Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines

Background. Patients with inflammatory bowel disease (IBD) are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis.Methods. We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA) findings.Results. 59% of patients (1004/1703) in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%), and of these, 196 patients had DXA completed (“at-risk” group). Ninety-five patients not meeting guidelines-based risk factors also had DXA completed (“not at-risk” group). 139 (70.9%) patients in “at-risk” group had low BMD, while 51 (53.7%) of “not-at-risk” patients had low BMD. Majority of the patients with osteoporosis (83.3%) missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47–6.42;P=0.003).Conclusions. Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.

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Parents’ social norms and children’s exposure to three behavioral risk factors for chronic disease

Journal of Behavioral Public Administration ◽

10.30636/jbpa.21.49 ◽

2019 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Oliver Drouin ◽

Jonathan P. Winickoff ◽

Anne N. Thorndike

Keyword(s):

Risk Factors ◽

At Risk ◽

Risk Factor ◽

Social Norms ◽

Risk Group ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Not At Risk ◽

Children’S Exposure ◽

At Home

Social norms predict health behaviors of adults and adolescents. We aimed to determine if parents’ beliefs about social norms were associated with children’s exposure to three behavioral risk factors. We asked 648 parents of children ages 0-18 years old attending two pediatric practices about their children’s exposure to smoking at home. Parents of 341 parents with children >2 years old were also asked about insufficient dental care, and 435 with children aged >12 months about their children’s sugar-sweetened beverage (SSB) consumption. Children were categorized as “at risk” or “not at risk” for each factor.The primary outcome was the parent-reported estimate of neighborhood prevalence of those same risk factors.Of eligible participants, 8% reported smoking at home, 23% that their child hadn’t seen a dentist for 6 months, and 35% that their child drank SSBs once a day or more. In multivariate analyses, parents with children in the “at risk” group estimated that the prevalence of each risk factor was higher in their neighborhood, than did participants with children in the “not at risk” group: difference of 12.2% [95% CI, 5.8%-18.6%] for tobacco-smoke exposure, 18.6% [95% CI, 10.7%-26.5%] for lack of regular dental visits and 12.1% [95% CI, 5.1%-19.0%] for SSB consumption (P<0.001 for all comparisons).Parents of children exposed to three behavioral risk factors reported higher perceived prevalence of each risk factor compared to parents of children not at risk. Addressing parents’ social norms beliefs could help promote healthier behaviors of children.

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Laryngeal Carcinoma in Patients With Inflammatory Bowel Disease: Clinical Outcomes and Risk Factors

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz210 ◽

2019 ◽

Vol 26 (7) ◽

pp. 1060-1067

Author(s):

Steffi E M van de Ven ◽

Lauranne A A P Derikx ◽

Iris D Nagtegaal ◽

Carla M van Herpen ◽

Robert P Takes ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Risk Factor ◽

Bowel Disease ◽

Case Control Studies ◽

Transplant Patients ◽

Immunosuppressive Medication ◽

Survival Difference ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) patients are at increased risk for developing extra-intestinal malignancies, mainly due to immunosuppressive medication. The risk of developing head and neck cancer in immunosuppressed transplant patients is increased. The relation between IBD patients and laryngeal cancer (LC) remains unclear. We aimed (1) to identify risk factors in IBD patients for LC development and (2) to compare clinical characteristics, outcome, and survival of LC in IBD patients with the general population. Methods All IBD patients with LC (1993–2011) were retrospectively identified using the Dutch Pathology Database. We performed 2 case–control studies: (1) to identify risk factors, we compared patients with IBD and LC (cases) with the general IBD population; (2) to analyze LC survival, we compared cases with controls from the general LC population. Results We included 55 cases, 1800 IBD controls, and 2018 LC controls. Cases were more frequently male compared with IBD controls (P < 0.001). For ulcerative colitis (UC), cases were older at IBD diagnosis (P < 0.001). Crohn’s disease (CD) cases were more frequently tobacco users (P < 0.001) and more often had stricturing (P = 0.006) and penetrating (P = 0.008) disease. We found no survival difference. Immunosuppressive medication had no impact on survival. Conclusions Male sex was a risk factor for LC in IBD patients. Older age at IBD diagnosis was a risk factor for UC to develop LC. Tobacco use and stricturing and penetrating disease were risk factors for LC development in CD patients. Inflammatory bowel disease was not associated with impaired survival of LC. Immunosuppressive medication had no influence on survival.

