scholarly journals P677 It’s time to grow up: what is it like to transition from the paediatric to adult inflammatory bowel disease service?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S553-S553
Author(s):  
P Keightley ◽  
R Prematunga ◽  
P Hoffmann ◽  
K Subramaniam
Keyword(s):  
Inflammatory Bowel Disease ◽  
Life Events ◽  
Bowel Disease ◽  
Stressful Life Events ◽  
Stressful Life ◽  
Growing Up ◽  
Adult Service ◽  
Inflammatory Bowel ◽  
The Mean ◽  
Distress Scale

Abstract Background inflammatory bowel disease (IBD) is a chronic disease with an increasing incidence in the paediatric population. We explored the experiences of two groups of patients, those who transitioned directly from the paediatric to the adult service before the transitional IBD clinic was established, referred to as ‘adult’ and those who engaged in the new transitional clinic, referred to as ‘transitional’. Methods Sixteen (8 in each group as described above) out of 20 suitable patients participated. Patients were administered the IBD Questionnaire (IBDQ), Kessler Psychological Distress Scale (K10), Patient- Doctor Relationship Questionnaire (PDRQ-9) and Stressful Life Events Questionnaire. A semi-structured interview was administered to patients and carers about their experiences of diagnosis, paediatric care, transition to adult services and adult care. Results The average age of participants in both groups was 17. The transitional clinic had a higher proportion of Crohn’s disease. In the adult group, there were more males and the reverse in the transitional group. The adult clinic patients had more active disease, use of steroids, and emergency department presentations. The mean CRP of 36 mg/l at first visit to the adult clinic improved to 12 mg/l, at last, follow-up whereas mean CRP at first and last visit to the transitional clinic remained at 2 mg/l. Both clinics had similar rates of compliance and attendance. In the transitional and adult clinics respectively the mean IBDQ was 193 (SD=31) and 174 (SD = 22) with higher scores reflecting better health-related quality of life, the K10 mean score was 16 (SD = 7.5) and 17.5 (SD = 4.3) indicating a moderate level of distress, the PDRQ-9 mean scores were 4.3/5 (SD = 0.75) and 4.8/5 (SD = 0.4) indicating good therapeutic relationships. Both groups reported a similar number of stressful life events. Key themes were identified in both patient and carer interviews: (1) Diagnosis and illness: Diagnostic uncertainty, frustration at the diagnostic process, and the importance of finding a doctor you trust. (2) Maturity: growing up fast for some and seeking independence, growing up slowly for others while non-ill peers matured faster. (3) Carer adjustment: The central role of mothers and fathers as carers. Some adolescents feel highly responsible for their parents’ and families’ well-being. Conclusion Patients with IBD and their carers face particular difficulties during the period of transition from a paediatric to adult service. These are factors specific to the illness and factors related to maturation and development. There should be flexibility around maturity which is not rigidly age-based but instead based on the specific developmental needs of different families and adolescents.

scholarly journals Stressful life events and psychosocial correlates of pediatric inflammatory bowel disease activity

2016 ◽  
Vol 6 (3) ◽  
pp. 322 ◽  
Author(s):  
George Giannakopoulos ◽  
George Chouliaras ◽  
Daphne Margoni ◽  
Sophia Korlou ◽  
Vassiliki Hantzara ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Life Events ◽  
Bowel Disease ◽  
Stressful Life Events ◽  
Stressful Life ◽  
Psychosocial Correlates ◽  
Pediatric Inflammatory Bowel Disease ◽  
Inflammatory Bowel

scholarly journals SAT0462 ASSESSMENT OF BONE MINERAL DENSITY IN INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1188.1-1188
Author(s):  
C. Daldoul ◽  
N. El Amri ◽  
K. Baccouche ◽  
H. Zeglaoui ◽  
E. Bouajina
Keyword(s):  
Bone Mineral Density ◽  
Inflammatory Bowel Disease ◽  
Bone Mineral ◽  
Bowel Disease ◽  
Mineral Density ◽  
Femoral Site ◽  
Significant Difference ◽  
History Of ◽  
Inflammatory Bowel ◽  
The Mean

