scholarly journals P261 Systematic review with meta-analysis: The impact of concomitant immune-mediated diseases on the disease course of inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S280-S281
Author(s):  
M Attauabi ◽  
M Zhao ◽  
F Bendtsen ◽  
J Burisch
Keyword(s):  
Biologic Therapy ◽  
Meta Analysis ◽  
Multidisciplinary Care ◽  
Disease Course ◽  
Immune Mediated ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Meta Analyses ◽  
The Impact

Abstract Background Several studies have shown an association between inflammatory bowel diseases [IBD] and immune-mediated diseases [IMIDs], but data on the impact of co-occurring IMIDs on IBD course are inconsistent. The aim of this study was to investigate the impact of co-occurring IMIDs on IBD phenotype and disease course. Methods PubMed and EMBASE were searched from database inception through December 2018 and updated in October 2019 for studies reporting prevalences or odds, risks or hazard ratios of IBD-related disease outcomes in patients with and without co-existing IMIDs. Meta-analyses were performed to estimate summary prevalences and risks of the outcomes which included disease extension, IBD-related surgery and hospitalisation, malignancy, mortality and need of medication (biologic therapy, steroids and immunomodulators). IMIDs were stratified into primary sclerosing cholangitis [PSC] and ‘IMIDs other than PSC’. Results A total of 93 studies comprising 14,307 IBD patients with IMIDs and 3,409,914 IBD patients without IMIDs were included in the study. Summary risks and prevalences with 95% confidence intervals for each outcome are presented in figures 1 and 2, respectively. The following results are all significant (p < 0.05). Compared with patients without co-occurring IMIDs, patients with ulcerative colitis [UC] and co-occurring IMIDs other than PSC more frequently received immunomodulators and steroids, and patients with Crohn’s disease [CD] and concomitant IMIDs other than PSC more often received biologic therapy. UC patients with co-existing IMIDs other than PSC more often underwent IBD-related surgery, while patients with CD and PSC received fewer surgeries. In addition, UC patients with co-occurring PSC were at increased risk for having extensive colitis, pancolitis, and malignancies. Patients with UC and PSC had a higher mortality rate, but no difference was found among patients with IMIDs other than PSC. PSC did not influence hospitalisation rates among IBD patients. Conclusion This meta-analysis found that IBD patients with co-existing IMIDs have a different disease course than patients without concomitant IMIDs. This study emphasises the importance of multidisciplinary care of IBD and that physicians caring for IBD patients need to be aware of IMIDs as a prognostic factor.

Systematic Review with Meta-analysis: The Impact of Co-occurring Immune-mediated Inflammatory Diseases on the Disease Course of Inflammatory Bowel Diseases

2020 ◽  
Author(s):  
Mohamed Attauabi ◽  
Mirabella Zhao ◽  
Flemming Bendtsen ◽  
Johan Burisch
Keyword(s):  
Systematic Review ◽  
Risk Ratio ◽  
Inflammatory Diseases ◽  
Meta Analysis ◽  
Disease Course ◽  
Immune Mediated ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background and Aims Patients with inflammatory bowel diseases (IBDs) are at risk of developing a variety of other immune-mediated inflammatory diseases (IMIDs). The influence of co-occurring IMIDs on the disease course of IBD remains unknown. The aim of this study was therefore to conduct a systematic review and meta-analysis of the impact of IMIDs on phenotypic presentation and outcome in patients with IBD. Methods PubMed and Embase were searched from their earliest records through December 2018 and updated in October 2019 for studies reporting proportions or ratios of IBD-related disease outcomes in patients with and without co-occurring IMIDs. Meta-analyses were performed to estimate summary proportions and risks of the main outcomes. PRISMA guidelines were used, and study quality was assessed according to the Newcastle-Ottawa Scale. Results A total of 93 studies were identified, comprising 16,064 IBD patients with co-occurring IMIDs and 3,451,414 IBD patients without IMIDs. Patients with IBD and co-occurring IMIDs were at increased risk of having extensive colitis or pancolitis (risk ratio, 1.38; 95% Cl, 1.25–1.52; P < 0.01, I2 = 86%) and receiving IBD-related surgeries (risk ratio, 1.17; 95% Cl, 1.01–1.36; P = 0.03; I2 = 85%) compared with patients without IMIDs. Co-occurrence of IMIDs other than primary sclerosing cholangitis in patients with IBD was associated with an increased risk of receiving immunomodulators (risk ratio, 1.15; 95% Cl, 1.06–1.24; P < 0.01; I2 = 60%) and biologic therapies (risk ratio, 1.19; 95% Cl, 1.08–1.32; P < 0.01; I2 = 53%). Conclusion This meta-analysis found that the presence of co-occurring IMIDs influences the disease course of IBD, including an increased risk of surgery and its phenotypical expression.

