What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

2017 ◽  
Vol 35 (1-2) ◽  
pp. 50-55 ◽  
Author(s):  
Jacques Cosnes
Keyword(s):  
Inflammatory Bowel Disease ◽  
Urinary Tract ◽  
High Risk ◽  
Bowel Disease ◽  
Immunosuppressive Treatment ◽  
Intestinal Resection ◽  
Immunosuppressive Drugs ◽  
Inflammatory Bowel ◽  
Risk Of Cancer ◽  
Prior Malignancy

Background: Treatment of inflammatory bowel disease (IBD) in patients with prior malignancy is challenging because therapeutic immunosuppression required for controlling IBD activity may increase the risk of cancer recurrence. Key Messages: Contrary to the observations in the post-transplant population, retrospective observational studies of IBD patients with prior malignancy have not demonstrated that immunosuppressive drugs increased significantly the risk of new or recurrent cancer. However, these studies are highly biased and do not permit the use of these drugs. Factors like the time since treatment completion, severity, and subtype of prior cancer should be weighed along with the current IBD activity before choosing the best therapeutic strategy. In practice, most cases of prior cancer require a delay of at least 2 years before starting or resuming immunosuppressants, including anti-TNF agents. This delay should be extended to 5 years in cancer with a high risk of recurrence including cancer of the urinary tract, gastrointestinal cancer, leukemias, and multiple myeloma. A special attention should be paid to cancers with a high risk of late metastasis (breast, melanoma, renal cell carcinoma). Enteral nutrition, Budesonide, mesalamine, and limited intestinal resection should be considered following the completion of cancer treatment and prior to the safe initiation of immunosuppressive treatment for IBD. Thiopurines should be avoided in case of prior Epstein-Barr virus-related lymphoma, HPV-related carcinomas, and cancer of the urinary tract. Methotrexate and anti-TNF agents seem to be safe except for the risk of recurrent melanoma for the latter. Conclusion: IBD patients with prior malignancy should benefit from individual decisions made on a case-by-case basis.

scholarly journals Resultados de la cirugía en enfermedad inflamatoria intestinal: experiencia en un centro de atención terciaria

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Cristina Suárez Ferrer ◽  
Víctor López Loma de Osorio ◽  
Isabel Pascual Miguelañez ◽  
Mario Álvarez Gallego ◽  
José A Gazo Martínez ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Odds Ratio ◽  
Combined Treatment ◽  
Immunosuppressive Treatment ◽  
Immunosuppressive Drugs ◽  
Time Of Surgery ◽  
Inflammatory Bowel ◽  
Disease Unit

Introduction. The development of the therapeutic arsenal in inflammatory bowel disease has reduced the need for surgery in these patients. However, in certain cases, it continues to be the treatment of choice. In addition, the patients who required surgery intervention are more complex due to the therapy received (corticosteroids and immunomodulators) and the time of evolution of the disease. Materials and methods. We included patients under stable follow-up, in the Inflammatory Bowel Disease Unit of our center, who required surgery between January 2015 and November 2016 for treatment of the underlying pathology. Demographic and baseline disease variables were collected from each patient, as well as those related to the results and safety of the surgery, assessing both early and delayed complications. Results. During the study period, among the 998 patients with stable follow-up in the Inflammatory Bowel Disease Unit, 26 of them underwent surgery representing 2.6% of the sample. 85% of patients were on treatment with an immunomodulator (thiopurines, antiTNF or both) at the time of surgery. Five patients (20%) presented early postoperative complications, most of them mild (Claiven-Dindo I 79.2% and II 16.7%), of whom three (60%) were on combined treatment with azathioprine and an anti-TNF. No deferred complications of surgery were observed during its subsequent evolution. In the patients who underwent abdominal surgery, multivariate analysis showed that the presence of immunosuppressive treatment -at the time of surgery- increased the risk of suffering complications with an odds ratio of 1.66, and the treatment with biliologics, with an odds ratio of 1.457. None of the patients -in whom a complication occurred- were on corticosteroids treatment at the time of surgery. Conclusion. In our experience, the frequency surgery-related complications are low, despite the increasing use of immunosuppressive drugs in our patients.