Background:Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is considered as a risk factor of low bone mineral density (BMD). In fact, the prevalence of osteoporosis ranges from 17% to 41% in IBD patients. The possible contributing factors may include malabsorption, glucocorticoid treatment and coexisting comorbiditiesObjectives:The purpose of our work was to determine the frequency and the determinants of osteoporosis in patients with IBD and to assess whether there is a difference in BMD status between UC and CD.Methods:This is a retrospective study, over a period of 5 years (from January 2014 to December 2018) and including patients followed for IBD who had a measurement of BMD by DEXA. Clinical, anthropometric and densitometric data (BMD at the femoral and vertebral site) were recorded. The WHO criteria for the definition of osteoporosis and osteopenia were applied.Results:One hundred and five patients were collected; among them 45 were men and 60 were women. The average age was 45.89 years old. The average body mass index (BMI) was 25.81 kg/m2 [16.44-44.15]. CD and UC were diagnosed in respectively 57.1% and 42.9%. A personal history of fragility fracture was noted in 4.8%. Hypothyroidism was associated in one case. Early menopause was recorded in 7.6%. 46.8% patients were treated with corticosteroids. The mean BMD at the vertebral site was 1.023 g/cm3 [0.569-1.489 g/cm3]. Mean BMD at the femoral site was 0.920g/cm3 [0.553-1.286g / cm3]. The mean T-score at the femoral site and the vertebral site were -1.04 SD and -1.27 SD, respectively. Osteoporosis was found in 25.7% and osteopenia in 37.1%. Osteoporosis among CD and UC patients was found in respectively 63% and 37%. The age of the osteoporotic patients was significantly higher compared to those who were not osteoporotic (52.23 vs 43.67 years, p = 0.01). We found a significantly higher percentage of osteoporosis among men compared to women (35.6% vs 18.3%, p=0.046). The BMI was significantly lower in the osteoporotic patients (23.87 vs 26.48 kg/m2, p=0.035) and we found a significant correlation between BMI and BMD at the femoral site (p=0.01). No increase in the frequency of osteoporosis was noted in patients treated with corticosteroids (27.9% vs 21.6%, p=0.479). Comparing the UC and CD patients, no difference was found in baseline characteristics, use of steroids or history of fracture. No statistically significant difference was found between UC and CD patients for osteoporosis(p=0.478), BMD at the femoral site (p=0.529) and at the vertebral site (p=0.568).Conclusion:Osteoporosis was found in 25.7% of IBD patients without any difference between CD and UC. This decline does not seem to be related to the treatment with corticosteroids but rather to the disease itself. Hence the interest of an early screening of this silent disease.Disclosure of Interests:None declared

scholarly journals Endoscopic Stricturotomy Is an Efficacious Option for Management of Strictures in Patients With Inflammatory Bowel Disease

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Nabeeha Mohy-ud-din ◽  
Gursimran S Kochhar
Keyword(s):  
Inflammatory Bowel Disease ◽  
Success Rate ◽  
Bowel Disease ◽  
Chart Review ◽  
Common Complication ◽  
Technical Success ◽  
Technical Success Rate ◽  
Safe Technique ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Strictures are a common complication for patients with inflammatory bowel disease. Endoscopic stricturotomy (ESt) is a novel procedure for treatment of these strictures. Methods A chart review was performed for patients with strictures who underwent ESt. Results Eleven patients were included in the study and the total number of strictures treated was 12. The mean length of the strictures was 10.25 ± 4.36 mm. Technical success was achieved in 92% (n = 11) of the procedures. Postprocedural bleeding occurred in 9% (n = 1) of patients, and none of the patients had complications of infection or perforation. Conclusions ESt is a safe technique with high technical success rate.

Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Hamdy Abd El Megeed ◽  
Shereen Abou Bakr Saleh ◽  
Christina Alphonse Anwar ◽  
Ahmed Elkattary Mohamed Elkattary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
High Sensitivity ◽  
Medical Patients ◽  
Mayo Score ◽  
Calprotectin Level ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p < 0.001) and Mayo score for UC (p < 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score > 287 and Mayo score > 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of > 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

scholarly journals Transition of Inflammatory Bowel Disease Patients from Pediatric to Adult Care: An Observational Study on a Joint-Visits Approach

2020 ◽  
Author(s):  
Antonio Corsello ◽  
Daniela Pugliese ◽  
Fiammetta Bracci ◽  
Daniela Knafelz ◽  
Bronislava Papadatou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Bowel Disease ◽  
Observational Study ◽  
Bowel Disease ◽  
Transition Process ◽  
Major Surgery ◽  
Adult Care ◽  
Inflammatory Bowel ◽  
The Mean

Abstract BackgroundTransition from pediatric to adult care of patients affected by Inflammatory Bowel Disease (IBD) is a critical step that needs specific care and multidisciplinary involvement. The aim of our study was to evaluate the outcome of the transition process of a cohort of IBD patients, exploring their readiness and the consequent impact on quality of life.MethodsThis observational study followed transitioned patients up for a minimum of 18 months after the beginning of transition process, from January 2014 to April 2019. Transition was carried-out through joint visits pediatricians and adult gastroenterologists. Clinical data before and after transition were collected. A subgroup of patients was submitted to an anonymous online questionnaire of 38 items drawn up based on the validated questionnaires TRAQ and SIBDQ within the first 6 months from the beginning of transition process.ResultsEighty-two patients with IBD were enrolled, with a mean age at transition of 20.2±2.7 years. Before transition, 40.2% of patients already had major surgery and 64.6% started biologics. At transition, 24% of patients were in moderate to severe active phase of their disease and 40% of them had already been treated with ≥ 2 biologics. The mean value of the TRAQ questionnaires was 3.4±0.5 and the mean score of SIBDQ was 53.9±9.8. A significant association was found between a TRAQ mean score > 3 and a SIBDQ > 50 (p=0.0129). Overall, 75% of patients had a positive opinion of the transition model adopted.ConclusionsA strong association has been found between TRAQ and SIBDQ questionnaires, showing how transition readiness has a direct impact on the quality of life of the young adult with IBD.

Construction of a model of risk in the use of alcohol and other illicit substances among adolescent students / Construcción de un modelo de riesgo en el consumo de alcohol y otras sustancias ilícitas en adolescentes estudiantes de Bachillerato

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Marisol Pérez Ramos ◽  
Emilia Lucio-Gómez Maqueo
Keyword(s):  
Life Events ◽  
Stressful Life Events ◽  
Binary Logistic Regression ◽  
Stressful Life ◽  
School Type ◽  
Time Schedule ◽  
Single Parent Family ◽  
Adolescent Students ◽  
Other Substances ◽  
The Mean

La presente investigación tuvo como objetivo principal identificar algunos factores vinculados con el consumo de drogas y alcohol en una población de estudiantes de educación media superior de la Ciudad de México. Se consideraron en específico variables intervinientes como: Edad del adolescente; sexo; promedio y turno escolar; tipo de familia y sucesos de vida estresantes.A través de un muestreo aleatorio simple estratificado, se obtuvo a 1997 adolescentes, a todos ellos se les aplicaron los instrumentos: Información sociodemográfica forma para adolescentes; Sucesos de vida forma adolescente; AUDIT y el ASSIST. La identificación de los adolescentes en riesgo se realizó a partir de los puntajes obtenidos en el AUDIT y ASSIST. De la muestra total el 25% (n=502), fueron detectados por consumo en riesgo de alcohol y alguna otra droga. El resto de los casos quedaron clasificados como casos de no riesgo. Se realizó una regresión logística binaria condicional, para identificar los factores que favorecen el consumo de alcohol, tabaco y otras drogas ilícitas en los adolescentes. Los resultados indican que ser varón; el pertenecer a una familia monoparental; la edad y los sucesos negativos en la salud, entre otros, aumentan el riesgo de consumir alcohol u alguna sustancia ilícita.  Abstract Several risk factors, which increment the probability of using alcohol and other illegal substances, like family dysfunction have been considered.The objective of this study was to identify factors associated with alcohol and other substances abuse in a sample of 1997 students from senior high school from Mexico City. The mean age of the adolescents was 16.7 (s.d.1.7). 52.7% were females and 47.3% males, 56% studied in the morning and 43.8% in the afternoon. Some variables were considered like adolescents’ age, grades, time-schedule in which they went to school, type of family and stressful life-events were considered specifically.The identification of adolescents at risk was done with AUDIT andASSIST. A binary logistic regression was calculated in order to identify those factors that increment alcohol, tobacco and other illegal substances use. Results indicate that a single parent family, being older and stressful life events, among others, increment risk consumption of alcohol and other substances.

