The COVID-19 Vaccination Hesitancy Among the People With Inflammatory Bowel Disease in China: A Questionnaire Study

Objective: To explore the attitudes and views of patients with inflammatory bowel disease (IBD) on COVID-19 vaccination.Methods: An online interview questionnaire concerning the acceptance or hesitancy toward vaccination for COVID-19 was designed and 543 patients with IBD in China were invited to complete the structured self-administered anonymous questionnaire.Results: Of all the participants, 50.7% were indecisive about the vaccination and only 16.0% opted for it. Vaccination hesitancy was significantly associated with women and those without medical or biomedical backgrounds. The acceptance of COVID-19 vaccination was higher in participants with no history of immune-modifying therapies, especially in those without immunosuppressants. Participants who considered vaccination critically important to self-health or the health of others were more likely to choose immediately or later vaccination. Safety and potential adverse reactions, personal hypoimmunity, efficacy, and reliability of COVID-19 vaccines were the top three concerns of the participants that were independent of their willingness for vaccination.Conclusions: This study discloses the presence of hesitancy for COVID-19 vaccination in patients with IBD. Further studies are warranted to evaluate the efficacy and safety of COVID-19 vaccines in IBD individuals, with a specific focus on the impact of immune-modifying therapies. Health education and recommendation from authoritative sources may facilitate COVID-19 vaccination efforts.

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P667 Characterization of a large Hispanic cohort with Inflammatory Bowel Disease across a 25-year span

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.787 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S591-S591

Author(s):

E A Torres ◽

L Ramos ◽

A Sanchez ◽

C Amaya ◽

A Perez-Gilbe

Keyword(s):

Inflammatory Bowel Disease ◽

Family History ◽

Bowel Disease ◽

Age At Onset ◽

Chi Square ◽

Physician Awareness ◽

History Of ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Inflammatory Bowel Disease (IBD) in Hispanics has increased, but characterization of this population is limited. We describe the demographic and clinical characteristics of a large Hispanic population with IBD and compare it among two periods, 1995- 2009 and 2010–2019. Methods The Registry of IBD has been recruiting patients with IBD continuously since 1995. Data is obtained from the subject and the medical record. This study includes 1365 Hispanics recruited between 1995 and 2019. Variables include age, gender, age at onset and diagnosis, IBD type, family history, smoking, extraintestinal manifestations (EIM), medications, and surgery for IBD. Descriptive statistics included frequency, median, mean, and standard deviation. SPSS software was used for comparison analysis utilizing Chi square and Fisher′s test. The protocol is approved by the IRB. Results 712 were males and 653 females. Crohn’s disease (CD) was more prevalent in males (479/836, 57.3%) and ulcerative colitis (UC) in females (288/517, 55.7%). The mean age at diagnosis was 34.1 + 15.4 for UC and 24.4 + 12 for CD (p<.001). History of smoking was infrequent (24.3%). Interval between onset of symptoms and diagnosis was 1.8 + 4.7 yrs. for UC and 2.5 + 5.3 yrs. for CD (p=.012). At recruitment, duration of disease was 7.4 + 8.4 yrs. for UC and 5.6 + 7.3 yrs. for CD (p<.001). Family history of IBD was present in 23% of CD and UC participants. The most frequent EIM was arthropathy in 37.9% and 25.9 % of UC and CD (p=.670), followed by skin manifestations in 13.2% and 18.9% respectively (p=.070). Aminosalicylates (94.9%) and corticosteroids (81.6%) were more frequent in UC, and immunomodulators (23%) and anti-TNF drugs (aTNF) (46.2%) in CD (p<.001). At the time of recruitment, 54.5% of CD and 23.7% of UC patients had previous surgery for IBD. Stratification of subjects into two groups by date of recruitment,1995–2009 and 2010–2019, showed similar ages at onset and diagnosis, but the time to diagnosis decreased for UC (2 vs 1.55 yrs.) and increased for CD (2.2 vs 2.6 yrs.) in the later interval. Medications varied between decades, with aTNF increasing markedly in CD and UC (p<.001) and aminosalicylates decreasing in CD (p<.001) in the later years. Surgery for UC decreased from 25.2% to 20.7%, whereas surgery for CD remained the same (52.2% vs 52.5%). Conclusion We describe a large cohort of Hispanics with IBD studied over two decades. Differences over time may reflect changes in disease phenotypes, environmental influences and the impact of physician awareness and new management guidelines and therapies. Further studies are needed to better characterize this population and explore outcomes.

