P194 Risk factors of axial spondyloarthritis among inflammatory bowel disease patients

Abstract Background Spondyloarthritis (SpA) is the most common extraintestinal manifestation (EIM) in inflammatory bowel disease (IBD) patients. However, the delay for the diagnosis of SpA in IBD patients is still unacceptably long, and may be the main cause of impairment due to ankylosing spondylitis. The aim of this study was to identify predictors of axial SpA in IBD patients, in order to prevent complications. Methods We conducted a retrospective study between 2001 and 2018 including all IBD patients diagnosed with symptomatic axial Spondyloarthritis (SpA) (Group1) and non-SpA patients among IBD (Group2). Diagnosis of SpA was based on ASAS 2009 criteria and confirmed by rheumatologists. Medical data were collected then uni and multivariate statistical analysis (p significant if ≤0.05) were performed. Results Seventy-eight patients with mean age 38 ± 11 years and sex ratio H/F = 1.6 were included. There were 58 (74.4%) Crohn’s disease (CD) patients and twenty patients (25.6%) had ulcerative colitis (UC). The average duration of IBD in all patients was 89.7 ± 69.1 months. SpA group included 26 patients (33.3%), six of whom (23%) had a late-stage disease (ankylosis). Most of the SpA patients (53.8%) had their disease before IBD onset with an average delay of 52.5 ± 68 months between SpA diagnosis and IBD symptoms. In univariate analysis, factors associated with SpA in IBD patients were familial history of IBD (p = 0.025) and the type of IBD (39.7% in CD vs. 15% in UC; p = 0.04). Among CD patients’, structuring-type was significantly associated with SpA (p = 0.04). Multivariate analysis showed that familial history of IBD (OR = 0.17; IC95%; 0.03–0.93; p = 0.04) and CD (OR = 3.72; IC 95%; 0.98–14.15; p = 0.05) were independent risk factors of axial SpA during IBD. EIMs other than SpA were more frequent in group 1 than in group 2 such as peripheral arthropathies (19.2% vs. 8.3% respectively; p = 0.02), anterior uveitis (11.5% vs. 0% respectively; p = 0.01) and erythema nodosum (7.7% vs. 0% respectively; p = 0.04). Conclusion In conclusion, predictors of symptomatic axial SpA were familial history of IBD and CD with structuring behaviour. Early-stage diagnosis is important to avoid ankylosis, which is a major cause of handicap in younger patients.

Download Full-text

Articular manifestations in patients with inflammatory bowel disease treated with vedolizumab

Rheumatology ◽

10.1093/rheumatology/keaa107 ◽

2020 ◽

Vol 59 (11) ◽

pp. 3275-3283 ◽

Cited By ~ 1

Author(s):

Anastasia Dupré ◽

Michael Collins ◽

Gaétane Nocturne ◽

Franck Carbonnel ◽

Xavier Mariette ◽

...

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Inflammatory Bowel Diseases ◽

Bowel Disease ◽

Bowel Diseases ◽

History Of ◽

Musculoskeletal Manifestations ◽

Inflammatory Bowel

Abstract Objective Vedolizumab (VDZ) has been incriminated in the occurrence of articular manifestations in patients with inflammatory bowel diseases (IBDs). The aim of this study was to describe musculoskeletal manifestations occurring in IBD patients treated by VDZ and to identify risk factors. Methods In this retrospective monocentric study, we included all consecutive patients treated by VDZ for IBD in our hospital. Incident musculoskeletal manifestations occurring during VDZ treatment were analysed and characteristics of patients with and without articular inflammatory manifestations were compared. Results Between 2013 and 2017, 112 patients were treated with VDZ for IBD: ulcerative colitis (n = 59), Crohn’s disease (n = 49) and undetermined colitis (n = 4). Four patients (3.6%) had a history of SpA, whereas 13 (11.6%) had a history of peripheral arthralgia. Some 102 (91.1%) patients had previously received anti-TNF. After a mean (S.d.) follow-up of 11.4 (8.6) months, 32 (28.6%) patients presented 35 musculoskeletal manifestations, of which 18 were mechanical and 17 inflammatory. Among the latter, 11 had axial or peripheral SpA, 5 had early reversible arthralgia and 1 had chondrocalcinosis (n = 1). Among the 11 SpA patients, only 3 (2.6%) had inactive IBD and may be considered as paradoxical SpA. The only factor associated with occurrence of inflammatory manifestations was history of inflammatory articular manifestation [7/16 (43.8%) vs 10/80 (12.5%), P = 0.007]. Conclusion Musculoskeletal manifestations occurred in almost 30% of IBD patients treated with VDZ, but only half of them were inflammatory. Since most of the patients previously received anti-TNF, occurrence of inflammatory articular manifestations might rather be linked to anti-TNF discontinuation than to VDZ itself.