scholarly journals DOP43 Impact of Inflammatory Bowel Diseases on the phenotype and severity of psoriasis and spondyloarthropathies

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S081-S081
Author(s):  
M Attauabi ◽  
M Damsgaard Wewer ◽  
F Bendtsen ◽  
J B Seidelin ◽  
J Burisch
Keyword(s):  
Systematic Review ◽  
Inflammatory Bowel Diseases ◽  
Meta Analysis ◽  
Disease Phenotype ◽  
Model Quality ◽  
High Quality ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background It is unclear whether inflammatory bowel diseases (IBD) affect the phenotype and severity of co-occurring axial spondyloarthropathies (axSpA) and psoriasis. Therefore, we aimed to investigate the characteristics of axSpA and psoriasis in relation to co-occurring IBD. Methods The systematic review and meta-analysis were conducted according to Cochrane’s recommendations. PubMed and EMBASE were searched from database inception till January 2020 for studies reporting disease phenotype and severity of axSpA and psoriasis in association with co-occurrence of IBD. Meta-analyses were performed using a random-effects model. Quality of the studies was assessed by the Newcastle-Ottawa Scale (NOS). Results The electronic search yielded 12,220 studies which were narrowed down to 152 after screening based on study titles and abstracts. Of these, a full-text review identified 20 eligible studies, including twelve and eight studies describing characteristics of axSpA and psoriasis, respectively, in relation to IBD. AxSpA was identified among a total of 321 and 8,660 patients with and without a co-occurring IBD, respectively, and the studies’ mean NOS score was 6.8, including seven and five studies of moderate and high quality, respectively. The meta-analysis demonstrated that presence of co-occurring IBD was associated with an increased risk of dactylitis (risk ratio (RR)=2.06 (95%CI 1.24–3.42), I2=0%), but not enthesitis (RR=0.93 (95%CI 0.48–1.81), I2=86%). Furthermore, IBD was associated with a significantly lower Bath Ankylosing Spondylitis Radiology Index (mean difference (meandiff) -2.28 (95%CI -3.26-(-1.30)), p<0.01, I2=0%), better Schober’s test results (meandiff 0.80 (95%CI 0.64–1.49), p<0.01, I2=0%), and a lower finger to floor distance (meandiff -6.36 (95%CI -10.36-(-2.36)), p<0.01, I2=0%). The phenotype of psoriasis was assessed among 680 and 222,279 patients with and without a co-occurring IBD. The mean NOS score was 7.4, including two studies of moderate methodological quality, while the remaining six studies were of high quality. The presence of IBD was associated with a significantly less frequent presentation of psoriasis in the nails (RR=0.14 (95%CI 0.05–0.42), I2=0%) but not psoriatic arthritis (RR=0.94 (95%CI 0.27–3.31), I2=75%). Finally, the presence of IBD was associated with a milder phenotype of psoriasis (RR=1.41 (95%CI 1.02–1.96), p=0.04, I2=70%). Conclusion This is the first systematic review with meta-analysis investigating the impact of IBD on the disease phenotype and severity of psoriasis and axSpA. Our data suggest that IBD modifies psoriasis and axSpA to be milder and emphasizes the importance of a multidisciplinary approach to patients with psoriasis or axSpA and co-occurring IBD.

scholarly journals Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring: A systematic review and meta-analysis protocol

2018 ◽  
Vol 1 ◽  
pp. 15
Author(s):  
Nicla Manzari ◽  
Karen Matvienko-Sikar ◽  
Franco Baldoni ◽  
Gerard W. O'Keeffe ◽  
Ali S. Khashan
Keyword(s):  
Systematic Review ◽  
Maternal Stress ◽  
Data Extraction ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Prenatal Maternal Stress ◽  
Cross Sectional ◽  
Increased Risk ◽  
Meta Analyses ◽  
The Impact

