P163 Changes in diagnostic delay in inflammatory bowel diseases over the years: a retrospective single-centre analysis

Abstract Background Delayed diagnosis is common in inflammatory bowel diseases (IBD) and has been reported to be longer for patients with Crohn’s disease (CD) than for those with ulcerative colitis (UC). Aims of study were to assess the median time to diagnosis in IBD patients, to examine whether diagnostic delay (DD) has improved over the years and its impact on biological treatment and need for surgery. Methods A retrospective monocentric study including IBD patients living in the area of Verona (Italy), diagnosed up to 2019 and followed-up for at least 6 months at IRCCS Sacro Cuore—Don Calabria, Negrar, was carried out. DD was defined as the period (months) from symptoms onset to histological diagnosis of IBD and reported as <6 months, 6–12 months and >12 months. Results Six-hundred-six patients (255 CD; 351 UC; 308 males; 298 females) were enrolled. Median DD was 10 (IQR 2–12), 6 (IQR 1–12) and 2 (IQR 1–7) months <2000, between 2001–2010, and >2010, respectively. Median time to diagnosis was not significantly longer in CD than in UC patients (4 vs. 3 months; IQR 1- 12). No sex- or age-related differences in DD were observed. Using the Mann–Whitney test, DD was longer in patients diagnosed <2000 and between 2001–2010, than in those diagnosed >2010 (p = 0.0000 and p = 0.0004). Comparing DD <2000 and >2010, the statistical difference was reported for UC (p = 0.0000) but not for CD (p = 0.2756). Considering the use of biologics over the years, patients diagnosed between 2000–2010, and >2010 were compared (194 CD and 333 UC), reporting a significant increase in their use both for CD (30 vs. 60; p = 0.0008) and UC (28 vs. 43; p = 0.0000). DD did not influence the need for biological treatment in both diseases (p = 0.987 for CD; p = 0.433 for UC). Considering a DD <6, 6–12, and >12 percentages of patients needing biologics were respectively 53.4%, 63.6% and 56.5% for CD and 28.5%, 34.1% and 26.3% for UC. Seventy-two CD and 27 UC patients needed surgery. Analyzing the time to surgery, DD did not influence the rate of resections in CD (p = 0.6559), as well as in UC (p = 0.2792). Conclusion In our cohort, DD has significantly decreased over the last years, more for UC than CD patients. This is probably related to the increased awareness of patients on disease and of general practitioners in sending them to the specialist. Considering the published literature, UC and CD did not differ in DD; moreover age at diagnosis did not affect DD in our patients. DD did not influence the need for biological treatment or surgery rates in both diseases. These results are probably related to the difference in disease extension and severity among the patients enrolled. An analysis on targeted patients at higher risk for bowel damage is presently under way.

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Anti-adhesion Molecules in IBD: Does Gut Selectivity Really Make the Difference?

Current Pharmaceutical Design ◽

10.2174/1381612825666190307165703 ◽

2019 ◽

Vol 25 (1) ◽

pp. 19-24 ◽

Cited By ~ 1

Author(s):

Ferdinando D'Amico ◽

Giulia Roda ◽

Laurent Peyrin-Biroulet ◽

Silvio Danese

Keyword(s):

Adhesion Molecules ◽

Biological Treatment ◽

Current Data ◽

New Drugs ◽

Inflammatory Infiltration ◽

New Class ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

The Difference ◽

Necrosis Factor

Inflammatory Bowel Disease is lifetime chronic progressive inflammatory disease. A considerable portion of patients, do not respond or lose response or experience side effect to “traditional” biological treatment such as anti-tumor necrosis factor (TNF)-α agents. The concept that the blockade of T cell traffic to the gut controls inflammation has stimulated the development of new drugs which selectively targets molecules involved in controlling cell homing to the intestine. The result is the reduction of the chronic inflammatory infiltration in the gut. In this regard, anti-adhesion molecules represent a new class of drugs for patients who don’t respond or lose response to traditional therapy. Moreover, some of these molecules such as vedolizumab, offer the advantage to target the delivery of a drug to the gut (gut selectivity) which could increase clinical efficacy and limit potential adverse events. In this article, we will give an overview of the current data on anti-adhesion molecules in Inflammatory Bowel Diseases.

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Age-related and gender features of circulating immune complexes and lipid metabolism in inflammatory bowel diseases

GASTROENTEROLOGY ◽

10.22141/2308-2097.53.1.2019.163456 ◽

2009 ◽

Vol 53 (1) ◽

pp. 39-43

Author(s):

M.V. Stoikevych ◽

I.A. Klenina ◽

O.M. Tatarchuk ◽

V.A. Karachinova ◽

N.S. Fedorova

Keyword(s):

Lipid Metabolism ◽

Immune Complexes ◽

Inflammatory Bowel Diseases ◽

Circulating Immune Complexes ◽

Age Related ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

And Gender ◽

Gender Features

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Sex- and Age-Related Estrogen Signaling Alteration in Inflammatory Bowel Diseases: Modulatory Role of Estrogen Receptors

International Journal of Molecular Sciences ◽

10.3390/ijms20133175 ◽

2019 ◽

Vol 20 (13) ◽

pp. 3175 ◽

Cited By ~ 6

Author(s):

Damian Jacenik ◽

Adam I. Cygankiewicz ◽

Anna Mokrowiecka ◽

Ewa Małecka-Panas ◽

Jakub Fichna ◽

...

