Inflammatory Bowel Disease in Maldives; A Single Center Clinical Experience

2021 ◽  
Vol 6 (1) ◽  
pp. 1363-1368
Author(s):  
Mohan Khadka
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Clinical Characteristics ◽  
Tertiary Hospital ◽  
Capital City ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Inflammatory Bowel

Introduction: Inflammatory bowel disease (IBD), once considered disease of west is also increasingly diagnosed in Asia in recent years. As there are already studies about IBD in Southeast Asia like India, Srilanka, it would be more informative to study the disease in Maldives as being closer to India and Srilanka. This is probably the first study about the disease from Maldives conducted in a single tertiary hospital center. The objectives of the study were to determine the prevalence, clinical characteristics and treatment of IBD in Maldives. Methodology: A preliminary hospital-based retrospective observational study was performed in ADK multispecialty hospital, a referral tertiary center located in the capital city of Maldives. Patients visiting gastroenterology OPD, who were diagnosed as IBD either Crohn's disease (CD) or Ulcerative colitis (UC) on basis of internationally established standard practice, were recruited in the study after informed oral consents for the duration of three years from January, 2017 to December, 2020. We collected clinical data including gender, age at diagnosis, symptomatology, severity, smoking habits, family history, disease phenotype, and behavior at diagnosis from each involved patients as per clinical proforma prepared for UC and Crohn's disease in separate forms. Result: Total 41 patients of IBD with 15 CD and 26 UC were recruited during study period. The prevalence of IBD in the country was estimated to be at least 20 per 100000 persons. Ileocolonic phenotype in CD and Extended colitis in UC were more common. Clinically, majority IBD patients presented with moderate to severe form. Biologic agents were frequently used in IBD. Conclusion: The prevalence of IBD in Maldives is also more or less similar to other Asian countries where as some aspects of clinical characteristics are similar to Western countries. There needs to be nationwide epidemiological study or multi center hospital based prospective or at least cross sectional study for detail and optimal information about various aspects of IBD. 

scholarly journals N01 Does physical activity positively impact fatigue in individuals with Inflammatory Bowel Disease?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S608-S608
Author(s):  
D Farrell ◽  
P Bager ◽  
F Bredin ◽  
V Cairnes ◽  
M Forry ◽  
...  
Keyword(s):  
Physical Activity ◽  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Cross Sectional ◽  
Objective Measurements ◽  
Inflammatory Bowel ◽  
Active Disease

Abstract Background Patients with Inflammatory Bowel Disease (IBD) often experience the problematic and burdensome symptom of fatigue, both during periods of relapse and remission. The optimal management of fatigue in IBD is uncertain, however there is evidence suggesting that physical activity is likely to be a beneficial way of managing the symptom. The aim of this study is to explore the relationship between fatigue and objective measurements of both physical activity metrics and varying intensities of physical activity for individuals with IBD. Methods A multi-centred, European, cross-sectional, correlational study was employed. A consecutive sample of 187 patients with Crohn’s disease (59%) or ulcerative colitis (41%) were recruited from six IBD centres in the Republic of Ireland (42%), United Kingdom (40%) and Denmark (18%). Fatigue was measured using the IBD-Fatigue (IBD-F) scale, including both the level of fatigue (IBD-F, Section 1) and impact of fatigue (IBD-F, Section 2). Physical activity was objectively measured using scientifically validated triaxial accelerometers (ActiGraph wGT3X-BT) during seven consecutive days. Results A moderate level of fatigue (IBD-F Section 1 Md (IQR) = 10 (6 – 13)), predominantly intermittent in nature (72%) was reported by participants (57.4% female; 59% Crohn’s disease; 43% active disease). Participants self-reported sleeping an average of 8.7 hours over the seven nights. During the week, the intensity of activity was predominantly sedentary (Md 5 days, 22 hours, 20 minutes) or light (Md 19 hours, 35 minutes). The median moderate-to-vigorous intensity of physical activity per day was 32.2 minutes and step count over the week was 47052 steps. There was no evidence of a unique linear or non-linear relationship between each of the objective measurements of physical activity with IBD-related fatigue. This lack of evidence extended separately to patients in remission and to patients with active disease. These findings are in the context of a statistically significant moderately-strong relationship between disease activity (measured using both HBI and SCCAI) and level of fatigue for both patients of Crohn’s disease (rs = .327, p = .001, n = 96) and ulcerative colitis (rs = .353, p = .003, n = 71). Conclusion This large multi-centred study shows no association between objective measurements of physical activity and IBD-fatigue. These findings suggest that engaging or not engaging in physical activity has no differential impact on self-assessment of fatigue.