Background: Prenatal maternal stress (PNMS) is defined as the experience of significant levels of prenatal stress, depression or anxiety during pregnancy. PNMS has been associated with increased risk of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) in exposed offspring. However, these findings are inconsistent and other studies found no association, meaning a clear consensus on the impact of PNMS on ASD and ADHD risk is required. The purpose of this systematic review and meta-analysis is to summarize and critically review the existing literature on the effects of PNMS on ASD and ADHD risk. Methods: Electronic databases (PubMed, PsycINFO, Web of Science, Scopus and EMBASE) will be searched for articles following a detailed search strategy. We will include cohort, case-control and cross-sectional studies that assessed maternal exposure to psychological and/or environmental stress and had ASD or ADHD as an outcome. Two reviewers will independently screen the titles, abstracts and full articles to identify eligible studies. We will use a standardised data extraction form for extracting data and a bias classification tool for assessing study quality. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The generic inverse variance method will be used if possible to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study because it will not involve the conduct or inclusion of any experimental or personal data that would require informed consent.  The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018084222.

scholarly journals The Associations between Inflammatory Bowel Disease and a Range of Other Diseases：Umbrella Review of Systematic Reviews and Meta-analyses

2021 ◽  
Author(s):  
Liqun Li ◽  
Qianli Cen ◽  
Lijian Liu ◽  
Jinxiu Wei ◽  
Jinjing Tan ◽  
...  
Keyword(s):  
Methodological Quality ◽  
Gallstone Disease ◽  
Cochrane Library ◽  
Increased Risk ◽  
Evidence Quality ◽  
Bowel Diseases ◽  
Thyroid Cancer Risk ◽  
Inflammatory Bowel ◽  
Meta Analyses

Abstract Background Multiple meta-analyses have reported inflammatory bowel diseases (IBD) are associated with an increased risk of diverse diseases, but the evidence quality remains unclear. Objectives We aimed to summarize and evaluate this existing evidence on the associations between IBD and a range of diseases a-crossed from meta-analyses. Methods PubMed, the Cochrane Library Database, Embase, Web of Science, CNKI Databases, Wanfang Databases and VIP Database were searched to obtain eligible literatures from inception to November 1, 2019. We appraised the methodological quality of the included meta-analyses using AMSTAR 2 tool, and evaluated the quality of evidence for each outcome using the GRADE approach. Results Nineteen articles covering associations between IBD and 28 types of health outcomes were included. The methodological quality of meta-analyses was rated moderate for 5.26%, low for 21.05%, and critically low for 73.68%. Overall, summary effect estimates were significant in 26 meta-analyses. The evidence quality was rated high for 3.57%, moderate for 21.43%, low for 28.57%, and very low for 46.43%. Evidence quality was high for association between IBD and an increased periodontitis risk (OR = 4.55; 95% CI, 3.00-6.19). Evidence quality was moderate for associations between IBD and an increased thyroid cancer risk (OR = 1.75; 95% CI, 1.48–2.07), myocardial infarction incidence (RR = 1.12; 95% CI, 1.05–1.21), preterm birth incidence (OR = 1.85; 95% CI, 1.67–2.05), stillbirth incidence (OR = 1.57; 95% CI, 1.03–2.38), gallstone disease prevalence (OR = 1.72; 95% CI, 1.40–2.12), and vitamin D deficiency prevalence (OR = 1.64; 95% CI, 1.30–2.08). Conclusions Though, associations between IBD and diverse diseases have been extensively studied, few of the reported associations have robust support. Further well-designed studies are essential to determine whether IBD increases the risk of other diseases.

scholarly journals Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring: A systematic review and meta-analysis protocol

2019 ◽  
Vol 1 ◽  
pp. 15 ◽  
Author(s):  
Nicla Manzari ◽  
Karen Matvienko-Sikar ◽  
Franco Baldoni ◽  
Gerard W. O'Keeffe ◽  
Ali S. Khashan
Keyword(s):  
Systematic Review ◽  
Maternal Stress ◽  
Data Extraction ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Prenatal Maternal Stress ◽  
Case Control Studies ◽  
Increased Risk ◽  
Meta Analyses ◽  
The Impact