Keyword(s):

Estrogen Receptor ◽

Estrogen Receptors ◽

Inflammatory Bowel Diseases ◽

Protein Level ◽

Estrogen Signaling ◽

Dependent Manner ◽

Tissue Samples ◽

Age Related ◽

Bowel Diseases ◽

Inflammatory Bowel

The pathogenesis of inflammatory bowel diseases (IBD) seems to be associated with alterations of immunoregulation. Several lines of evidence suggest that estrogens play a role in the modulation of immune responses and may be related to the etiology of IBD. The purpose of this work was to examine the involvement of G protein-coupled estrogen receptor (GPER), estrogen receptor α (ERα), estrogen receptor β (ERβ) and ERα spliced variants ERα36 and ERα46 in Crohn’s disease (CD) and ulcerative colitis (UC). The studied group included 73 patients with IBD and 31 sex and age-related controls. No differences in serum levels of 17β-estradiol nor of CYP1A1 and SULT1E1 enzymes involved in estrogen catabolism were stated. The expression pattern of estrogen receptors in tissue samples was quantified using real-time PCR and Western blotting. Statistically significant up-regulation of GPER and ERα in both CD and UC as well as down-regulation of ERβ in CD patients was found. However, differences in the expression of estrogen receptors in CD and UC have been identified, depending on the sex and age of patients. In men, up-regulation of GPER, ERα and ERα46 expression was shown in CD and UC patients. In women under 50 years of age, GPER protein level increased in UC whereas ERβ expression tended to decrease in CD and UC patients. In turn, in women over 50 the protein level of ERα increased in UC while ERβ expression decreased in CD patients. Dysregulation of estrogen receptors in the intestinal mucosa of patients with CD and UC indicates that estrogen signaling may play a role in the local immune response and maintain epithelial homeostasis in a gender- and age-dependent manner.

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Epidemiology and diagnosis of inflammatory bowel diseases

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.9.579 ◽

2021 ◽

Vol 64 (9) ◽

pp. 579-587

Author(s):

Kang-Moon Lee

Keyword(s):

Inflammatory Bowel Diseases ◽

Public Awareness ◽

Intestinal Tuberculosis ◽

Diagnostic Delay ◽

Perianal Fistula ◽

Diagnostic Tools ◽

Male Predominance ◽

The Past ◽

Bowel Diseases ◽

Inflammatory Bowel

Background: Over the past three decades, inflammatory bowel diseases (IBD) have been rapidly increasing in the African, South American, and Asian countries, including Korea. However, in Korea, the public awareness of IBD remains low, and diagnostic delay is not uncommon due to the physicians' lack of clinical experience. It is essential to understand the trends and regional differences in the epidemiology of IBD for proper diagnosis and treatment.Current Concepts: Although lower than those of the West, the prevalence and incidence of IBD in Korea rank among the highest in Asia and are steadily increasing. In the past 10 years, the prevalence of IBD has almost doubled, while its incidence has decreased gradually. As compared to Western IBD patients, Korean patients have higher proportion of proctitis in ulcerative colitis, male predominance, more ileocolonic involvement, and higher incidence of perianal fistula in Crohn disease. There is no single gold standard for the diagnosis of IBD. Thus, diagnosis can be made by clinical evaluation, including a detailed history taking, physical examination, and a combination of endoscopic, radiologic, laboratory, and histologic findings.Discussion and Conclusion: Population-based studies have revealed the current trends and characteristics of the epidemiology of IBD in Korea. Continued education and development of diagnostic tools will help clinicians to diagnose IBD accurately and differentiate it from other diseases such as intestinal tuberculosis.

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P338 effectiveness and safety of biological therapies in elderly inflammatory bowel diseases patients results from a multi center study of Geteccu

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.462 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S363-S364

Author(s):

C J Suarez Ferrer ◽

F Mesonero ◽

B Caballol ◽

R Saiz Chumillas ◽

I Bastón-Rey ◽

...

