrosis factorα(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-TNFαtherapy (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-TNFαtherapy 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-TNFαmay affect Treg percentages and that Treg modifications may correlate with clinical response, but differently in early versus late disease.

scholarly journals A cross-sectional survey of multi-generation inflammatory bowel disease consanguinity and its relationship with disease onset

2017 ◽  
Vol 23 (6) ◽  
pp. 337 ◽  
Author(s):  
Mahmoud Mosli ◽  
Abdulelah Alzahrani ◽  
Showlag Showlag ◽  
Abdullah Alshehri ◽  
Ahmed Hejazi ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Onset ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Inflammatory Bowel

Current recommendations on the role of diet in the aetiology and management of IBD

2021 ◽  
pp. flgastro-2020-101429
Author(s):  
Konstantinos Gerasimidis ◽  
Lihi Godny ◽  
Rotem Sigall-Boneh ◽  
Vaios Svolos ◽  
Catherine Wall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Onset ◽  
Well Being ◽  
Disease Development ◽  
Dietary Recommendations ◽  
Exclusive Enteral Nutrition ◽  
Established Disease ◽  
Inflammatory Bowel

Diet is a key modifier of risk of inflammatory bowel disease development and potentially a treatment option in patients with established disease. International organisations in gastroenterology and inflammatory bowel disease have published guidelines for the role of diet in disease onset and its management. Here, we discuss the major overarching themes arising from these guidelines and appraise recent literature on the role of diet for inflammatory bowel disease prevention, treatment of active disease and maintenance of remission, considering these themes. Except for exclusive enteral nutrition in active Crohn’s disease, we currently possess very little evidence to make any further dietary recommendations for the management of inflammatory bowel disease. There is also currently uncertainty on the extrapolation of epidemiological dietary signals on risk of disease development and preclinical experiments in animal models to management, once disease is established. Until high-quality evidence from clinical research becomes available, the only specific recommendations for inflammatory bowel disease we might safely give are those of healthy eating which apply for the general population for overall health and well-being.

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 &lt;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 &lt;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&lt;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 &lt; 0.01) and pre-operative steroids (OR 6.1, 95% CI 1.8–11.4, p &lt; 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.

High Adherence to Surveillance Guidelines in Inflammatory Bowel Disease Patients Results in Low Colorectal Cancer and Dysplasia Rates, While Rates of Dysplasia are Low Before the Suggested Onset of Surveillance

2019 ◽  
Vol 13 (10) ◽  
pp. 1343-1350 ◽  
Author(s):  
Kelita Singh ◽  
Alex Al Khoury ◽  
Zsuzsanna Kurti ◽  
Lorant Gonczi ◽  
Jason Reinglas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Duration ◽  
Interquartile Range ◽  
Colorectal Adenomas ◽  
British Society ◽  
Low Grade ◽  
High Adherence ◽  
Inflammatory Bowel

Abstract Background Patients with Crohn’s disease [CD] and ulcerative colitis [UC] are at increased risk for colorectal dysplasia [CRD] and colorectal cancer [CRC]. Adherence to CRC surveillance guidelines is reportedly low internationally. Aim To evaluate surveillance practices at the tertiary IBD Center of the McGill University Health Center [MUHC] and to determine CRD/CRC incidence. Methods A representative inflammatory bowel disease cohort with at least 8 years of disease duration [or with primary sclerosing cholangitis] who visited the MUHC between July 1 and December 31, 2016 were included. Adherence to surveillance guidelines was compared to modified 2010 British Society of Gastroenterology guidelines. Incidence rates of CRC, high-grade dysplasia [HGD], low-grade dysplasia [LGD] and colorectal adenomas [CRA] were calculated based on pathology. Results In total, 1356 CD and UC patients (disease duration: 12 [interquartile range: 6–22) and 10 [interquartile range: 5–19] years) were identified. The surveillance cohort consisted of 680 patients [296 UC and 384 CD]. Adherence to surveillance guidelines was 76/82% in UC/colonic CD. An adequate number of biopsies were taken in 54/54% of UC/colonic CD patients. The incidence of CRC/HGD in UC and CD with colonic involvement was 19.5/58.5 and 25.1/37.6 per 100,000 patient-years, respectively. The incidence of dysplasia before 8 years of disease duration was low in both UC/CD [19.5 and 12.5/100,000 patient-years] with no CRC detected. The CRA rate was 30/38% in UC/colonic CD. Conclusion High adherence to surveillance guidelines and low CRC and dysplasia, but not CRA rates were found, suggesting that adhering to updated, stratified, surveillance recommendations may result in low advanced neoplasia rates. The incidence of dysplasia before the start of surveillance was low.

Surveillance in inflammatory bowel disease: an overview

2019 ◽  
Vol 17 (8) ◽  
pp. 32-37
Author(s):  
Sara Koo ◽  
Jignesh Jatania ◽  
Colin Rees
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Disease Duration ◽  
The Other ◽  
Surveillance Colonoscopy ◽  
Targeted Biopsy ◽  
White Light Endoscopy ◽  
Increased Risk ◽  
Inflammatory Bowel

Patients with inflammatory bowel disease (IBD), including both ulcerative colitis and Crohn's disease, are at an increased risk of developing colorectal cancer. It is well accepted that this risk increases after 8–10 years of disease duration. Patients should be offered a surveillance colonoscopy after this time. Previously, white-light endoscopy with random biopsies every 10 cm was undertaken for surveillance, but recent evidence suggests that chromoendoscopy along with targeted biopsy is superior to this and the other available methods. This article reviews the available evidence for IBD surveillance, surveillance guidelines and the evidence for chromoendoscopy. Additionally, an overview of the assessment, reporting of any visible abnormal lesions and management of subsequently proven dysplastic lesions is given.

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