P413. Healthcare expenditures for inflammatory bowel disease peak in patients with a short disease duration

Introduction: Adherence to therapy is a key factor when analyzing the efficacy of a treatment in clinical practice. The aim of our study was to assess the frequency of non-adherence to treatment among patients with inflammatory bowel disease and evaluate which factors could be related. Material and Methods: One hundred thirty eight consecutive inflammatory bowel disease outpatients (55.8% with Crohn’s disease and 44.2% with Ulcerative Colitis) filled in an anonymous questionnaire, which included information about demography, duration of the disease, specific therapy for inflammatory bowel disease, and data possibly related to extent of non-adherence to treatment. Statistics were performed with SPSS v.18.0. Categorical variables were compared with Fisher’s exact test. A p value < 0.05 was considered statistically significant. Significant variables in univariate analysis were included in the logistic regression analysis. Results: Overall non-adherence was reported by 29.7% of patients. 70.7% of them reported unintentional non-adherence and 51.2% forgot at least one dose per week. Non-adherence was statistically associated with: short disease duration (p < 0.001); young age (p = 0.001); topical aminosalicylates (p = 0.005); the perception that medical therapy isn’t effective enough (p = 0.007) and high educational level (p = 0.011). In a logistic regression analysis, topical aminosalicylates use (p = 0.004), short disease duration (p = 0.006) and young age (p = 0.027) were identified as significant predictors of non-adherence. Discussion: Young patients, patients with short disease duration and under topical aminosalicyates presented a higher risk for nonadherence to treatment. Conclusions: Gastroenterologist’s attention should be focused on the identification of risk factors potentially involved in non-adherence to therapy and in the promotion of measures to improve it. Keywords: Inflammatory Bowel Disease; Crohn Disease; Colitis, Ulcerative; Patient Compliance; Risk Factors; Treatment Refusal.

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.853 ◽

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

BioMed Research International ◽

10.1155/2013/286368 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 20

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.

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Peer Review #2 of "Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting (v0.1)"

10.7287/peerj.587v0.1/reviews/2 ◽

2014 ◽

Author(s):

H Sifuentes

Keyword(s):

Inflammatory Bowel Disease ◽

Peer Review ◽

Bowel Disease ◽

Care Setting ◽

Clinical Care ◽

Insurance Status ◽

Healthcare Expenditures ◽

Inflammatory Bowel

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P255 Predictors of postoperative morbidity in patients with inflammatory bowel disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.384 ◽

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.

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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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz066 ◽

2019 ◽

Vol 13 (10) ◽

pp. 1343-1350 ◽

Cited By ~ 4

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.

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Surveillance in inflammatory bowel disease: an overview

Gastrointestinal Nursing ◽

10.12968/gasn.2019.17.8.32 ◽

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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Identifying predictors of low health-related quality of life among patients with inflammatory bowel disease: comparison between Crohn’s disease and ulcerative colitis with disease duration

Journal of Clinical Nursing ◽

10.1111/j.1365-2702.2010.03614.x ◽

2011 ◽

Vol 20 (11-12) ◽

pp. 1578-1587 ◽

Cited By ~ 29

Author(s):

Susanna Jäghult ◽

Fredrik Saboonchi ◽

Unn-Britt Johansson ◽

Regina Wredling ◽

Marjo Kapraali

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Disease Duration ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Inflammatory Bowel

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Milder multiple sclerosis course in patients with concomitant inflammatory bowel disease

Multiple Sclerosis Journal ◽

10.1177/1352458513515081 ◽

2013 ◽

Vol 20 (8) ◽

pp. 1135-1139 ◽

Cited By ~ 9

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.

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