scholarly journals P670 Usefulness of monitoring the concentration of azathioprine metabolites in the children with inflammatory bowel disease and autoimmune hepatitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S549-S550
Author(s):  
K Bąk-Drabik ◽  
J Duda-Wrońska ◽  
D Dąbrowska-Piechota ◽  
P Adamczyk
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Autoimmune Hepatitis ◽  
Bowel Disease ◽  
Immunosuppressive Drug ◽  
Therapeutic Drug ◽  
Paediatric Patients ◽  
Inflammatory Bowel ◽  
The Mean ◽  
Dose Change

Abstract Background Azathioprine (AZA) is an immunosuppressive drug, which is metabolised in the liver and kidneys into 6-thioguanine- the form responsible for the therapeutic effect. Despite its anti-inflammatory, antibacterial and immunomodulating properties, azathioprine has also dose-related side effects, such as bone marrow suppression, liver damage and pancreatitis. The purpose of this study was to assess the usefulness of monitoring the concentration of azathioprine metabolites: 6-tioguanine (6-TG) and 6-methylmercaptopurine (6-MMP) in the group of paediatric patients with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH). Methods The clinical data of 46 paediatric patients (24 girls) with IBD and AIH, aged 8–17 years, hospitalised in the Department of Gastroenterology, who had undergone a blood examination for AZA metabolites concentration, were analysed. Results Initial mean dose of azathioprine was 1.23 mg/kg/day in IBD and 1.16 mg/kg/day in AIH. In 30% of patients, the concentrations of 6-TG and 6-MMP were within the normal range. Forty-eight per cent of patients required a dose change due to: elevated 6-TG concentration (32.6%) or underdosage (15.4%). After modification the mean dose was 1.16 mg/kg/day in IBD and 0.85 mg/kg/day in AIH. In 10.7 % of patients, the concentrations of 6-TG and 6 MMP were below the proper range, in the same percentage of patients metabolites were undetectable. Conclusion In a significant number of cases monitoring the concentration of AZA metabolites indicated the necessity to reduce the dose of AZA allowing to achieve the therapeutic optimum and prevent serious side effects. Receiving undetectable concentration of metabolites is a sign of non-compliance. The final doses of AZA were found to be lower than the recommended doses. Therapeutic drug monitoring (TDM), which involves measurement of drug or active metabolite levels is a good strategy that can be used to optimise IBD and AIH therapeutics.

