Risk factors for diagnostic delay in Crohn's disease and their impact on long-term complications: how do they differ in a tuberculosis endemic region?

2018 ◽  
Vol 47 (10) ◽  
pp. 1367-1374 ◽  
Author(s):  
R. Banerjee ◽  
P. Pal ◽  
B. G. Girish ◽  
D. N. Reddy
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Diagnostic Delay ◽  
Endemic Region

scholarly journals Management of Crohn’s disease in an immunosuppressed COVID-19-positive patient: safety-driven prioritisation of nutritional therapy as a bridge to restarting immunosuppression

2021 ◽  
Vol 14 (3) ◽  
pp. e239404
Author(s):  
Clare Harris ◽  
Richard James Harris ◽  
Louise Downey ◽  
Markus Gwiggner
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Patient Safety ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Nutritional Therapy ◽  
Interleukin 12 ◽  
Inflammatory Bowel ◽  
Term Maintenance

Active inflammatory bowel disease (IBD), combined immunosuppression and corticosteroid therapy have all been identified as risk factors for a poor outcome in COVID-19 infection. The management of patients with both COVID-19 infection and active IBD is therefore complex. We present the case of a 31-year-old patient with Crohn’s disease, on dual immunosuppression with infliximab and mercaptopurine presenting with inflammatory small bowel obstruction and COVID-19 infection. The case highlights the use of nutritional therapy, which remains underused in the management of adults with IBD, to manage his flare acutely. Following negative SARS-CoV-2 PCR testing and SARS-CoV-2 IgG testing confirming an antibody response, ustekinumab (anti-interleukin 12/23) was prescribed for long-term maintenance.

Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn’s Disease

2019 ◽  
Vol 13 (10) ◽  
pp. 1334-1342 ◽  
Author(s):  
Alain Schoepfer ◽  
Jessica Santos ◽  
Nicolas Fournier ◽  
Susanne Schibli ◽  
Johannes Spalinger ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Diagnostic Delay ◽  
Perianal Fistula ◽  
Adult Patients ◽  
Adult Onset ◽  
Systematic Analysis ◽  
Internal Fistula ◽  
The Impact

Abstract Background and Aims Length of diagnostic delay is associated with bowel strictures and intestinal surgery in adult patients with Crohn’s disease [CD]. Here we assessed whether diagnostic delay similarly impacts on the natural history of paediatric CD patients. Methods Data from the Swiss IBD Cohort Study were analysed. Frequency of CD-related complications [bowel stenosis, perianal fistula, internal fistula, any fistula, resection surgery, fistula/abscess surgery, any complication] at diagnosis and in the long term [up to 30 years after CD diagnosis] was compared between paediatric patients [diagnosed <18 years] and adult patients [diagnosed ≥18 years] using multivariate Cox proportional hazard regression modelling. Results From 2006 to 2016, 387 paediatric and 1163 adult CD patients were included. Median [interquartile range: IQR] diagnostic delay was 3 [1–9] for the paediatric and 6 [1–24] months for the adult group, respectively. Adult onset CD patients presented at diagnosis more frequently with bowel stenosis [p <0.001] and bowel surgery [p <0.001] compared with paediatric CD patients. In the long term, length of diagnostic delay was significantly associated with bowel stenosis [p = 0.001], internal fistula [p = 0.038], and any complication [p = 0.024] in the adult onset CD population. No significant association between length of diagnostic delay and CD-related outcomes in the long term was observed in the paediatric population. Conclusions Adult CD patients have longer diagnostic delay compared with paediatric CD patients and present at diagnosis more often with bowel stenosis and surgery. Length of diagnostic delay was found to be predictive for CD-related complications only in the adult but not in the paediatric CD population.