scholarly journals Anemia in Crohn’s Disease—The Unseen Face of Inflammatory Bowel Disease

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1046
Author(s):  
Mihaela Dranga ◽  
Lucian Vasile Boiculese ◽  
Iolanda Popa ◽  
Mariana Floria ◽  
Oana Gavril ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Clinical Manifestations ◽  
World Health ◽  
Tertiary Center ◽  
Inflammatory Bowel ◽  
The Impact

Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact on QoL, mainly due to clinical manifestations, which are more severe during the periods of disease activity. Our aim was to estimate the impact of anemia on QoL in patients with Crohn’s disease. Material and Methods. We made a prospective study on 134 patients with Crohn’s disease (CD) in a Romanian tertiary center. The CD diagnosis was established by colonoscopy and histopathological examination. In particular cases, additional examinations were required (small bowel capsule endoscopy, computed tomography enterography, and magnetic resonance enterography). Anemia was defined according to the World Health Organization’s definition, the activity of the disease was assessed by Crohn’s disease activity index (CDAI) score, and the QoL was evaluated by Inflammatory Bowel Disease Questionnaire 32 (IBDQ 32). Results: 44.8% patient had anemia, statistically related to the activity of the disease and corticoids use. We found a strong association between QoL and disease activity on all four sub-scores: patients with more severe activity had a significantly lower IBDQ (260.38 ± 116.96 vs. 163.85 ± 87.20, p = 0.001) and the presence of anemia (127.03 vs. 148.38, p = 0.001). In multiple regression analyses, both disease activity and anemia had an impact on the QoL. Conclusions: Anemia has high prevalence in the CD in northeastern region of Romania. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease. Both anemia and disease activity had a strong negative and independent impact on QoL.

scholarly journals Risk of Vaccine-Preventable Infections in Swiss Adults with Inflammatory Bowel Disease

Digestion ◽  
2021 ◽  
pp. 1-9
Author(s):  
Laure F. Pittet ◽  
Charlotte M. Verolet ◽  
Pierre Michetti ◽  
Elsa Gaillard ◽  
Marc Girardin ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Immunosuppressive Treatment ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Varicella Zoster ◽  
Significant Difference ◽  
Inflammatory Bowel

<b><i>Background:</i></b> Patients with inflammatory bowel disease (IBD) have a higher risk of infection and are frequently not up to date with their immunizations. <b><i>Objectives:</i></b> This study aims to review vaccination status and evaluate whether age, disease type, or treatment regimen could predict the absence of seroprotection against selected vaccine-preventable infection in adults with IBD. <b><i>Methods:</i></b> Cross-sectional study using questionnaire, immunization records review, and assessment of tetanus-specific, varicella-specific, and measles-specific immunoglobulin G concentrations. ClinicalTrials.gov: NCT01908283. <b><i>Results:</i></b> Among the 306 adults assessed (median age 42.7 years old, 70% with Crohn’s disease, 78% receiving immunosuppressive treatment), only 33% had an immunization record available. Absence of seroprotection against tetanus (6%) was associated with increasing age and absence of booster dose; absence of seroprotection against varicella (1%) or measles (3%) was exclusively observed in younger patients with Crohn’s disease. There was no statistically significant difference in immunoglobulin concentrations among treatment groups. Although vaccinations are strongly recommended in IBD patients, the frequencies of participants with at least 1 dose of vaccine recorded were low for nearly all antigens: tetanus 94%, diphtheria 87%, pertussis 54%, poliovirus 22%, measles-mumps-rubella 47%, varicella-zoster 0%, <i>Streptococcus pneumoniae</i> 5%, <i>Neisseria meningitidis</i> 12%, hepatitis A 41%, hepatitis B 48%, human papillomavirus 5%, and tick-borne encephalitis 6%. <b><i>Conclusions:</i></b> Although many guidelines recommend the vaccination of IBD patients, disease prevention through immunization is still often overlooked, including in Switzerland, increasing their risk of vaccine-preventable diseases. Serological testing should be standardized to monitor patients’ protection during follow-up as immunity may wane faster in this population.