Download Full-text

Colorectal cancer

Oxford Textbook of Oncology ◽

10.1093/med/9780199656103.003.0039_update_001 ◽

2016 ◽

pp. 444-477

Author(s):

Alex Boussioutas ◽

Stephen Fox ◽

Iris Nagtegaal ◽

Alexander Heriot ◽

Jonathan Knowles ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Inflammatory Bowel Disease ◽

Colon Cancer ◽

Bowel Disease ◽

Colonic Cancer ◽

Early Stage ◽

Inflammatory Bowel ◽

Resected Stage ◽

Stage Ii Colon Cancer

This chapter covers colorectal cancer, and includes information on epidemiology, risk factors (chronic inflammation/inflammatory bowel disease, radiation, diet and lifestyle, post cholecystectomy, diabetes, obesity and insulin resistance, cigarette smoking, alcohol, ureterocolic anastamosis, and genetic risk factors, screening, and chemoprevention (aspirin, and NSAIDS), the molecular biology and pathology of colorectal cancer, colorectal carcinoma (location, pathologic prognostic markers, and predictive markers), surgical management (colonic cancer and inflammatory bowel disease, hereditary non-polyposis colonic cancer or HNPCC, presenting as an emergency, treatment of polyp or early cancers, liver and lung metastasis, peritoneal disease, results of surgery and treatment for colon cancer, medical management of early stage disease, adjuvant chemotherapy for stage III disease (T1-4, N1-2M0), adjuvant therapy of patients with resected stage II colon cancer, radiotherapy, multidisciplinary care and special groups, the role of allied teams, and surveillance and follow-up.

Download Full-text

Epidemiology and Risk Factors of Portal Venous System Thrombosis in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.744505 ◽

2022 ◽

Vol 8 ◽

Author(s):

Hanyang Lin ◽

Zhaohui Bai ◽

Fanjun Meng ◽

Yanyan Wu ◽

Li Luo ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Inflammatory Bowel Disease ◽

Colorectal Surgery ◽

Bowel Disease ◽

Venous System ◽

Portal Venous System ◽

Urgent Surgery ◽

History Of ◽

Inflammatory Bowel

BackgroundPatients with inflammatory bowel disease (IBD) may be at risk of developing portal venous system thrombosis (PVST) with worse outcomes. This study aims to explore the prevalence, incidence, and risk factors of PVST among patients with IBD.MethodsPubMed, Embase, and Cochrane Library databases were searched. All the eligible studies were divided according to the history of colorectal surgery. Only the prevalence of PVST in patients with IBD was pooled if the history of colorectal surgery was unclear. The incidence of PVST in patients with IBD after colorectal surgery was pooled if the history of colorectal surgery was clear. Prevalence, incidence, and risk factors of PVST were pooled by only a random-effects model. Subgroup analyses were performed in patients undergoing imaging examinations. Odds ratios (ORs) with 95% CIs were calculated.ResultsA total of 36 studies with 143,659 patients with IBD were included. Among the studies where the history of colorectal surgery was unclear, the prevalence of PVST was 0.99, 1.45, and 0.40% in ulcerative colitis (UC), Crohn's disease (CD), and unclassified IBD, respectively. Among the studies where all the patients underwent colorectal surgery, the incidence of PVST was 6.95, 2.55, and 3.95% in UC, CD, and unclassified IBD after colorectal surgery, respectively. Both the prevalence and incidence of PVST became higher in patients with IBD undergoing imaging examinations. Preoperative corticosteroids therapy (OR = 3.112, 95% CI: 1.017–9.525; p = 0.047) and urgent surgery (OR = 1.799, 95% CI: 1.079–2.998; p = 0.024) are significant risk factors of PVST in patients with IBD after colorectal surgery. The mortality of patients with IBD with PVST after colorectal surgery was 4.31% (34/789).ConclusionPVST is not rare, but potentially lethal in patients with IBD after colorectal surgery. More severe IBD, indicated by preoperative corticosteroids and urgent surgery, is associated with a higher risk of PVST after colorectal surgery. Therefore, screening for PVST by imaging examinations and antithrombotic prophylaxis in high-risk patients should be actively considered.Systematic Review RegistrationRegistered on PROSPERO, Identifier: CRD42020159579.