Strictureplasty for Crohn’s disease of the small bowel in the biologic era: long-term outcomes and risk factors for recurrence

2020 ◽  
Vol 24 (7) ◽  
pp. 711-720 ◽  
Author(s):  
M. Rottoli ◽  
M. Tanzanu ◽  
C. A. Manzo ◽  
M. L. Bacchi Reggiani ◽  
P. Gionchetti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Long Term Outcomes ◽  
Risk Factors For Recurrence

scholarly journals P442 Strictureplasty for Crohn’s disease of the small bowel in the biological era: long-term outcomes and risk factors for site specific recurrence

2019 ◽  
Vol 13 (Supplement_1) ◽  
pp. S331-S332
Author(s):  
M Rottoli ◽  
C A Manzo ◽  
M Tanzanu ◽  
F Rizzello ◽  
P Gionchetti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Long Term Outcomes ◽  
Site Specific

Similar birth-cohort patterns in Crohn’s disease and multiple sclerosis

2017 ◽  
Vol 24 (2) ◽  
pp. 140-149 ◽  
Author(s):  
Amnon Sonnenberg ◽  
Vladeta Ajdacic-Gross
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Birth Cohort ◽  
Environmental Risk ◽  
Time Trends ◽  
The United States ◽  
Environmental Risk Factors

Background: The etiology of Crohn’s disease and multiple sclerosis is unknown. Genetic susceptibility and environmental factors are believed to play a role in both diseases. Objectives: To compare the long-term time trends of the two diseases and thus gain insight about their etiology. Methods: We analyzed mortality data of Crohn’s disease and multiple sclerosis from Canada, England, Italy, the Netherlands, Switzerland, and the United States during the past 60 years. Age–period–cohort (APC) analyses based on logit models served to disentangle the separate influences of age, period, and cohort effects on the overall time trends. Results: The long-term time trends of Crohn’s disease and multiple sclerosis have been shaped by strikingly similar birth-cohort patterns. In both diseases alike, mortality increased in all generations born prior to 1910. It peaked among generations born between 1910 and 1930 and then declined in all subsequent generations. Similar birth-cohort patterns of Crohn’s disease and multiple sclerosis were found in each country analyzed separately. Conclusion: The birth-cohort patterns indicate that the development of Crohn’s disease and multiple sclerosis is influenced by exposure to environmental risk factors during an early period of life. These environmental risk factors may be similar or even identical in Crohn’s disease and multiple sclerosis.

scholarly journals Long-Term Follow-Up, Association between CARD15/NOD2 Polymorphisms, and Clinical Disease Behavior in Crohn’s Disease Surgical Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Francesco Giudici ◽  
Tiziana Cavalli ◽  
Cristina Luceri ◽  
Edda Russo ◽  
Daniela Zambonin ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perioperative Complications ◽  
Severe Disease ◽  
Diagnostic Delay ◽  
Age At Diagnosis ◽  
Clinical Biomarkers ◽  
Long Term Follow Up

Background. CARD15/NOD2 is the most significant genetic susceptibility in Crohn’s disease (CD) even though a relationship between the different polymorphisms and clinical phenotype has not been described yet. The study is aimed at analyzing, in a group of CD patients undergoing surgery, the relationship between CARD15/NOD2 polymorphisms and the clinical CD behavior after a long-term follow-up, in order to identify potential clinical biomarkers of prognosis. Methods. 191 surgical CD patients were prospectively characterized both for the main single nucleotide polymorphisms of CARD15/NOD2 and for many other environmental risk factors connected with the severe disease form. After a mean follow-up of 7.3 years, the correlations between clinical features and CD natural history were analyzed. Results. CARD15/NOD2 polymorphisms were significantly associated with younger age at diagnosis compared to wild type cases ( p < 0.05 ). Moreover, patients carrying a 3020insC polymorphism presented a larger Δ between diagnosis and surgery ( p = 0.0344 ). Patients carrying an hz881 and a 3020insC exhibited, respectively, a lower rate of responsiveness to azathioprine ( p = 0.012 ), but no difference was found in biologic therapy. Finally, the risk of surgical recurrence was significantly associated, respectively, to age at diagnosis, to familial CD history, to diagnostic delay, to arthritis, and to the presence of perioperative complications. Conclusions. 3020insC CARD15 polymorphism is associated with an earlier CD onset, and age at CD diagnosis < 27 years was confirmed to have a detrimental effect on its clinical course. In addition, the familiarity seems to be connected with a more aggressive postoperative course. Finally, for the first time, we have observed a lower rate of responsiveness to azathioprine in patients carrying an hz881 and a 3020insC.

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