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

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.132 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S52-S53

Author(s):

David Drevno ◽

Sherry Hickok ◽

Sabina Ali

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Risk Factor ◽

Quality Improvement ◽

Bowel Disease ◽

Biologic Therapy ◽

Number Of Patients ◽

Increased Risk ◽

Inflammatory Bowel ◽

Exposure History

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

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Incidence, Risk Factors and Evaluation of Osteoporosis in Patients With Inflammatory Bowel Disease: A Danish Population-Based Inception Cohort With 10 Years of Follow-Up

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa019 ◽

2020 ◽

Vol 14 (7) ◽

pp. 904-914 ◽

Cited By ~ 3

Author(s):

Bobby Lo ◽

Jakob Præst Holm ◽

Marianne Kajbæk Vester-Andersen ◽

Flemming Bendtsen ◽

Ida Vind ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

At Risk ◽

Bowel Disease ◽

Population Based ◽

Control Population ◽

Inception Cohort ◽

Mineral Density ◽

Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease [IBD] including Crohn’s disease [CD] and ulcerative colitis [UC] are at risk of developing metabolic bone disease. The aims here were to investigate the screening strategy, incidence and risk factors of osteoporosis in a prospective population-based inception cohort. Method Between 2003 and 2004 all incident patients diagnosed with CD and UC in a well-defined Copenhagen area were included and followed until 2015. Data were compared with a control population [at a ratio of 1:20]. Regression models were performed with several covariates. The sensitivity of the Danish registries for osteoporosis was also assessed. Results A total of 513 patients were included [213 CD, 300 UC]. Overall, 338 (66%, CD: 164 [77%], UC: 174 [58%], p < 0.001] patients received ≥ 500 mg corticosteroid within a year, resulting in 781 patient-years at risk of osteoporosis. Of those, only 83 [10.6%] patient-years were followed by a dual-energy X-ray absorptiometry scan within the same or the following 2 years. Overall, 73 [14.2%] IBD patients (CD: 31 [14.6%], UC: 42 [14%]) and 680 [6.6%, p < 0.001] controls were diagnosed with osteoporosis during follow-up. The risk of osteoporosis was increased compared to the control population (odds ratio: CD: 2.9 [95% confidence interval: 2.0–4.1], UC: 2.8 [2.1–3.9]). Conclusion In this population-based inception cohort, the incidence of osteoporosis was significantly higher compared to a control population. Measurement of bone mineral density is infrequent, especially in patients at high risk of developing osteoporosis. These results demonstrate the need of further awareness of the risk of osteoporosis among IBD patients, and prospective population-based studies are warranted.

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Cancer Risk in Inflammatory Bowel Disease: A 6-Year Prospective Multicenter Nested Case–Control IG-IBD Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz155 ◽

2019 ◽

Cited By ~ 7

Author(s):

