scholarly journals A249 FREQUENCY AND CLINICAL SIGNIFICANCE OF INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH AUTOIMMUNE HEPATITIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 126-127
Author(s):  
E Lytvyak ◽  
L A Dieleman ◽  
A J Montano-Loza
Keyword(s):  
Inflammatory Bowel Disease ◽  
Autoimmune Hepatitis ◽  
Median Time ◽  
Bowel Disease ◽  
Cox Regression ◽  
Age At Diagnosis ◽  
Response To Treatment ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Previous studies suggested that patients with autoimmune hepatitis (AIH) and inflammatory bowel disease (IBD) have poorer outcomes; however, the significance of this association is limited. Aims To describe the phenotype of AIH-associated IBD and assess the impact of IBD on the response to treatment and risk of adverse liver outcomes in patients with AIH. Methods In our retrospective cohorts, we identified patients with concomitant diagnoses of IBD and a definite AIH. The comparison cohort consisted of AIH patients matched by gender, age at diagnosis, ethnicity, and time to follow-up. Chi-square and Mann-Whitney tests were used to assess differences. Univariate analysis was performed using the Cox proportional hazards model. Results We identified a total of 16 patients (9 males, 56.3%) with AIH-associated IBD from a cohort of 6006 IBD patients (0.27%) and 357 AIH patients (4.5%). All patients were Caucasians. Twelve patients (75.0%) had ulcerative colitis with a pancolonic extent; 4 (25.0%) – Crohn’s disease: one patient had ileitis, three – ileocolitis with one having stricturing and fistulising gastroduodenal, ileocolonic and perianal disease. The median age at IBD diagnosis was 26.5 years old and varied from 2 to 53. The age at AIH diagnosis ranged from 7 to 59 years old (median 21.1) and median follow-up time was 11.1 years ranging from 11 days to 35.2 years. The matching cohort of 113 AIH-IBD- patients was comparable to the AIH-IBD+ cohort by gender (44 males, 38.9%; p=0.188), age at diagnosis (median 28.4, IQR 32; p=0.442), ethnicity, and the follow-up time (median 8.7 years, IQR 10.2; p=0.764). There was no difference in AST, ALT and ALP at diagnosis. Complete response rates were similar in AIH-IBD+ and AIH-IBD- groups (50.0% vs. 53.1%; p=0.816). The risk of developing cirrhosis and a median time to its onset did not differ significantly: 28.6% vs. 31.0% (p=0.853) and 11.8 vs. 8.2 years (p=0.359), respectively. In univariate Cox regression, IBD was not a predictor of progression to cirrhosis (HR 0.45; 95% CI 0.13–1.50; p=0.192). The risk of developing decompensation and a median time was also comparable between groups: 21.4% vs. 33.0% (p=0.384) and 18.4 vs. 9.8 years (p=0.053), supported by the Cox regression analysis (HR 0.44; 95% CI 0.13–1.48; p=0.187). The presence of IBD was not associated with higher need in liver transplant (18.8% vs. 30.1%; p=0.348), median time was slightly shorter (1.48 vs. 4.73 years; p=0.542), also evidenced by Cox regression (HR 1.40; 95% CI 0.42–4.65; p=0.578). The risk of liver-related death was also not different among the two groups (6.3% vs. 4.4%; p=0.746), and IBD was not a predictor of it (HR 1.94; 95% CI 0.17–21.69; p=0.589). Conclusions The presence of IBD in patients with AIH is rare and do not identify a subgroup of patients with worse response to treatment or poor clinical outcomes. Funding Agencies AbbVie

scholarly journals Incisional hernia repair by synthetic mesh prosthesis in patients with inflammatory bowel disease: a comparative analysis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Heise ◽  
Charles Schram ◽  
Roman Eickhoff ◽  
Jan Bednarsch ◽  
Marius Helmedag ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Risk Factor ◽  
Hernia Repair ◽  
Bowel Disease ◽  
Hernia Recurrence ◽  
Postoperative Course ◽  
Major Complications ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up. Methods The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan–Meier method and risk factors for recurrence determined by Cox regressions. Results General complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn’s disease (CD, 1/19, HR = 1.0, p = 0.021). Conclusion IBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.