Evaluation of Clinical Characteristics and Knowledge in Inflammatory Bowel Disease Patients

2021 ◽  
Vol 10 (29) ◽  
pp. 2202-2207
Author(s):  
Sathya Prabha G. ◽  
Srinivasan N. ◽  
Manisenthil Kumar K.T. ◽  
Aravindh S.
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Clinical Characteristics ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Inflammatory Bowel

BACKGROUND Chronic conditions of Ulcerative Colitis and Crohn’s Disease with unknown aetiology and relapse were collectively known as inflammatory bowel disease (IBD). The occurrence of the disease in recent years has increased in developing countries like India with the higher rate of prevalence. The objective of the study was to evaluate the sociodemographic, clinical characteristics and knowledge in inflammatory bowel disease at a tertiary care hospital and also associate the variables with the disease and knowledge that was provided with pictorial education. Significantly, knowledge about the clinical condition and informational demands have hitherto not been studied in south India. METHODS This was an observational and nonrandomized study in 54 inflammatory bowel disease patients which was conducted from November 2018 to December 2019 at a tertiary care hospital. We obtained the patients sociodemographic and clinical characteristics through patient’s proforma and evaluated the patient’s disease knowledge using the validated questionnaire through direct interview method. Once after collecting the baseline information, patients were educated and provided with pictorial leaflets. RESULTS After the recruitment of 54 patients, there were 26 (48.6 %) ulcerative colitis patients and 28 (51.4 %) Crohn’s disease patients. Among inflammatory bowel disease patients, location of ulcerative colitis was maximum in pancolitis portion with mean of 16.00 ± 1.46 and the location of Crohn’s disease was maximum in ileac part with a mean of 15.91 ± 1.97. Insufficient knowledge of disease was observed during baseline visit but there was a slight improvement in the post visit after the pictorial education. The mean knowledge score during the baseline visit was 9.56 ± 3.26 and in the post visit period was 15.17 ± 1.16. CONCLUSIONS This study suggests that pictorial education may improve knowledge and empower the patients by reducing the risk of various complications of the disease, as increasing trend of the disease can be managed by better outcome with the healthcare members. KEY WORDS Inflammatory Bowel Disease (IBD), Sociodemographic Features, Clinical Characteristics and Knowledge

Localization and Activity of Inflammatory Bowel Disease Using 111ln Leukocyte Imaging

1988 ◽  
Vol 27 (03) ◽  
pp. 83-86 ◽  
Author(s):  
B. Briele ◽  
F. Wolf ◽  
H. J. Biersack ◽  
F. F. Knapp ◽  
A. Hotze
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Cell Uptake ◽  
Disease Extent ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Leukocyte Imaging

A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of 111ln-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn’s disease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn’s disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

Prebiotics and Probiotics in Inflammatory Bowel Disease: Where are we now and where are we going?

2020 ◽  
Vol 15 (3) ◽  
pp. 216-233 ◽  
Author(s):  
Maliha Naseer ◽  
Shiva Poola ◽  
Syed Ali ◽  
Sami Samiullah ◽  
Veysel Tahan
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Clinical Trials ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Effects ◽  
Bowel Disease ◽  
Relapse Prevention ◽  
Remission Induction ◽  
Inflammatory Bowel