Background: Prenatal maternal stress (PNMS) is defined as the experience of significant levels of prenatal stress, depression or anxiety during pregnancy. PNMS has been associated with increased risk of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) in exposed offspring. However, these findings are inconsistent and other studies found no association, meaning a clear consensus on the impact of PNMS on ASD and ADHD risk is required. The purpose of this systematic review and meta-analysis is to summarize and critically review the existing literature on the effects of PNMS on ASD and ADHD risk. Methods: Electronic databases (PubMed, PsycINFO, Web of Science, Scopus and EMBASE) will be searched for articles following a detailed search strategy. We will include cohort and case-control studies that assessed maternal exposure to psychological and/or environmental stress and had ASD or ADHD as an outcome. Two reviewers will independently screen the titles, abstracts and full articles to identify eligible studies. We will use a standardised data extraction form for extracting data and a bias classification tool for assessing study quality. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The generic inverse variance method will be used if possible to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study because it will not involve the conduct or inclusion of any experimental or personal data that would require informed consent.  The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018084222.

scholarly journals Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽  
2019 ◽  
Vol 69 (5) ◽  
pp. 852-858 ◽  
Author(s):  
Julien Kirchgesner ◽  
Nynne Nyboe Andersen ◽  
Fabrice Carrat ◽  
Tine Jess ◽  
Laurent Beaugerie
Keyword(s):  
Incidence Rates ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Cox Proportional Hazard Models ◽  
Inflammatory Bowel ◽  
Artery Disease ◽  
The Impact ◽  
Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

scholarly journals Hypertensive disorders of pregnancy and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018313 ◽  
Author(s):  
Gillian M Maher ◽  
Gerard W O’Keeffe ◽  
Louise C Kenny ◽  
Patricia M Kearney ◽  
Ted G Dinan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neurodevelopmental Disorders ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Meta Analyses ◽  
The Impact

IntroductionHypertensive disorders of pregnancy (HDPs), that is chronic hypertension, gestational hypertension, pre-eclampsia (de novo or superimposed on chronic hypertension) and white coat hypertension, affect approximately 5%–15% of pregnancies. HDP exposure has been linked to an increased risk of autism spectrum disorder, attention deficit/hyperactivity disorder and other neurodevelopmental disorders in children. However, findings are inconsistent, and a clear consensus on the impact of HDPs on the risk of neurodevelopmental disorders is needed. Therefore, we aim to synthesise the published literature on the relationship between HDPs and the risk of neurodevelopmental disorders in the form of a systematic review and meta-analysis.Methods and analysisWe will include cohort, case–control and cross-sectional studies in which diagnosis of an HDP was reported, and neurodevelopmental disorders were the outcome of interest based on a preprepared protocol. A systematic search of PubMed, CINAHL, Embase, PsycINFO and Web of Science will be conducted in accordance with a detailed search strategy. Two authors will independently review the titles and abstracts of all studies, perform data extraction using a standardised data collection form and assess study quality using a bias classification tool. Meta-analyses will be performed to calculate overall pooled estimates using the generic inverse variance method. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, therefore, does not require ethics approval. Findings will be presented at scientific conferences and disseminated through publication in a peer-reviewed journal.RegistrationCRD42017068258.

scholarly journals Systematic review and meta-analysis: the impact of co-occurring immune-mediated inflammatory diseases on the disease localization and behavior of Crohn’s disease

2021 ◽  
Vol 14 ◽  
pp. 175628482110048
Author(s):  
Mohamed Attauabi ◽  
Mirabella Zhao ◽  
Flemming Bendtsen ◽  
Johan Burisch
Keyword(s):  
Systematic Review ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Diseases ◽  
Meta Analysis ◽  
Random Effect ◽  
Immune Mediated ◽  
Increased Risk ◽  
The Impact ◽  
Upper Gastrointestinal