Keyword(s):

Elderly Patients ◽

Inflammatory Bowel Diseases ◽

Clinical Remission ◽

Biological Treatment ◽

Moderate Activity ◽

Biological Drugs ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Multi Center Study

Abstract Background Biological drugs are being increasingly used for the treatment of inflammatory bowel diseases (IBD) in elderly patients. Despite the particular characteristics of this population subgroup, the efficacy and safety of these treatments in real clinical practice is poorly evaluated. Methods Retrospective and multicenter study of GETECCU, carried out in 28 Spanish hospitals. Patients with IBD who started biological treatment (Infliximab, Adalimumab, Golimumab, Ustekinumab or Vedolizumab) aged 65 years or older were included. Efficacy (clinical- at the criteria of the responsible physician-, biochemical and endoscopic) was assessed at 12-14 weeks and at 52 weeks of treatment. Adverse effects such as tumors or serious infections were also recorded. Results A total of 570 patients were included, baseline characteristics are shown in Table 1. Biologics used were: Infliximab (214, 37.5%), Adalimumab (167, 29.3%), Golimumab (16, 2.8%), Ustekinumab (73, 12.8%) and Vedolizumab (100, 17.5%). After 12-14 weeks of treatment, in 38.7% (220) of the cases clinical remission had been achieved and in 47.7% (270) there was clinical response without remission. However, 80 patients (13.9%) had no response, resulting in treatment discontinuation due to primary failure. At week 52, only 379 patients (66.5%) continued on biological treatment: 216 (57%) were in clinical remission (216, 57.0%) while 129 (34%) had response without remission and 34 (9%)had no response. In addition, 119 patients (21%) had an endoscopic study performed: 47 (39,5%) presented with endoscopic remission, 38 (31,9%) with mild activity, 28 (23,5%) with moderate activity and 6, (5.1%) with severe activity. At the end of the follow-up, only 60% of the patients continued on biological treatment, being the reason for withdraw lack of efficacy or due to the report of adverse side effects. Regarding treatment safety in this population, 12.1% (68 patients) suffered an infectious complication with a microbiological diagnosis, requiring hospitalization in 62.1% of the cases. In addition, 39 patients (6.9%) were diagnosed with a tumor until the end of the follow-up, noting that 34.2% of the cases continued on biological therapy after the diagnosis. Likewise, in 25 patients (36.8%) this infection forced discontinuation of biological treatment. Finally, 10 patients stopped biological treatment due to a serious adverse reaction to it Conclusion Response rates to biological treatment in elderly patients are similar to those described in the general population, with approximately one third of failures happening during the first year. However, a remarkable proportion of patients developed a serious adverse effect that could be related to treatment

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Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not?

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa110 ◽

2020 ◽

Vol 26 (7) ◽

pp. e71-e71 ◽

Cited By ~ 1

Author(s):

Roberto Grassia ◽

Sara Soro ◽

Clara Benedetta Conti

Keyword(s):

Inflammatory Bowel Diseases ◽

Biological Treatment ◽

Bowel Diseases ◽

Inflammatory Bowel

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Delayed diagnosis of colorectal sexually transmitted diseases due to their resemblance to inflammatory bowel diseases

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2018.08.004 ◽

2018 ◽

Vol 75 ◽

pp. 34-38 ◽

Cited By ~ 2

Author(s):

Itzchak Levy ◽

Shiraz Gefen-Halevi ◽

Israel Nissan ◽

Natan Keller ◽

Shlomo Pilo ◽

...

Keyword(s):

Sexually Transmitted Diseases ◽

Inflammatory Bowel Diseases ◽

Delayed Diagnosis ◽

Sexually Transmitted ◽

Bowel Diseases ◽

Inflammatory Bowel

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Immunological aspects of determination of an adequate biological treatment sequence for inflammatory bowel diseases: the expert board statement (St. Petersburg, May 22, 2021)

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2021-49-060 ◽

2021 ◽

Vol 49 ◽

Author(s):

E. A. Belousova ◽

I. G. Kozlov ◽

D. I. Abdulganieva ◽

O. P. Alexeeva ◽

I. V. Gubonina ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Clinical Guidelines ◽

Biological Treatment ◽

Genetically Engineered ◽

Treatment Sequence ◽

Patient Profile ◽

Depth Analysis ◽

Bowel Diseases ◽

Inflammatory Bowel

On May 22, 2021, the Expert Board met in St. Petersburg to discuss their position on immunological aspects of determination of an adequate biological treatment sequence for inflammatory bowel diseases (IBD). The Expert Board aimed at discussion of current strategies, development of a consensus on determination of an adequate biological treatment sequence for IBD. The main topics of the agenda were the contribution of immune system to the pathophysiology of Crohn's disease, ulcerative colitis and their complications, efficacy of genetically engineered biological agents (GEBA) at various stages of IBD management. Participation of the leading Russian experts in IBD, as well as involvement of other specialties, made it possible to consider the topic by a multidisciplinary team, with an in-depth analysis of IBD pathophysiology, to better understand the course of the disease in some contradictory situation, for instance, when clinical remission is not associated with an endoscopically confirmed remission. One of the expected effects of this Expert Board meeting would be an improvement of GEBA administration in clinical practice, mostly due to the modification of clinical guidelines. This would ascertain and confirm the algorithms for GEBA administration for IBD, including the optimal treatment sequence depending on an agent’s mechanism of action and the patient profile. The clarification of the optimal GEBA sequence in the clinical guidelines could lead to more frequent GEBA administration in local medical clinics and institutions in the regions, where GEBA are used insufficiently due to little experience and absence of their precise positioning in the clinical guidelines.

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