scholarly journals P312 Introduction of bowel ultrasonography for follow-up of paediatric inflammatory bowel disease: A single-centre experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S310-S310
Author(s):  
R Lev Zion ◽  
G Focht ◽  
N Asayag ◽  
D Turner
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Wall Thickness ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Wall Thickening ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Bowel ultrasonography (BUS) for imaging of inflammatory bowel disease (IBD) is increasingly recognised as a prominent non-invasive tool to supplement, and in some cases replace traditional endoscopic and imaging modalities, with high sensitivity and specificity. The increasing number of gastroenterologists trained to perform BUS has transformed BUS into a bedside tool to guide routine clinical decision making and accurately monitor response to treatment. However, this process is still in its infancy in paediatric IBD. We present here data on the first 2 years of implementation of BUS performed by a paediatric gastroenterologist (RLT) at the paediatric IBD centre at Shaare Zedek Medical Center in Jerusalem. We aim to describe trends, results and clinical implications of the US studies performed during this period. Methods The electronic medical record system was searched for all BUS studies performed on IBD patients by RLT as part of his weekly IBD clinic between 2017–2019. Studies performed on other caregivers’ patients were excluded to ensure uniform documentation and nomenclature. Findings were classified as normal (wall thickness <3 mm), mild (wall thickening 3–4 mm and blood flow < Limberg 3) or significant signs of inflammation (wall thickness ≥4 mm or 3–4 mm with Limberg ≥3). Charts were reviewed to assess the impact of BUS findings on clinical management. Results A total of 83 bedside BUS studies were performed on 55 IBD patients (42 with Crohn’s – CD) during the study period, with a mean age of 15.1 ± 3.7 years. Thirty-four had one study (23 with CD), 15 had two (13 with CD) and 6 had three or more (all with CD). Overall, 32 studies were normal, 20 showed mild findings and 30 showed significant inflammation. Four studies found stenosis and one showed an abscess. Follow-up studies of initially active disease showed 10/16 (63%) with improvement, including 9/16 (56%) with sonographic remission. 22/83 (27%) studies were felt upon review to have had a direct impact on clinical decision-making. These included decisions not to switch therapy due to normal BUS despite symptoms, admission due to discovery of an abscess, decision to escalate therapy due to lack of sonographic improvement, and decision to continue adalimumab in the presence of a stricture due to favourable prognostic characteristics as per the CREOLE study. Conclusion Bedside BUS is a practical and useful tool that can be integrated into a paediatric IBD clinic, with the ability to provide relevant information in real-time and thus impact on day-to-day patient management.

The Impact of Vedolizumab on Pre-Existing Extraintestinal Manifestations of Inflammatory Bowel Disease: A Multicenter Study

2020 ◽  
Author(s):  
Guilherme Piovezani Ramos ◽  
Christina Dimopoulos ◽  
Nicholas M McDonald ◽  
Laurens P Janssens ◽  
Kenneth W Hung ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Primary Outcome ◽  
Extraintestinal Manifestations ◽  
Limited Data ◽  
Peripheral Arthritis ◽  
Factors Associated ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background There are limited data on how vedolizumab (VDZ) impacts extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD). The aim of this study was to determine the clinical outcomes of EIMs after initiation of VDZ for patients with IBD. Methods A multicenter retrospective study of patients with IBD who received at least 1 dose of VDZ between January 1, 2014 and August 1, 2019 was conducted. The primary outcome was the rate of worsening EIMs after VDZ. Secondary outcomes were factors associated with worsening EIMs and peripheral arthritis (PA) specifically after VDZ. Results A total of 201 patients with IBD (72.6% with Crohn disease; median age 38.4 years (interquartile range, 29-52.4 years); 62.2% female) with EIMs before VDZ treatment were included. The most common type of EIM before VDZ was peripheral arthritis (PA) (68.2%). Worsening of EIMs after VDZ occurred in 34.8% of patients. There were no statistically significant differences between the worsened EIM (n = 70) and the stable EIM (n = 131) groups in term of age, IBD subtype, or previous and current medical therapy. We found that PA was significantly more common in the worsening EIM group (84.3% vs 59.6%; P < 0.01). Worsening of EIMs was associated with a higher rate of discontinuation of VDZ during study follow-up when compared with the stable EIM group (61.4% vs 44%; P = 0.02). Treatment using VDZ was discontinued specifically because of EIMs in 9.5% of patients. Conclusions Almost one-third of patients had worsening EIMs after VDZ, which resulted in VDZ discontinuation in approximately 10% of patients. Previous biologic use or concurrent immunosuppressant or corticosteroid therapy did not predict EIM course after VDZ.