Download Full-text

Risk Factors for Medication Nonadherence to Self-Injectable Biologic Therapy in Adult Patients With Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz253 ◽

2019 ◽

Vol 26 (2) ◽

pp. 314-320 ◽

Cited By ~ 6

Author(s):

Nisha B Shah ◽

Jennifer Haydek ◽

James Slaughter ◽

Jonathan R Ashton ◽

Autumn D Zuckerman ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biologic Therapy ◽

Univariate Analysis ◽

Tertiary Care ◽

Multivariable Analysis ◽

Psychiatric History ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background In inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), nonadherence to biologic therapy increases risk of disease flare. The aim of this study was to identify risk factors for nonadherence. Methods This was a single-center retrospective study evaluating patients with IBD treated at a tertiary care center and prescribed self-injectable biologic therapy using the center’s specialty pharmacy. Adherence was defined using medication possession ratio (MPR). Nonadherence was defined as MPR <0.86. Results Four hundred sixty patients (n = 393 with CD and n = 67 with UC) were evaluated with mean MPR (interquartile range) equaling 0.89 (0.48–1). Overall, 69% of patients were adherent (defined as MPR ≥0.86), 66% of patients with CD and 87% of patients with UC. In univariate analysis, several factors increased risk of nonadherence: CD diagnosis, insurance type, psychiatric history, smoking, prior biologic use, and narcotic use (P < 0.05). In multivariable analysis, Medicaid insurance (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.85–15.6) and CD diagnosis (OR, 2.8; 95% CI, 1.3–6.0) increased risk of nonadherence. In CD, as the number of risk factors increased (narcotic use, psychiatric history, prior biologic use, and smoking), the probability of nonadherence increased. Adherence was 72% in patients with 0–1 risk factors, decreasing to 62%, 61%, and 42% in patients with 2, 3, and 4 risk factors, respectively (P < 0.05). Conclusions This study identified risk factors for nonadherence to biologic therapy. In patients with CD, the probability of nonadherence increased as the number of risk factors increased.

Download Full-text

Colorectal cancer

Oxford Textbook of Oncology ◽

10.1093/med/9780199656103.003.0039 ◽

2016 ◽

pp. 444-477

Author(s):

Alex Boussioutas ◽

Stephen Fox ◽

Iris Nagtegaal ◽

Alexander Heriot ◽

Jonathan Knowles ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Inflammatory Bowel Disease ◽

Colon Cancer ◽

Bowel Disease ◽

Colonic Cancer ◽

Early Stage ◽

Inflammatory Bowel ◽

Resected Stage ◽

Stage Ii Colon Cancer

Download Full-text

Prevalence of Anal Intraepithelial Lesions in Patients with Inflammatory Bowel Disease

Journal of Coloproctology ◽

10.1055/s-0041-1730425 ◽

2021 ◽

Vol 41 (03) ◽

pp. 222-227

Author(s):

Mariane Christina Savio ◽

Rosimeri Kuhl Svoboda Baldin ◽

Norton Luiz Nóbrega ◽

Guilherme Mattioli Nicollelli ◽

Antonio Sérgio Brenner ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Intraepithelial Neoplasia ◽

Female Gender ◽

Anal Intercourse ◽

Receptive Anal Intercourse ◽

Cross Sectional ◽

History Of ◽

Inflammatory Bowel

Abstract Introduction Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal canal associated with HPV, with a higher prevalence in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) are at potential risk for their development, due to the use of immunosuppressants and certain characteristics of the disease. Method This is a prospective, cross-sectional, and interventional study that included 53 patients with IBD treated at a tertiary outpatient clinic, who underwent anal smear for cytology in order to assess the prevalence of AIN and associated risk factors. Results Forty-eight samples were negative for dysplasia and 2 were positive (4%). Both positive samples occurred in women, with Crohn's disease (CD), who were immunosuppressed and had a history of receptive anal intercourse. Discussion The prevalence of anal dysplasia in IBD patients in this study is similar to that described in low-risk populations. Literature data are scarce and conflicting and there is no evidence to recommend screening with routine anal cytology in patients with IBD. Female gender, history of receptive anal intercourse, immunosuppression and CD seem to be risk factors.

