scholarly journals P173 Very–Early-Onset inflammatory bowel disease: Russian single centre experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S224-S224
Author(s):  
A Shchigoleva ◽  
P Shumilov
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Early Onset ◽  
Biologic Therapy ◽  
Clinical Symptoms ◽  
Allogenic Stem Cell Transplantation ◽  
Steroid Dependency ◽  
Number Of Patients ◽  
Inflammatory Bowel ◽  
Clinical Records

Abstract Background The incidence of very early-onset inflammatory bowel disease (VEOIBD) is on the rise in Russia but the clinical data is lacking. We aim to study the disease phenotype, clinical course and the presence of primary immunodeficiency (PID) patients in this group. Methods Clinical records of VEOIBD patients treated in Russian State Pediatric Hospital between 2000 and 2018 were revised. In 60 patients admitted between 2016 and 2018 targeted sequencing (PID panel) was performed. 10 patients received genetic testing previously. Results 135 VEOIBD patients were identified: 95 (70%)with ulcerative colitis (UC), 31 (23%) with Crohn’s disease, 9 (7%) with PID. In 14 (11%) IBD patients the diagnosis was changed from UC to CD and vice versa. Median time of diagnosis was 7 months in UC, 24 months in CD and 44 months in PID. The most common clinical symptoms were loose stools (UC—98%, CD—84%), bloody stools (UC—93, CD—65%), stomach ache (UC—53%, CD—52%), fever (UC—35%, CD—42%). Common laboratory features included anemia (UC—56%, CD—39%), low serum ferrum level (UC—75%, CD—61%), thrombocytosis (UC—53%, CD—45%). From 103 patients tested for ANCA 26% had positive results (24—UC, 3—CD). Mean calprotectin level (76 patients) was 750 ± 54.4 μg/g. Pancolitis was seen in UC (84%), as well as in CD (61%). Epithelioid granulomas in CD were present in 7 patients, in 5 of them they were detected years after initial diagnosis. Sixty-nine% of UC and 90% of CD patients received steroids as induction therapy, steroid-dependency was common (42% in UC and 55% in CD). Forty-nine% of patients with UC and 23% od CD patients received azathioprine, anti-TNF agents were used in 26% UC patients and 77% CD patients. In 35% of patients receiving anti-TNF biologic therapy was started before the age of 6 years. 23,8% of VEOIBD patients failed to achieve clinical remission. Total colectomy was performed in 11 patients, in 3 of them the diagnosis was subsequently changed to CD. Segmental resection was performed in 9 CD patients, in 3 of them while on therapy. The most common form of PID was XIAP deficiency (3 patients), 2 of them achieved endoscopic remission after allogenic stem cell transplantation. Conclusion In the VEOIBD group CD resembles UC clinically and endoscopically. A substantial number of patients requires immunosuppressive and biologic therapy before the age of 6 years. Colectomy rates are still high regardless the use of biologics. Boys with refractory VEOIBD should be screened for XIAP deficiency.

Management of Biological Therapy Before Elective Inflammatory Bowel Disease Surgeries

2019 ◽  
Vol 25 (10) ◽  
pp. 1613-1620 ◽  
Author(s):  
Tawnya M Hansen ◽  
Laura E Targownik ◽  
Ahmer Karimuddin ◽  
Yvette Leung
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Biologic Therapy ◽  
Preoperative Treatment ◽  
Necrosis Factor Alpha ◽  
Number Of Patients ◽  
Inflammatory Bowel ◽  
Factor Alpha ◽  
Alpha Therapy ◽  
Necrosis Factor

Abstract Increasing uptake of biologic therapy has contributed to declining surgical rates for inflammatory bowel disease (IBD). However, a significant number of patients on biologic therapy will go on to require surgery. The literature is conflicted with regard to the preoperative management of biologic therapy before urgent or elective IBD surgery. This article reviews the available data on postoperative complications following preoperative treatment with anti-tumor necrosis factor alpha therapy, anti-integrin therapy, and anti-interleukin therapy.

P016 IMPROVING TUBERCULOSIS RE SCREENING IN INFLAMMATORY BOWEL DISEASE PATIENTS RECEIVING BIOLOGIC THERAPY: A SINGLE CENTER QUALITY IMPROVEMENT INITIATIVE.

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S52-S53
Author(s):  
David Drevno ◽  
Sherry Hickok ◽  
Sabina Ali
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Risk Factor ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Biologic Therapy ◽  
Number Of Patients ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Exposure History

