scholarly journals Impact of Diagnostic Delay on Disease Course in Pediatric Versus Adult-onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

2021 ◽  
Author(s):  
Alain M. Schoepfer ◽  
Vu Dang Chau Tran ◽  
Jean-Benoit Rossel ◽  
Christiane Sokollik ◽  
Johannes Spalinger ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ulcerative Colitis ◽  
Diagnostic Delay ◽  
Adult Patients ◽  
Adult Onset ◽  
Considerable Morbidity ◽  
The Impact ◽  
Onset Group ◽  
Pediatric Onset

Introduction: Given the lack of data we aimed to assess the impact of the length of diagnostic delay on natural history of ulcerative colitis in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years). Methods: Data from the Swiss Inflammatory Bowel Disease cohort study were analyzed. Diagnostic delay was defined as interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extra-intestinal manifestations (EIM). Results: A total of 184 pediatric and 846 adult patients were included. Median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (P=0.873). In both, pediatric and adult-onset groups, length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIM were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay compared to the adult-onset group with short diagnostic delay (p = 0.022). In the long term, length of diagnostic delay was associated in the adult onset group with colorectal dysplasia (p=0.023), EIMs (p<0.001) and more specifically arthritis/arthralgias (p<0.001) and ankylosing spondylitis/sacroiliitis (p<0.001). In the pediatric-onset UC group, length of diagnostic delay in the long term was associated with arthritis/arthralgias (p=0.017); however, it was not predictive for colectomy and UC-related hospitalization. Conclusions: As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.

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.

scholarly journals Correlation of Body Mass Index with Oncologic Outcomes in Colorectal Cancer Patients: A Large Population-Based Study

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3592
Author(s):  
Chong-Chi Chiu ◽  
Chung-Han Ho ◽  
Chao-Ming Hung ◽  
Chien-Ming Chao ◽  
Chih-Cheng Lai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Survival Rates ◽  
Normal Weight ◽  
P Value ◽  
Administrative Claims ◽  
The Impact

It has been acknowledged that excess body weight increases the risk of colorectal cancer (CRC); however, there is little evidence on the impact of body mass index (BMI) on CRC patients’ long-term oncologic results in Asian populations. We studied the influence of BMI on overall survival (OS), disease-free survival (DFS), and CRC-specific survival rates in CRC patients from the administrative claims datasets of Taiwan using the Kaplan–Meier survival curves and the log-rank test to estimate the statistical differences among BMI groups. Underweight patients (<18.50 kg/m2) presented higher mortality (56.40%) and recurrence (5.34%) rates. Besides this, they had worse OS (aHR:1.61; 95% CI: 1.53–1.70; p-value: < 0.0001) and CRC-specific survival (aHR:1.52; 95% CI: 1.43–1.62; p-value: < 0.0001) rates compared with those of normal weight patients (18.50–24.99 kg/m2). On the contrary, CRC patients belonging to the overweight (25.00–29.99 kg/m2), class I obesity (30.00–34.99 kg/m2), and class II obesity (≥35.00 kg/m2) categories had better OS, DFS, and CRC-specific survival rates in the analysis than the patients in the normal weight category. Overweight patients consistently had the lowest mortality rate after a CRC diagnosis. The associations with being underweight may reflect a reverse causation. CRC patients should maintain a long-term healthy body weight.

scholarly journals Indirect costs associated with ulcerative colitis: a systematic literature review of real-world data

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joelle Constantin ◽  
Petar Atanasov ◽  
Daniel Wirth ◽  
Andras Borsi
Keyword(s):  
Ulcerative Colitis ◽  
Sick Leave ◽  
Indirect Costs ◽  
Cochrane Library ◽  
Real World Data ◽  
Eligibility Criteria ◽  
Productivity Costs ◽  
Productivity Losses ◽  
The Impact