scholarly journals Daily Aspirin Use Does Not Impact Clinical Outcomes in Patients With Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Parita Patel ◽  
Guimin Gao ◽  
George Gulotta ◽  
Sushila Dalal ◽  
Russell D Cohen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clinical Outcomes ◽  
Bowel Disease ◽  
Smoking Status ◽  
Mucosal Inflammation ◽  
Related Complication ◽  
Inflammatory Bowel ◽  
Daily Aspirin ◽  
The Impact

Abstract Background Although several studies have associated the use of nonsteroidal anti-inflammatory drugs with disease flares in patients with inflammatory bowel disease (IBD), little is known about the impact of daily aspirin use on clinical outcomes in patients with IBD. Methods We conducted a retrospective analysis of a prospectively collected registry of patients with IBD from May 2008 to June 2015. Patients with any disease activity with daily aspirin use were matched 1:4 to controls by age, sex, disease, disease location, and presence of cardiac comorbidity. Patients with at least 18 months of follow-up were included in the final analysis. The primary outcomes of interest were having an IBD-related hospitalization, IBD-related surgery, and requiring corticosteroids during the follow-up period. Results A total of 764 patients with IBD were included in the analysis, of which 174 patients were taking aspirin. There was no statistical difference in age, gender, diagnosis (Crohn’s disease vs ulcerative colitis), disease duration, Charlson Comorbidity Index, smoking status, medication usage, or baseline C-reactive protein between groups. After controlling for covariables and length of follow-up in the entire population, aspirin use was not associated with a risk of being hospitalized for an IBD-related complication (odds ratio [OR], 1.46; P = 0.10), corticosteroid use (OR, 0.99; P = 0.70), or having an IBD-related surgery (OR, 0.99; P = 0.96). Conclusion In this single-center analysis, aspirin use did not impact major clinical outcomes in patients with IBD. Although the effect of aspirin use on mucosal inflammation was not directly assessed in this study, these findings support the safety of daily aspirin use in this population.

scholarly journals DOP42 Impact of discontinuing thiopurines at anti-TNF initiation in inflammatory bowel disease: A nationwide Danish cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S079-S080
Author(s):  
S Bohn Thomsen ◽  
R Ungaro ◽  
K Allin ◽  
G Poulsen ◽  
A Mikael ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
Bowel Disease ◽  
Cox Regression ◽  
Clinical Event ◽  
P Value ◽  
The Past ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background The impact of discontinuing vs. continuing thiopurines at anti-TNF initiation in thiopurine experienced patients with inflammatory bowel disease (IBD) is unclear. Methods We used the nationwide Danish registers to establish a national cohort of patients with IBD who received thiopurines prior to initiating anti-TNF during 2003–2014. We compared patients who discontinued vs. continued thiopurine within 90 days of anti-TNF initiation. Our primary outcome was a composite of any clinical event: corticosteroids, hospitalisation, surgery, or death. We used Cox regression models to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Analyses were adjusted for sex, diagnosis-age, IBD-subtype, disease duration, calendar year, pre-anti-TNF thiopurine duration, and past disease severity including hospitalisations the past year, surgery past 5 years, and corticosteroid use the past year. Results Of 6998 anti-TNF exposed, 1602 patients (Crohn’s disease, n = 1000, ulcerative colitis, n = 602) received thiopurines prior to anti-TNF. Of these, 489 (44%) received thiopurines for more than 180 days. At anti-TNF initiation, 503 patients discontinued thiopurines and were followed for a median 3.54 years and 1099 continued thiopurines with a median follow-up of 3.92 years. Discontinuing thiopurines at anti-TNF initiation statistically significantly increased the risk of the composite outcome (aHR 1.25; 95% CI 1.09 to 1.45). Analyses of the individual outcomes revealed a statistically significantly increased risk of later corticosteroid use in thiopurine discontinuers (aHR 1.31; 95% CI 1.11 to 1.56), but no increased risk of the remaining outcomes. IR; incidence rate, HR; hazard ratio, CI; confidence interval, IBD; inflammatory bowel disease. P-value is the test of interaction between the variable and the treatment groups. Conclusion In our nationwide cohort study of patients with IBD, we found that continuing thiopurines after anti-TNF initiation impacted the outcome favourably, especially regarding corticosteroid use. Further studies are warranted to investigate this central clinical question.