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Cannabis and Cannabis Derivatives for Abdominal Pain Management in Inflammatory Bowel Disease

Medical Cannabis and Cannabinoids ◽

10.1159/000517425 ◽

2021 ◽

pp. 1-10

Author(s):

Kaleb Bogale ◽

Wesley Raup-Konsavage ◽

Shannon Dalessio ◽

Kent Vrana ◽

Matthew D. Coates

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Clinical Setting ◽

Bowel Disease ◽

Pain Perception ◽

Visceral Pain ◽

Human Studies ◽

History Of ◽

Inflammatory Bowel ◽

The Impact

For centuries, cannabis and its components have been used to manage a wide variety of symptoms associated with many illnesses. Gastrointestinal (GI) diseases are no exception in this regard. Individuals suffering from inflammatory bowel disease (IBD) are among those who have sought out the ameliorating properties of this plant. As legal limitations of its use have eased, interest has grown from both patients and their providers regarding the potential of cannabis to be used in the clinical setting. Similarly, a growing number of animal and human studies have been undertaken to evaluate the impact of cannabis and cannabinoid signaling elements on the natural history of IBD and its associated complications. There is little clinical evidence supporting the ability of cannabis or related products to treat the GI inflammation underlying these disorders. However, 1 recurring theme from both animal and human studies is that these agents have a significant impact on several IBD-related symptoms, including abdominal pain. In this review, we discuss the role of cannabis and cannabinoid signaling in visceral pain perception, what is currently known regarding the efficacy of cannabis and its derivatives for managing pain, related symptoms and inflammation in IBD, and what work remains to effectively utilize cannabis and its derivatives in the clinical setting.

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Novel trends with biologics in inflammatory bowel disease: sequential and combined approaches

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211006669 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110066

Author(s):

Giuseppe Privitera ◽

Daniela Pugliese ◽

Loris Riccardo Lopetuso ◽

Franco Scaldaferri ◽

Matteo Neri ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Current Knowledge ◽

New Drugs ◽

Management Algorithm ◽

History Of Disease ◽

History Of ◽

Complex Landscape ◽

Inflammatory Bowel ◽

The Impact

Inflammatory bowel disease (IBD) management has changed dramatically over the past 20 years, after the introduction of targeted biological therapies. However, the impact of these new drugs in changing the natural history of disease is still under debate. Recent evidence seems to suggest that the extent of their efficacy might be, at least partially, dependent on the timing of their introduction and on the subsequent management strategy. In this complex landscape, the potential role for a more dynamic approach with treatments based on sequencing and combining targeted therapies has been explored only minimally so far. In this review, we aim to explore the potential biological rationale behind the use of sequential and combination therapies in IBD, to summarise the current knowledge on this topic and to propose a management algorithm that combines these notions.

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The impact of inflammatory bowel disease on hard teeth tissues – preliminary results from POLIBD study

10.26226/morressier.59a6b34bd462b80290b5599d ◽

2017 ◽

Author(s):

Rafa Filip

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Preliminary Results ◽

Inflammatory Bowel ◽

The Impact

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Exploitation of Marine-Derived Robust Biological Molecules to Manage Inflammatory Bowel Disease

Marine Drugs ◽

10.3390/md19040196 ◽

2021 ◽

Vol 19 (4) ◽

pp. 196

Author(s):

Muhammad Bilal ◽

Leonardo Vieira Nunes ◽

Marco Thúlio Saviatto Duarte ◽

Luiz Fernando Romanholo Ferreira ◽

Renato Nery Soriano ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bioactive Compounds ◽