The incidence, prevalence, and cost of care associated with diagnosis and management of inflammatory bowel disease are on the rise. The role of gut microbiota in the causation of Crohn's disease and ulcerative colitis has not been established yet. Nevertheless, several animal models and human studies point towards the association. Targeting intestinal dysbiosis for remission induction, maintenance, and relapse prevention is an attractive treatment approach with minimal adverse effects. However, the data is still conflicting. The purpose of this article is to provide the most comprehensive and updated review on the utility of prebiotics and probiotics in the management of active Crohn’s disease and ulcerative colitis/pouchitis and their role in the remission induction, maintenance, and relapse prevention. A thorough literature review was performed on PubMed, Ovid Medline, and EMBASE using the terms “prebiotics AND ulcerative colitis”, “probiotics AND ulcerative colitis”, “prebiotics AND Crohn's disease”, “probiotics AND Crohn's disease”, “probiotics AND acute pouchitis”, “probiotics AND chronic pouchitis” and “prebiotics AND pouchitis”. Observational studies and clinical trials conducted on humans and published in the English language were included. A total of 71 clinical trials evaluating the utility of prebiotics and probiotics in the management of inflammatory bowel disease were reviewed and the findings were summarized. Most of these studies on probiotics evaluated lactobacillus, De Simone Formulation or Escherichia coli Nissle 1917 and there is some evidence supporting these agents for induction and maintenance of remission in ulcerative colitis and prevention of pouchitis relapse with minimal adverse effects. The efficacy of prebiotics such as fructooligosaccharides and Plantago ovata seeds in ulcerative colitis are inconclusive and the data regarding the utility of prebiotics in pouchitis is limited. The results of the clinical trials for remission induction and maintenance in active Crohn's disease or post-operative relapse with probiotics and prebiotics are inadequate and not very convincing. Prebiotics and probiotics are safe, effective and have great therapeutic potential. However, better designed clinical trials in the multicenter setting with a large sample and long duration of intervention are needed to identify the specific strain or combination of probiotics and prebiotics which will be more beneficial and effective in patients with inflammatory bowel disease.

scholarly journals The Changing Prognosis of Ulcerative Colitis and Crohn’s Disease by Decades

2021 ◽  
Author(s):  
Burton I Korelitz ◽  
Judy Schneider
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
Inflammatory Bowel

Abstract We present a bird’s eye view of the prognosis for both ulcerative colitis and Crohn’s disease as contained in the database of an Inflammatory Bowel Disease gastroenterologist covering the period from 1950 until the present utilizing the variables of medical therapy, surgical intervention, complications and deaths by decades.

scholarly journals Leucine-rich alpha-2 glycoprotein is a potential biomarker to monitor disease activity in inflammatory bowel disease receiving adalimumab: PLANET study

2021 ◽  
Author(s):  
Shinichiro Shinzaki ◽  
Katsuyoshi Matsuoka ◽  
Hiroki Tanaka ◽  
Fuminao Takeshima ◽  
Shingo Kato ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Fecal Calprotectin ◽  
Potential Biomarker ◽  
Adalimumab Therapy ◽  
Adalimumab Treatment ◽  
Inflammatory Bowel

Abstract Background This multicenter prospective study (UMIN000019958) aimed to evaluate the usefulness of serum leucin-rich alpha-2 glycoprotein (LRG) levels in monitoring disease activity in inflammatory bowel disease (IBD). Methods Patients with moderate-to-severe IBD initiated on adalimumab therapy were enrolled herein. Serum LRG, C-reactive protein (CRP), and fecal calprotectin (fCal) levels were measured at week 0, 12, 24, and 52. Colonoscopy was performed at week 0, 12, and 52 for ulcerative colitis (UC), and at week 0, 24, and 52 for Crohn’s disease (CD). Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn’s Disease (SES-CD) for CD and the Mayo endoscopic subscore (MES) for UC. Results A total of 81 patients was enrolled. Serum LRG levels decreased along with improvements in clinical and endoscopic outcomes upon adalimumab treatment (27.4 ± 12.6 μg/ml at week 0, 15.5 ± 7.7 μg/ml at week 12, 15.7 ± 9.6 μg/ml at week 24, and 14.5 ± 6.8 μg/ml at week 52), being correlated with endoscopic activity at each time point (SES-CD: r = 0.391 at week 0, r = 0.563 at week 24, r = 0.697 at week 52; MES: r = 0.534 at week 0, r = 0.429 at week 12, r = 0.335 at week 52). Endoscopic activity better correlated with LRG compared to CRP and fCal on pooled analysis at all time points (SES-CD: LRG: r = 0.636, CRP: r = 0.402, fCal: r = 0.435; MES: LRG: r = 0.568, CRP: 0.389, fCal: r = 0.426). Conclusions Serum LRG is a useful biomarker of endoscopic activity both in CD and UC during the adalimumab treatment.

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