P053 VARIATIONS IN HEALTHCARE UTILIZATION PATTERNS AMONG HIGH RISK INFLAMMATORY BOWEL DISEASE PATIENTS ENROLLED IN HIGH DEDUCTIBLE HEALTH PLANS

2020 ◽  
Vol 158 (3) ◽  
pp. S110-S111
Author(s):  
Jeffrey Berinstein ◽  
Shirley Cohen-Mekelburg ◽  
Calen Steiner ◽  
Megan Mcleod ◽  
Mohamed Noureldin ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
High Risk ◽  
Healthcare Utilization ◽  
Bowel Disease ◽  
Health Plans ◽  
Utilization Patterns ◽  
Inflammatory Bowel

Fr517 USE OF USTEKINUMAB AND RISK OF NEW OR RECURRENT CANCERS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE AND PRIOR MALIGNANCY

2021 ◽  
Vol 160 (6) ◽  
pp. S-342
Author(s):  
Badar Hasan ◽  
Kanwarpreet S. Tandon ◽  
Rafael Miret ◽  
Sikandar Khan ◽  
Amir Riaz ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Inflammatory Bowel ◽  
Prior Malignancy

New Methylation Biomarker Panel for Early Diagnosis of Dysplasia or Cancer in High-Risk Inflammatory Bowel Disease Patients

2018 ◽  
Author(s):  
Daniel Azuara ◽  
Susanna Aussó ◽  
Francisco Rodriguez-Moranta ◽  
Jordi Guardiola ◽  
Xavier Sanjuan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
High Risk ◽  
Early Diagnosis ◽  
Bowel Disease ◽  
Biomarker Panel ◽  
Inflammatory Bowel

scholarly journals P255 Predictors of postoperative morbidity in patients with inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S277-S278
Author(s):  
N Imperatore ◽  
L Pellegrini ◽  
L Bucci ◽  
A Rispo ◽  
A D Guarino ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Wound Infection ◽  
Anastomotic Leak ◽  
Bowel Disease ◽  
Disease Duration ◽  
Intestinal Resection ◽  
Operative Morbidity ◽  
Urinary Infections ◽  
Inflammatory Bowel ◽  
Surgery Duration

Abstract Background More than half of patients suffering from inflammatory bowel disease (IBD) requires surgery in their lifetime. However, predictors of post-operative morbidity and mortality are poorly investigated. Our aim was to assess the predictors of post-operative mortality and morbidity in IBD. Methods retrospective cohort study enrolling all IBD subjects followed-up and operated at our tertiary IBD Centre from 2015 to 2018. For each patient, we evaluated patient-dependent (comorbidities, smoking, drugs, nutritional status), disease-dependent (disease duration, location, behaviour, extension), surgery-dependent variables (duration, emergency/election, laparoscopy/laparotomy, bowel/colic resection, length of intestinal resection). Results 158 subjects were operated during the period study (males 53.8%, Crohn’s disease 75.3%, mean age 41.9 + 16.2, disease duration 109.5 + 98.3 months); the majority (83%) underwent an elective surgery. No patient died. About morbidity, 40 (25.3%) developed post-operative complications: wound infection (8.9%), respiratory complications (6.9%), prolonged ileum (5.1%), anastomotic leak (3.2%), urinary infections (3.2%), abdominal abscess (3.2%), anastomotic bleeding (3.2%), other infections (2.5%), abdominal bleeding (1.9%), obstruction (1.3%). Two subjects (1.3%) required re-operation within 30 days. A surgery-duration <142 min was predictive for a better post-operative outcome (sensitivity 80%, specificity 42%, PPV 32%, NPV 85.9%). At binary logistic regression, stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6–6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4–9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.4–0.8, p = 0.01), surgery duration <142 min (OR 0.2, 95% CI 0.08–0.7, p = 0.03), were the only predictors for post-operative morbidities. A pre-operative BMI<24 was also predictive for anastomotic leak (OR 4.3, 95% CI 1.8–8.6, p = 0.02); pre-operative hypoalbuminemia was predictive for urinary infections (OR 2.5, 95% CI 1.8–7.9, p = 0.04); pre-operative infliximab was predictive for pneumonia (OR 3.8, 95% CI 2.2–6.3, p = 0.01); diabetes (OR 5.7, 95% CI 2.3–9.8, p < 0.01) and pre-operative steroids (OR 6.1, 95% CI 1.8–11.4, p < 0.01) were predictors of wound infection; need for TPN predicted prolonged ileum (OR 6.1, 95% CI 2.3–15.3, p = 0.03). Conclusion about a quarter of IBD patients undergoing surgery develops a post-operative complication, especially infective. Several patient-related, disease-related and surgery-related factors are predictive for post-operative morbidity. The recognition of these factors, as well the multidisciplinary approach (gastroenterologists, surgeons and nutritionists), and intensive preoperative management could be able to minimise these complications.

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