Bowel Disease ◽

Clinical Translation ◽

Biologically Active ◽

Naturally Occurring ◽

Inflammatory Bowel ◽

Functional Features ◽

Biological Entities ◽

The Impact

Naturally occurring biological entities with extractable and tunable structural and functional characteristics, along with therapeutic attributes, are of supreme interest for strengthening the twenty-first-century biomedical settings. Irrespective of ongoing technological and clinical advancement, traditional medicinal practices to address and manage inflammatory bowel disease (IBD) are inefficient and the effect of the administered therapeutic cues is limited. The reasonable immune response or invasion should also be circumvented for successful clinical translation of engineered cues as highly efficient and robust bioactive entities. In this context, research is underway worldwide, and researchers have redirected or regained their interests in valorizing the naturally occurring biological entities/resources, for example, algal biome so-called “treasure of untouched or underexploited sources”. Algal biome from the marine environment is an immense source of excellence that has also been demonstrated as a source of bioactive compounds with unique chemical, structural, and functional features. Moreover, the molecular modeling and synthesis of new drugs based on marine-derived therapeutic and biological cues can show greater efficacy and specificity for the therapeutics. Herein, an effort has been made to cover the existing literature gap on the exploitation of naturally occurring biological entities/resources to address and efficiently manage IBD. Following a brief background study, a focus was given to design characteristics, performance evaluation of engineered cues, and point-of-care IBD therapeutics of diverse bioactive compounds from the algal biome. Noteworthy potentialities of marine-derived biologically active compounds have also been spotlighted to underlying the impact role of bio-active elements with the related pathways. The current review is also focused on the applied standpoint and clinical translation of marine-derived bioactive compounds. Furthermore, a detailed overview of clinical applications and future perspectives are also given in this review.

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SAT0462 ASSESSMENT OF BONE MINERAL DENSITY IN INFLAMMATORY BOWEL DISEASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6007 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1188.1-1188

Author(s):

C. Daldoul ◽

N. El Amri ◽

K. Baccouche ◽

H. Zeglaoui ◽

E. Bouajina

Keyword(s):

Bone Mineral Density ◽

Inflammatory Bowel Disease ◽

Bone Mineral ◽

Bowel Disease ◽

Mineral Density ◽

Femoral Site ◽

Significant Difference ◽

History Of ◽

Inflammatory Bowel ◽

The Mean

Background:Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is considered as a risk factor of low bone mineral density (BMD). In fact, the prevalence of osteoporosis ranges from 17% to 41% in IBD patients. The possible contributing factors may include malabsorption, glucocorticoid treatment and coexisting comorbiditiesObjectives:The purpose of our work was to determine the frequency and the determinants of osteoporosis in patients with IBD and to assess whether there is a difference in BMD status between UC and CD.Methods:This is a retrospective study, over a period of 5 years (from January 2014 to December 2018) and including patients followed for IBD who had a measurement of BMD by DEXA. Clinical, anthropometric and densitometric data (BMD at the femoral and vertebral site) were recorded. The WHO criteria for the definition of osteoporosis and osteopenia were applied.Results:One hundred and five patients were collected; among them 45 were men and 60 were women. The average age was 45.89 years old. The average body mass index (BMI) was 25.81 kg/m2 [16.44-44.15]. CD and UC were diagnosed in respectively 57.1% and 42.9%. A personal history of fragility fracture was noted in 4.8%. Hypothyroidism was associated in one case. Early menopause was recorded in 7.6%. 46.8% patients were treated with corticosteroids. The mean BMD at the vertebral site was 1.023 g/cm3 [0.569-1.489 g/cm3]. Mean BMD at the femoral site was 0.920g/cm3 [0.553-1.286g / cm3]. The mean T-score at the femoral site and the vertebral site were -1.04 SD and -1.27 SD, respectively. Osteoporosis was found in 25.7% and osteopenia in 37.1%. Osteoporosis among CD and UC patients was found in respectively 63% and 37%. The age of the osteoporotic patients was significantly higher compared to those who were not osteoporotic (52.23 vs 43.67 years, p = 0.01). We found a significantly higher percentage of osteoporosis among men compared to women (35.6% vs 18.3%, p=0.046). The BMI was significantly lower in the osteoporotic patients (23.87 vs 26.48 kg/m2, p=0.035) and we found a significant correlation between BMI and BMD at the femoral site (p=0.01). No increase in the frequency of osteoporosis was noted in patients treated with corticosteroids (27.9% vs 21.6%, p=0.479). Comparing the UC and CD patients, no difference was found in baseline characteristics, use of steroids or history of fracture. No statistically significant difference was found between UC and CD patients for osteoporosis(p=0.478), BMD at the femoral site (p=0.529) and at the vertebral site (p=0.568).Conclusion:Osteoporosis was found in 25.7% of IBD patients without any difference between CD and UC. This decline does not seem to be related to the treatment with corticosteroids but rather to the disease itself. Hence the interest of an early screening of this silent disease.Disclosure of Interests:None declared