Download Full-text

INCIDENCE AND RISK FACTORS FOR NEOPLASIA IN INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.105 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S43-S43

Author(s):

Joana Lemos Garcia ◽

Isadora Rosa ◽

Joana Moleiro ◽

João Pereira da Silva ◽

António Dias Pereira

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Bowel Disease ◽

Remission Rate ◽

Statistical Significance ◽

Univariate Analysis ◽

Tobacco Exposure ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Introduction and goals Inflammatory Bowel Disease (IBD) patients may have an increased risk of neoplasia due to IBD itself or its therapy. The aim of this study was to evaluate the incidence of malignant neoplasia in IBD patients in a portuguese hospital, the associated risk factors and the therapy adjustments made. Methods Unicentric retrospective cohort study. All patients followed for IBD in a tertiary portuguese hospital and oncological center during 2015–2020 were included. Demographic and clinical data were registered. Results A total of 318 patients were included: female n=175(55.0%), age at diagnosis=37.24(±15,28)years-old, Crohn’s disease (CD) n=168(52.8%), Primary Sclerosing Cholangitis n=7, family history of cancer n=12, previous diagnosis of neoplasia n=23(7.2%), smokers n=49 (15.4%). A total of 42 cancers were diagnosed in 36 patients (11.3%) - median of 12.0(IQR=8.0–21.0) years after IBD diagnosis. Most affected organs: skin (n=15 in 11 patients; melanoma=1), colon and rectum (n=8 in 6 patients), prostate (n=4), breast (n=3) and anal canal (n=2). In those with non-melanoma skin cancer, 6 patients were under active treatment with azathioprine and 2 had stopped it for more than two years. In both univariate/multivariate analysis, the occurrence of neoplasia was associated with tobacco exposure (p=0.0.29/p=0.004), age (p<0.001/p=0,003) and IBD duration (p=0.001/p=0.017). There was no association with IBD therapy. In 9 cases, the cancer treatment was different because of the IBD (type of surgery n=6, drugs used n=2, radiotherapy not used n=1); IBD treatment was changed in 9 patients; clinical remission was lost in 1 patient in whom azathioprine treatment was halted after cancer. In the last follow-up, 3 patients remained with active oncological disease and 5 had died, 3 of which with active cancer. In those affected by cancer, in the univariate analysis, its cure/remission was negatively associated with tobacco exposure (p=0.003) and positively with salicylates use (p=0.016) and IBD remission before cancer diagnosis (p=0.008). In the multivariate analysis, the statistical significance was lost. Overall survival was lower in smokers with or without neoplasia (p<0.001) and in those who developped cancer (p=0.003). Conclusion In IBD patients, cancer mostly affected the skin and the lower digestive system. As in the general population, age and tobacco exposure were risk factors for the development of neoplasia. Tobacco is globally associated with lower survival rates and may be associated with a lower cure/remission rate, while salicylates and IBD remission may have a beneficial effect.

Download Full-text

Dysplasia Surveillance in Inflammatory Bowel Disease: A Cohort Study

GE Portuguese Journal of Gastroenterology ◽

10.1159/000510728 ◽

2020 ◽

pp. 1-9

Author(s):

Sofia Saraiva ◽

Isadora Rosa ◽

Joana Moleiro ◽

João Pereira da Silva ◽

Ricardo Fonseca ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Cohort Study ◽

Bowel Disease ◽

Univariate Analysis ◽

Surveillance Program ◽

Low Grade ◽

Increased Risk ◽

Surveillance Programs ◽

History Of ◽

Inflammatory Bowel

Introduction: Patients with colonic inflammatory bowel disease (IBD) are at an increased risk for colorectal cancer (CRC), whereby surveillance colonoscopy is recommended. Aim: To study the clinical and endoscopic variables associated with dysplasia in IBD patients. Methods: A cohort study was conducted on IBD patients who were part of a colonoscopy surveillance program between 2011 and 2016. Results: A total of 342 colonoscopies were performed on 162 patients (105 with ulcerative colitis [UC] and 57 with Crohn’s disease). Random biopsies were performed at least once on 81.5% of patients; 33.3% of the patients underwent chromoendoscopy (CE) at least once. Endoscopically resectable lesions were detected in 55 patients (34%), and visible lesions deemed unfit for endoscopic resection were found in 5 patients (3.1%). Overall, 62 dysplastic visible lesions (58 with low-grade dysplasia and 3 with high-grade dysplasia) and 1 adenocarcinoma were found in 34 patients. Dysplasia in random biopsies was present in 3 patients, the yield of random biopsies for dysplasia being 1.85%/patient (3/162), 1.75%/colonoscopy (6/342), and 0.25%/biopsy (9/3,637). Dysplasia detected in random biopsies was significantly associated with a personal history of visible dysplasia (p = 0.006). Upon univariate analysis, dysplasia was significantly associated with the type of IBD, the performance of random biopsies, and CE (p = 0.016/0.009/0.05, respectively). On multivariate analysis, dysplasia was associated with duration of disease. Conclusion: Our data confirm that patients with long-standing IBD, in particular UC, should be enrolled in dysplasia surveillance programs, and that performing CE and random biopsies seems to help in the detection of colonic neoplastic lesions.