scholarly journals P226 Assessing the effectiveness of the nurse navigator role in an inflammatory bowel disease medical home: A retrospective cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S255-S255
Author(s):  
C G Heisler ◽  
K Gawdat ◽  
N Nazer ◽  
M Stewart ◽  
B Currie ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
Healthcare System ◽  
Bowel Disease ◽  
Retrospective Cohort Study ◽  
Medical Home ◽  
Retrospective Cohort ◽  
Nurse Navigator ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Patients living with chronic illnesses require long-term and often repeated interactions with the healthcare system. inflammatory bowel disease (IBD) is an incurable, chronic gastrointestinal disease which frequently flares and remits. The nurse navigator (NN) serves as the point of first contact for IBD connecting patients with their multidisciplinary care team in order to facilitate and expedite assessment, treatment and navigation through the healthcare system with the goal of improving disease-related outcomes while reducing healthcare system burden. The aim of this study was to assess the impact of implementation of an IBD NN role within a multidisciplinary IBD Medical home on access to care, disease-related outcomes, patient satisfaction with care, and healthcare resource use. Methods This was a retrospective cohort study comparing an IBD patient population that had access to a 24/7 NN-led helpline to a reference population who did not have access to such a service. Data between August 2017 and October 2019 were extracted from patient charts. Distribution of the number of flares and time to clinical assessment between the NN exposed cohort and a non-NN exposed cohort are planned using multivariate analysis. This is a preliminary description of the NN-exposed cohort only. Results Preliminary results identified a total of 643 patients in the NN-exposed cohort. The majority of our NN-exposed population were female (64.3%). The mean age was 46.42 ± 16.86 years. Sixty-five per cent of patients had CD, 33% UC and 2% IBDU. Of the 729 calls extracted, care coordination (39%) was the most frequent indication for calls followed by flare (25%), and medication education (16%). Patients made the majority (52.8%) of calls compared with NN initiated calls (47.2%). The mean number of calls per patient was 2.64 ± 2.51 (range 1–18) during the study period. Time to clinic assessment post flare call was on average 10.22 ± 8.51 days. Conclusion These results are descriptive of the NN-exposed cohort. Data comparing outcomes amongst the NN-exposed cohort to the non-exposed cohort will be presented at ECCO.

scholarly journals Identification of Environmental Risk Factors Associated With the Development of Inflammatory Bowel Disease

2020 ◽  
Vol 14 (12) ◽  
pp. 1662-1671
Author(s):  
Kimberley W J van der Sloot ◽  
Rinse K Weersma ◽  
Behrooz Z Alizadeh ◽  
Gerard Dijkstra
Keyword(s):  
Inflammatory Bowel Disease ◽  
Environmental Factors ◽  
Bowel Disease ◽  
Multiple Testing ◽  
Stressful Life Events ◽  
Population Based ◽  
Factors Associated ◽  
Disease Aetiology ◽  
Inflammatory Bowel ◽  
Genetic And Environmental Factors

Abstract Background and Aims Multiple genetic and environmental factors are involved in the aetiology of inflammatory bowel disease [IBD] including Crohn’s disease [CD] and ulcerative colitis [UC], but data on these exposome factors are difficult to identify. Several exposome factors such as smoking have been shown to be involved; as for other environmental factors, eg stress, results have been conflicting. Methods We performed a case-control study including 674 IBD patients of the 1000IBD cohort, frequency-matched based on sex and age with 1348 controls from the population-based Lifelines Cohort Study. Exposome data were obtained using the validated Groningen IBD Environmental Questionnaire [GIEQ], capturing exposome factors through different stages of life using 844 items, of which 454 were applicable to study the role of 93 exposome factors in disease aetiology. Logistic regression [LR] modelling with Bonferroni correction for multiple testing was applied to estimate the multivariable-adjusted effect of each exposome factor. Results For IBD, we identified four novel factors: stressful life events (CD odds ratio [OR] 2.61/UC OR 2.92), high perceived stress [2.29/2.67], alcohol use [0.40/0.43], and bronchial hyper-reactivity [3.04/2.36]. Four novel factors were associated with only CD: prenatal smoke exposure [1.89], having a bed partner [0.53], allergies [2.66], and cow’s milk hypersensitivity [5.87]; and two solely with UC: carpet flooring [0.57] and neuroticism [1.32]. Nine factors were replicated. Conclusions In this study we identified 10 novel, and replicated nine previously reported, exposome factors associated with IBD. Identifying these factors is important for both understanding disease aetiology and future prevention strategies to decrease the development of IBD in genetically susceptible persons.

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