Livia Biancone ◽

Alessandro Armuzzi ◽

Maria Lia Scribano ◽

Fabiana Castiglione ◽

Renata D’incà ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Risk Factor ◽

Urinary Tract ◽

Bowel Disease ◽

Clinical Characteristics ◽

Case Control ◽

Incident Cancer ◽

Inflammatory Bowel ◽

Nested Case Control

Abstract Background In a 6-year, multicenter, prospective nested case–control study, we aimed to evaluate risk factors for incident cancer in inflammatory bowel disease (IBD), when considering clinical characteristics of IBD and immunomodulator use. The secondary end point was to provide characterization of incident cancer types. Methods All incident cases of cancer occurring in IBD patients from December 2011–2017 were prospectively recorded in 16 Italian Group for the Study of Inflammatory Bowel Disease units. Each of the IBD patients with a new diagnosis of cancer was matched with 2 IBD patients without cancer, according to IBD phenotype (ulcerative colitis [UC] vs Crohn’s disease [CD]), age (±5 years), sex. Risk factors were assessed by multivariate logistic regression analysis. Results Cancer occurred in 403 IBD patients: 204 CD (CD cases), 199 UC (UC cases). The study population included 1209 patients (403 IBD cases, 806 IBD controls). Cancer (n = 403) more frequently involved the digestive system (DS; 32%), followed by skin (14.9%), urinary tract (9.7%), lung (6.9%), genital tract (6.5%), breast (5.5%), thyroid (1.9%), lymphoma (2.7%, only in CD), adenocarcinoma of the small bowel (SBA; 3.9%, 15 CD, 1 pouch in UC), other cancers (15.9%). Among cancers of the DS, colorectal cancer (CRC) more frequently occurred in UC (29% vs 17%; P < 0.005), whereas SBA more frequently occurred in CD (13% vs 6.3% P = 0.039). In CD, perforating (B3) vs non-stricturing non-perforating (B1) behavior represented the only risk factor for any cancer (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.33–4.11). In CD, risk factors for extracolonic cancer (ECC) were a B3 vs B1 and a stricturing (B2) vs B1 behavior (OR, 2.95; 95% CI, 1.62–5.43; OR, 1.79; 95% CI, 1.09–2.98). In UC, risk factors for ECC and for overall cancer were abdominal surgery for UC (OR, 4.63; 95% CI, 2.62–8.42; OR, 3.34; 95% CI, 1.88–5.92) and extensive vs distal UC (OR, 1.73; 95% CI, 1.10–2.75; OR, 1.99; 95% CI, 1.16–3.47). Another risk factor for ECC was left-sided vs distal UC (OR, 1.68; 95% CI, 1.00–2.86). Inflammatory bowel disease duration was a risk factor for skin and urinary tract cancers. Conclusions Perforating CD, extensive UC, and abdominal surgery for UC were identified as risk factors for overall incident cancer and for ECC. The clinical characteristics associated with severe IBD may increase cancer risk.

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A nationwide survey concerning the mortality and risk of progressing severity due to arterial and venous thromboembolism in inflammatory bowel disease in Japan

Journal of Gastroenterology ◽

10.1007/s00535-021-01829-5 ◽

2021 ◽

Author(s):

Katsuyoshi Ando ◽

Mikihiro Fujiya ◽

Kenji Watanabe ◽

Sakiko Hiraoka ◽

Hisashi Shiga ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Risk Factor ◽

Venous Thromboembolism ◽

Bowel Disease ◽

Severe Disease ◽

Laboratory Data ◽

Nationwide Survey ◽

Inflammatory Bowel ◽

Independent Risk Factors

Abstract Background The mortality and risk factors of severe disease and death due to arterial and venous thromboembolism (ATE and VTE, respectively) in patients with inflammatory bowel disease (IBD) remain unclear, especially in Asia. Aims This study aimed to reveal the mortality and risk factors of TE in IBD patients in Japan. Methods In the primary surveillance, responses to questionnaires regarding the number of cases of severe TE and TE-associated death in IBD patients in a span of over the past 10 years were obtained from 32 institutions in Japan. In the secondary surveillance, detailed data about IBD patients with TE were collected. The characteristics, laboratory data, therapy status, and situation at the time of TE development were retrospectively collected, and the data were compared between the patients with and without severe TE and TE-associated death. Results The incidence of TE was 1.89% among 31,940 IBD patients. The frequencies of severe TE and TE-associated mortality were 10.7% and 1.0% among the total IBD and TE with IBD patients, respectively. The only risk factor for severe ATE and ATE-associated death was ischemic heart disease. The independent risk factors for severe VTE and VTE-associated death were age (≤ 45 years old), the site of VTE, and disease severity, with anti-TNF therapy as a potential negative risk factor. Patients with severe VTE had a high risk of developing persistent VTE and sequelae. Conclusion Unlike ATE, the incidence of VTE was comparable in Asian and Western countries. Therapeutic and prophylactic strategies for managing IBD-associated TE in Asia are urgently needed.

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