scholarly journals Impact of Bariatric Surgery on the Long-term Disease Course of Inflammatory Bowel Disease

2019 ◽  
Vol 26 (7) ◽  
pp. 1089-1097 ◽  
Author(s):  
Manuel B Braga Neto ◽  
Martin H Gregory ◽  
Guilherme P Ramos ◽  
Fateh Bazerbachi ◽  
David H Bruining ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Weight Loss ◽  
Bowel Disease ◽  
Inflammatory Bowel ◽  
A Prospective Study ◽  
Prospective Study Design ◽  
The Impact

Abstract Background An association between inflammatory bowel disease (IBD) and obesity has been observed. Little is known about the effect of weight loss on IBD course. Our aim was to determine the impact of bariatric surgery on long-term clinical course of obese patients with IBD, either Crohn's disease (CD) or ulcerative colitis (UC). Methods Patients with IBD who underwent bariatric surgery subsequent to IBD diagnosis were identified from 2 tertiary IBD centers. Complications after bariatric surgery were recorded. Patients were matched 1:1 for age, sex, IBD subtype, phenotype, and location to patients with IBD who did not undergo bariatric surgery. Controls started follow-up at a time point in their disease similar to the disease duration in the matched case at the time of bariatric surgery. Inflammatory bowel disease medication usage and disease-related complications (need for corticosteroids, hospitalizations, and surgeries) among cases and controls were compared. Results Forty-seven patients met inclusion criteria. Appropriate matches were found for 25 cases. Median follow-up among cases (after bariatric surgery) and controls was 7.69 and 7.89 years, respectively. Median decrease in body mass index after bariatric surgery was 12.2. Rescue corticosteroid usage and IBD-related surgeries were numerically less common in cases than controls (24% vs 52%; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.08–1.23; 12% vs 28%; OR, 0.2; 95% CI, 0.004–1.79). Two cases and 1 control were able to discontinue biologics during follow-up. Conclusions Inflammatory bowel disease patients with weight loss after bariatric surgery had fewer IBD-related complications compared with matched controls. This observation requires validation in a prospective study design.

scholarly journals Fecal Calprotectin Use in Inflammatory Bowel Disease and Beyond: A Mini-Review

2015 ◽  
Vol 29 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Bashaar Alibrahim ◽  
Mohammed I Aljasser ◽  
Baljinder Salh
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Intestinal Tract ◽  
Fecal Calprotectin ◽  
Response To Treatment ◽  
Gastrointestinal Disorders ◽  
Disease Relapse ◽  
Inflammatory Bowel ◽  
Irritable Bowel

Given the number of inflammatory disorders affecting the gastrointestinal tract directly and indirectly, coupled with the considerable overlap with functional disorders, it is evident that more useful noninvasive diagnostic tests are required to aid with diagnosis. If these tests can also have some utility for individual patient follow-up in terms of disease activity and response to treatment, as well as providing forewarning of disease relapse, it would be extremely useful information for the clinician. One recently described test that may fulfill several of these attributes is based on leakage of a mononuclear cell cytoplasmic protein, calprotectin, along the intestinal tract, which can then be quantified in feces. This has been used to distinguish patients exhibiting symptoms of irritable bowel syndrome from patients with inflammatory bowel disease, with a measure of success greater than with currently used techniques. The present article summarizes the experience with this test used in inflammatory bowel disease, as well as a variety of gastrointestinal disorders.

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