Abstract Background The economic burden of ulcerative colitis (UC), specifically related to indirect costs, is not extensively documented. Understanding and quantifying it is required by health care decision makers. Aim To assess the impact of indirect costs of UC in observation studies. Method A systematic literature search was conducted in MEDLINE®, Embase® and Cochrane Library to capture all relevant publications reporting outcomes on absenteeism, presenteeism and productivity losses in moderate to severe UC. Eligibility criteria for inclusion into the review were established using a predefined PICOS scheme. All costs were adjusted to 2017 currency values (USD dollars, $). Results In total, 18 studies reporting data on indirect costs were included in the analysis. Absenteeism costs were classified into three categories: sick leave, short-term and long-term disability. Most of the studies captured absenteeism costs related specifically to sick leave, which was experienced on average by 10 to 24% patients with UC. Only three studies captured presenteeism costs, as these are difficult to measure, however costs ranged from 1602 $ to 2947 $ per patient year. The proportion of indirect costs accounted for 35% of total UC costs (Total UC costs were defined as the sum of healthcare costs, productivity costs and out-of-pocket costs). Discussion A limited number of studies were identified describing the indirect costs in patients with moderate to severe UC. Insufficient data on different components of costs allowed a limited analysis on the impact of indirect costs in patients with UC. Further studies are needed to gain an understanding of the influence of UC on patients’ functional abilities.

Activity of Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis Predicts Poorer Clinical Outcomes

2020 ◽  
Vol 26 (12) ◽  
pp. 1901-1908 ◽  
Author(s):  
Matthew Peverelle ◽  
Sarang Paleri ◽  
Jed Hughes ◽  
Peter De Cruz ◽  
Paul J Gow
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
High Grade ◽  
Long Term Outcomes ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background The impact of inflammatory bowel disease (IBD) activity on long-term outcomes after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is unknown. We examined the impact of post-LT IBD activity on clinically significant outcomes. Methods One hundred twelve patients undergoing LT for PSC from 2 centers were studied for a median of 7 years. Patients were divided into 3 groups according to their IBD activity after LT: no IBD, mild IBD, and moderate to severe IBD. Patients were classified as having moderate to severe IBD if they met at least 1 of 3 criteria: (i) Mayo 2 or 3 colitis or Simple Endoscopic Score–Crohn’s Disease ≥7 on endoscopy; (ii) acute flare of IBD necessitating steroid rescue therapy; or (iii) post-LT colectomy for medically refractory IBD. Results Moderate to severe IBD at any time post-transplant was associated with a higher risk of Clostridium difficile infection (27% vs 8% mild IBD vs 8% no IBD; P = 0.02), colorectal cancer/high-grade dysplasia (21% vs 3% both groups; P = 0.004), post-LT colectomy (33% vs 3% vs 0%) and rPSC (64% vs 18% vs 20%; P &lt; 0.001). Multivariate analysis revealed that moderate to severe IBD increased the risk of both rPSC (relative risk [RR], 8.80; 95% confidence interval [CI], 2.81–27.59; P &lt; 0.001) and colorectal cancer/high-grade dysplasia (RR, 10.45; 95% CI, 3.55–22.74; P &lt; 0.001). Conclusions Moderate to severe IBD at any time post-LT is associated with a higher risk of rPSC and colorectal neoplasia compared with mild IBD and no IBD. Patients with no IBD and mild IBD have similar post-LT outcomes. Future prospective studies are needed to determine if more intensive treatment of moderate to severe IBD improves long-term outcomes in patients undergoing LT for PSC.

scholarly journals Long-term Cognitive Outcomes in Patients With Pediatric-Onset vs Adult-Onset Multiple Sclerosis

2019 ◽  
Vol 76 (9) ◽  
pp. 1028 ◽  
Author(s):  
Kyla A. McKay ◽  
Ali Manouchehrinia ◽  
Lindsay Berrigan ◽  
John D. Fisk ◽  
Tomas Olsson ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Outcomes ◽  
Adult Onset ◽  
Pediatric Onset

Peripheral Blood Eosinophilia and Long-term Severity in Pediatric-Onset Inflammatory Bowel Disease

2020 ◽  
Vol 26 (12) ◽  
pp. 1890-1900
Author(s):  
Krishnapriya Marangattu Prathapan ◽  
Claudia Ramos Rivers ◽  
Alyce Anderson ◽  
Filippos Koutroumpakis ◽  
Ioannis E Koutroubakis ◽  
...  
Keyword(s):  
Health Care ◽  
Natural History ◽  
Peripheral Blood ◽  
Care Utilization ◽  
Adult Onset ◽  
Blood Eosinophilia ◽  
Inflammatory Bowel ◽  
Peripheral Blood Eosinophilia ◽  
Pediatric Onset