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A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.100 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 77-79

Author(s):

Y Hanna ◽

P Tandon ◽

V W Huang

Keyword(s):

Inflammatory Bowel Disease ◽

Disease Activity ◽

Bowel Disease ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Categorical Variables ◽

History Of ◽

Inflammatory Bowel ◽

Adverse Pregnancy ◽

Aspirin Prophylaxis

Abstract Background Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established. Aims To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention. Methods All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin > 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant. Results 127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception. Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005). 13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830). Conclusions Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding. Funding Agencies None

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GUT-DIRECTED SELF-HYPNOSIS FOR INFLAMMATORY BOWEL DISEASE PROTOCOL: COMPLIMENTARY PSYCHOTHERAPY FOR REMISSION AUGMENTATION, IBS-LIKE SYMPTOMS, AND SURGERY RECOVERY

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.126 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S53-S53

Author(s):

Joshua Paulton ◽

Amanjot Gill ◽

Joelle Prevost

Keyword(s):

Inflammatory Bowel Disease ◽

Stress Response ◽

Mechanism Of Action ◽

Bowel Disease ◽

Relaxation Techniques ◽

Markers Of Inflammation ◽

Post Surgery ◽

Patient Goals ◽

History Of ◽

Inflammatory Bowel

Abstract Background Gut-directed hypnosis (GDH) is a complimentary therapy for Inflammatory Bowel Disease (IBD), that can be learnt by patients to practice self-hypnosis. GDH in IBD has augmented remission and improved inflammation. GDH has a history of successful use for Irritable Bowel Syndrome (IBS). In IBD it may also improve IBS-like symptoms in remission and recovery from surgery. GDH is suitable for youth and adult IBD patients. In hypnosis, a relaxed state is inducted then suggestions to subconscious mind processes are made. In IBD, the mechanism of action of GDH is unknown but may influence the disease stress response. Aims Aims are the development of a GDH self-hypnosis protocol for IBD, with appropriate target symptoms. Patients first learn to practice with a clinician, then as complimentary psychotherapy for remission augmentation, IBS-like symptoms, and surgery recovery. Methods GDH is practiced first with a clinician, and then by patients as self-hypnosis (table 1). Patients receive psycho-education on GDH for IBD. Next, appropriate treatment goals are made, based on target symptoms. Relaxation techniques induce patient to a deeply relaxed state. Therapeutic suggestions specific to patient goals are given: verbal suggestions, visualizations, and post-hypnotic suggestions. Suggestions can focus on having a healthy digestive system, inflammation and symptoms reduction, and achievement and sustainment of remission. Patients emerge from hypnosis, are debriefed, and encouraged to practice ongoing self-hypnosis. Results In IBD, GDH self-hypnosis can be learnt from clinicians and practiced by patients as a complimentary therapy. Patients’ achievement and sustainment of remission, with clinical markers of inflammation can be monitored. Patients can monitor subjective improvement of IBS-like symptoms and post surgery, recovery progress can be monitored. Conclusions GDH has a history of use for IBS. In IBD, it has been shown to modulate remission, and may improve IBS-like symptoms, and in surgery recovery. The mechanism of action of GDH in IBD may influence the disease stress response. Clinicians trained in GDH are limited currently. Patients may learn GDH self- hypnosis to as a complimentary psychotherapy.

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Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000786 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000786

Author(s):

Abbie Maclean ◽

James J Ashton ◽

Vikki Garrick ◽

R Mark Beattie ◽

Richard Hansen

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Delayed Diagnosis ◽

High Standard ◽

Current Evidence ◽

Faecal Calprotectin ◽

Paediatric Patients ◽

Inflammatory Bowel ◽

Working Practices ◽

The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

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