Background: Patients with Crohn’s disease (CD) are at increased risk of co-occurring immune-mediated inflammatory diseases (IMIDs). As discrepancy exists regarding the phenotypic presentation of CD among patients with such co-occurring IMIDs, we aimed to conduct a systematic review with meta-analysis characterizing the phenotype of CD among this subgroup of patients. Methods: PubMed, Embase, and Scopus were searched from their earliest records to October 2019 for studies reporting the behavior and localization of CD according to the Vienna or Montreal Classifications and CD-related surgery in patients with co-occurring IMIDs. These studies were the subject of a random effect meta-analysis. Results: After reviewing 24,413 studies, we identified a total of 23 studies comprising 1572 and 35,043 CD patients with and without co-occurring IMIDs, respectively, that fulfilled our inclusion criteria. Overall, patients with co-occurring IMIDs were more likely to have upper gastrointestinal inflammation than were patients without co-occurring IMIDs [relative risk (RR) = 1.49 (95% confidence interval (CI) 1.09–2.04), p = 0.01, I2 = 7%]. In addition, presence of primary sclerosing cholangitis (PSC) was associated with a lower occurrence of ileal affection [RR = 0.44 (95% CI 0.24–0.81), p < 0.01, I2 = 32%], increased occurrence of colonic affection [RR = 1.78 (95% CI 1.33–2.38), p < 0.01, I2 = 32%] and an increased likelihood of non-stricturing and non-penetrating behavior [RR = 1.43 (95% CI 0.97–2.11), p = 0.07, I2 = 86%]. The latter reached significance when cumulating different IMIDs [RR = 1.30 (95% CI 1.09–1.55), p < 0.01, I2 = 88%]. CD patients with PSC also underwent fewer CD-related surgeries [RR = 0.55 (95% CI 0.34–0.88), p = 0.01, I2 = 0%], irrespective of CD location or behavior. Conclusion: This study emphasizes that CD patients with co-existing PSC are likely to have a unique inflammatory distribution primarily confined to the colon, while patients with IMIDs in general have higher likelihood of affection of upper gastrointestinal tract and a non-stricturing and non-penetrating behavior. As such a phenotype of CD is typically associated with a milder disease course; future studies are needed to confirm these results.

scholarly journals Epidural-Related Fever and Maternal and Neonatal Morbidity: A Systematic Review and Meta-Analysis

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 259-270 ◽  
Author(s):  
Sophie Jansen ◽  
Enrico Lopriore ◽  
Christiana Naaktgeboren ◽  
Marieke Sueters ◽  
Jacqueline Limpens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Antibiotic Treatment ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Increased Risk ◽  
Observational Cohort ◽  
Meta Analyses ◽  
The Impact

<b><i>Background:</i></b> While epidural analgesia (EA) is associated with maternal fever during labor, the impact on the risk for maternal and/or neonatal sepsis is unknown. <b><i>Objectives:</i></b> The aim of this systematic review was to investigate the effect of epidural-related intrapartum fever on maternal and neonatal outcomes. <b><i>Methods:</i></b> OVID MEDLINE, OVID Embase, the Cochrane Library, Cochrane Controlled Register of Trials, and clinical trial registries were searched for randomized controlled trials (RCT) and observational cohort studies from inception to November 2018. A total of 761 studies were identified with 100 eligible for full-text review. Only articles investigating the relationship between EA and maternal fever during labor were eligible for inclusion. Study quality was assessed using the Cochrane’s Risk of Bias tool and National Institute of Health Quality Assessment Tool. Two meta-analyses – one each for the RCT and observational cohort groups – were performed using the random-effects model of Mantel-Haenszel to produce summary risk ratios (RR) with 95% CI. <b><i>Results:</i></b> Twelve RCTs and 16 observational cohort studies involving 579,157 parturients were included. RRs for maternal fever for the RCT and cohort analyses were 3.54 (95% CI 2.61–4.81) and 5.60 (95% CI 4.50–6.97), respectively. Meta-analyses of RR for maternal infection in both groups were infeasible given few occurrences. Meta-analysis of data from observational studies showed an increased risk for maternal antibiotic treatment in the epidural group (RR 2.60; 95% CI 1.31–5.17). For both analyses, neonates born to women with an epidural were not evaluated more often for suspected sepsis. Neither analysis reported an increased rate of neonatal bacteremia or neonatal antibiotic treatment after EA, although data precluded conclusiveness. <b><i>Conclusion:</i></b> EA increases the risk of intrapartum fever and maternal antibiotic treatment. However, a definite conclusion on whether EA increases the risk for a proven maternal and/or neonatal bacteremia cannot be drawn due to the low quality of data. Further research on whether epidural-related intrapartum fever is of infectious origin or not is therefore needed.

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