Abstract Background Peripheral blood eosinophilia (PBE) is a biomarker of an aggressive multiyear natural history in adults with inflammatory bowel diseases (IBDs). Additionally, PBE at diagnosis is associated with higher disease activity in pediatric-onset IBD. We sought to determine if PBE can function as a biomarker of long-term disease severity in pediatric-onset IBD patients who are followed into adulthood. Methods We analyzed a consented, prospective, natural history IBD registry at an adult tertiary center from 2009 to 2018. Prevalence of PBE was evaluated in both pediatric- and adult-onset IBD patients. Demographics, clinical characteristics, and health care utilization data were compared in patients with and without PBE. Results Among 2800 adult IBD patients, 23.4% had pediatric-onset disease. PBE was found in 34% of the pediatric-onset patients compared with 26.8% of the adult-onset IBD patients (P &lt; 0.001). In the pediatric-onset IBD cohort, PBE was associated with higher rates of allergies (P &lt; 0.0001), but not of asthma, allergic rhinitis, or primary sclerosing cholangitis. In the adult IBD patients with pediatric-onset disease, PBE was associated with higher rates of C-reactive protein elevation (P &lt; 0.0001), erythrocyte sedimentation rate elevation (P &lt; 0.0001), higher health care utilization, and higher average health care charges per year (P &lt; 0.00001). Conclusions Peripheral blood eosinophilia was more prevalent in adult IBD patients with pediatric-onset compared with adult-onset disease. Among all IBD patients with long-term follow-up, PBE defined a subgroup with more severe illness. These data suggest that PBE may be a biomarker for a high-risk subgroup with high cost trajectory and long-term severity in pediatric-onset IBD that persists into adulthood.

The impact of skeletal muscle and adipose tissue on long-term survival in patients with resectable colorectal cancer.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 3585-3585
Author(s):  
Michael B. Sawyer ◽  
Jessica Hopkins ◽  
Rebecca Reif ◽  
David Bigam ◽  
Vickie E. Baracos ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

The impact of preoperative dexamethasone on long-term survival following surgery for colorectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 644-644
Author(s):  
Stephen Thomas McSorley ◽  
Bo Khor ◽  
Campbell SD Roxburgh ◽  
Paul G. Horgan ◽  
Donald C McMillan
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Cox Regression ◽  
Elective Surgery ◽  
Matched Cohort ◽  
Curative Intent ◽  
Term Survival ◽  
Negative Effect ◽  
The Impact

644 Background: Steroids given at the induction of anaesthesia are associated with a reduction in the magnitude of the postoperative systemic inflammatory response and fewer complications following elective surgery for colorectal cancer (McSorley et al. Ann Surg Oncol 2017;24(8):2104-2112). The present study examined their impact on survival. Methods: Patients who underwent elective surgery, with curative intent, for stage I-III colorectal cancer at a single centre between 2008 and 2016 were included. Data on preoperative dexamethasone was obtained from anaesthetic records, and its impact on cancer specific (CSS) and overall survival (OS) assessed using Cox regression in an unmatched (n=556) and a propensity score matched cohort (n=276) (Table 1). Results: After excluding postoperative mortalities (n=3), there were 98 deaths (18%), with 57 (10%) due to cancer. Of those alive at censoring, the median follow up was 47 months (range 16-110). In the unmatched cohort, there was no significant association between dexamethasone and CSS (HR 0.90, 95% CI 0.52-1.53, p=0.688) or OS (HR 0.95, 95% CI 0.63-1.43, p=0.804). In the propensity score matched cohort, there was no significant association between dexamethasone and CSS (HR 1.18, 95% CI 0.55-2.53, p=0.668) or OS (HR 1.21, 95% CI 0.67-2.17), p=0.532). Conclusions: These results suggest that whilst preoperative steroids are associated with improved short term outcomes following surgery for colorectal cancer, they have no negative effect on long term outcomes. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document