Abstract Background Biological agents have revolutionized the management of inflammatory bowel disease (IBD). There is a known increased risk of tuberculosis (TB) reactivation with biologic therapy (1). ACG guidelines recommend screening for active and latent TB infection (LTBI) prior to starting certain biologic agents (2). However, there are no consensus guideline on the utility of yearly screening testing in IBD patients without TB risk factors. With a number of patients now receiving the biologic therapy outside their primary care centers it has become increasingly difficult to effectively provide ongoing TB screening. With this quality improvement exercise, we aim to improve TB re-screening in patients receiving biologics by completing a yearly phone screening for exposure history. Method An interdisciplinary team from GI and ID developed a TB risk factor screening questionairre, adapting the California Department of Public Health’s Pediatric TB Risk Assessment tool (3). A list of patients receiving biologics was sorted by month of birth in the EMR. When the current calendar month aligned with the patient’s birth month, a GI RN reviewed the TB questionnaire with the patient (≥18 yo) and/or legal guardian by phone. If one or more TB risk factors were identified, the GI RN would notify the provider and a QuantiFERON-TB Gold (QFT) was ordered to be completed. Results 60 patients were found on biologic therapy (median age 17 yo) (38 males, 22 females) (68% CD, 28% UC, 3.3% IBD-U)(75% IFX, 12% ADA, and 3% other) to be to eligible TB screening between January - July 2019, 48 patients completed the phone screening. All 61 patients had completed TB screening prior to starting biologic therapy, which was reported to be negative. 13 patients were unable to be reached. 6/48 were identified as having at least 1 risk factor for TB. 5/6 patients with a positive screen had a negative QFT. 1 patient was away at college and a request to his adult GI managing his biologic was sent. Conclusion Screening for LTBI is required prior to starting a biologic therapy, though there are no guidelines for routine TB screening following initiation of the biologic. We propose performing an annual phone screening for TB exposure history for IBD patients on biologic therapy. QTF testing remains appropriate in patients with potential risk factors, such as being a health care worker or travel to/living in high endemic TB regions. References

scholarly journals P480 Assessing primary response to biologic therapy in Inflammatory Bowel Disease - ‘the when and the how?’

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S470-S470
Author(s):  
A C Moore ◽  
S Peake
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Biological Therapy ◽  
Biologic Therapy ◽  
Clinical Symptoms ◽  
Primary Response ◽  
Mucosal Inflammation ◽  
Faecal Calprotectin ◽  
Blood Tests ◽  
Inflammatory Bowel

Abstract Background ECCO guidelines state that patients started on biologic therapy for Inflammatory Bowel Disease (IBD) should be reviewed between week 10 and 16 depending on the biologic used and response assessed using predefined objective criteria. The study aim was to ascertain, the time point, and by which methods patients with IBD are being assessed for primary response. Methods A retrospective chart review was conducted of 50 consecutive patients with IBD who had been started on biological therapy between October 2018 and June 2019 at a tertiary referral university teaching hospital in London, UK. Results Patients were started on 5 biologics; infliximab (20 patients), adalimumab (11 patients), vedolizumab (6 patients), ustekinumab (9 patients) and tofacitinib (4 patients). Twenty two patients had Ulcerative Colitis and 28 patients had Crohn’s Disease. All 50 patients were still receiving biological therapy at the time of their first assessment in a consultant led IBD clinic. On average, patients were assessed at week 13 for primary response. Figure 1 outlines the time to assessment of disease response, according to the biologic used. The most frequently used methods were clinical symptoms (49 patients, 98%) and blood tests (47 patients, 94%). Disease activity scores were rarely documented. Other methods of disease assessment were faecal calprotectin (13 patients, 26%), ileocolonoscopy (11 patients, 22%) and radiological studies (2 patients, 4%). Only 19 patients (38%) had either a faecal calprotectin or a colonoscopy ordered at their appointment. Thirteen patients (26%) had undergone an endoscopic assessment of their disease when the data was analysed in December 2019. Conclusion Patients are being assessed in a timely fashion for primary response to biological therapy, in line with current ECCO guidelines. Clinical symptoms and blood tests are being heavily relied on to assess for primary response to therapy. Patient-reported symptoms do not correlate well with mucosal inflammation in IBD1. Faecal Calprotectin, as a surrogate marker of mucosal inflammation, and colonoscopy are being underused. Potential reasons for the low rates of colonoscopy may include patient’s wishes and lack of endoscopy capacity. The importance of a mucosal healing assessment is imperative to be able to optimise treatment appropriately and improve long-term outcomes for our patients. Reference

scholarly journals Different renal manifestations associated with very early onset pediatric inflammatory bowel disease: case report and review of literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
A. Angeletti ◽  
S. Arrigo ◽  
A. Madeo ◽  
M. Molteni ◽  
E. Vietti ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Interstitial Nephritis ◽  
Inflammatory Bowel Diseases ◽  
Bowel Disease ◽  
Early Onset ◽  
Renal Involvement ◽  
Granulomatous Interstitial Nephritis ◽  
Disease Case ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel diseases are characterized by chronic inflammation of the gastrointestinal tract. In particular, Crohn disease and ulcerative colitis represent the two most common types of clinical manifestations. Extraintestinal manifestations of inflammatory bowel diseases represent a common complications, probably reflecting the systemic inflammation. Renal involvement is reported in 4–23% of cases. However, available data are limited to few case series and retrospective analysis, therefore the real impact of renal involvement is not well defined. Case presentation We report the case of a 10-years old male affected by very early onset unclassified-Inflammatory bowel diseases since he was 1-year old, presenting with a flare of inflammatory bowel diseases associated with acute kidney injury due to granulomatous interstitial nephritis. Of interest, at 7-year-old, he was treated for IgA nephropathy. To our knowledge, no previous reports have described a relapse of renal manifestation in inflammatory bowel diseases, characterized by two different clinical and histological phenotypes. Conclusions The link between the onset of kidney injuries with flares of intestinal inflammation suggest that nephritis maybe considered an extra-intestinal manifestation correlated with active inflammatory bowel disease. However, if granulomatous interstitial nephritis represents a cell-mediated hypersensitivity reaction than a true extraintestinal manifestation of inflammatory bowel diseases is still not clarified. We suggest as these renal manifestations here described may be interpreted as extraintestinal disorder and also considered as systemic signal of under treatment of the intestinal disease.

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 (<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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