Download Full-text

Risk of Inflammatory Bowel Disease in Psoriasis Patients Treated with Anti-Interleukin-17 Agents: A Bayesian Metaanalysis

10.1101/19012179 ◽

2019 ◽

Author(s):

N. Gill ◽

M. Pietrosanu ◽

R. Gniadecki

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Family History ◽

Bowel Disease ◽

Hidradenitis Suppurativa ◽

Absolute Risk ◽

Interleukin 17 ◽

Increased Risk ◽

History Of ◽

Inflammatory Bowel

AbstractBackgroundUse of interleukin-17 inhibitors (IL-17i) in psoriasis has been associated with an increased risk of inflammatory bowel disease (IBD). However, the clinical significance of this association is not understood.ObjectivesTo quantify the absolute risk of IBD in patients with psoriasis treated with IL-17i, stratified by known IBD risk factors.MethodsLiterature searches were performed to identify known IBD risk factors and the prevalences were quantified by a meta-analysis of proportions. The Bayesian model was used to estimate the probability of a new-onset or a flare of IBD in patients with psoriasis.ResultsThe prevalence of Crohn’s disease (CD) or ulcerative colitis (UC) in the general psoriasis population was 0.0010. Use of IL-17i increased the risk of CD to 0.0037 and UC to 0.0028, translating to a number needed to harm (NNH) of 373 for CD and 564 for UC. In patients who had concomitant hidradenitis suppurativa, the use of IL-17i was associated with a decrease in NNH for CD and UC to 18 and 76, respectively, whereas for patients with a family history of IBD, the NNH values were 6 (for CD) and 10 (for UC).ConclusionsIn patients with no risk factors, the probability of IBD flare or onset during IL-17i treatment is negligible and additional IBD screening procedures are not indicated. In contrast, the patients with psoriasis who have hidradenitis suppurativa or first-degree family history of IBD as risk factors should be monitored for signs and symptoms of CD and UC during IL-17i therapy.

Download Full-text

Risk Factors of Urothelial Cancer in Inflammatory Bowel Disease

Journal of Clinical Medicine ◽

10.3390/jcm10153257 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3257

Author(s):

Gian Paolo Caviglia ◽

Giorgio Martini ◽

Angelo Armandi ◽

Chiara Rosso ◽

Marta Vernero ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

General Population ◽

Bowel Disease ◽

Urothelial Cancer ◽

Increased Risk ◽

History Of ◽

Inflammatory Bowel ◽

Number Of Publications

Extraintestinal cancers are important complications in patients with inflammatory bowel disease (IBD). A limited number of publications are available regarding the association between IBD and urothelial cancer. The primary outcome of our study was the comparison of the prevalence of urothelial cancer in patients with IBD with respect to the prevalence in the general population. Secondary outcomes were the assessment of risk factors for the onset of urothelial cancer in IBD. In a retrospective study we examined the medical records of all patients with a confirmed diagnosis of IBD followed in our clinic between 1978 and 2021. For each of the patients with identified urothelial cancer, more than ten patients without cancer were analyzed. Furthermore, 5739 patients with IBD were analyzed and 24 patients diagnosed with urothelial cancer were identified. The incidence of urothelial cancer, compared with the incidence in the general population, was not significantly different (0.42% vs. 0.42%; p = 0.98). Twenty-three cases were then compared (1 case was discarded due to lack of follow-up data) against 250 controls. During the multivariate analysis, smoking (odds ratio, OR = 8.15; 95% confidence interval, CI = 1.76–37.63; p = 0.007) and male sex (OR = 4.04; 95% CI = 1.29–12.66; p = 0.016) were found as risk factors. In conclusion, patients with IBD have a similar risk of developing urothelial cancer compared to the general population, but males with a history of smoking are at increased risk.

Download Full-text