scholarly journals Prevalence, Risk Factors and Course of Osteoporosis in Patients with Crohn’s Disease at a Tertiary Referral Center

2019 ◽  
Vol 8 (12) ◽  
pp. 2178 ◽  
Author(s):  
Peter Hoffmann ◽  
Johannes Krisam ◽  
Christian Kasperk ◽  
Annika Gauss
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Categorical Variables ◽  
Primary Study ◽  
Mineral Density ◽  
Steroid Use ◽  
Factors Influencing ◽  
Increased Risk ◽  
Male Sex

Background: Patients with Crohn’s disease are at increased risk for fractures due to low bone mineral density (BMD). Real-world data are necessary to optimize surveillance and treatment strategies. Methods: Patients with Crohn’s disease who underwent at least one dual-energy X-ray absorptiometry (DXA) scans were recruited. The primary study endpoints were (1) prevalence of osteoporosis, and (2) factors influencing changes of BMD. To identify potential risk factors for reduced BMD, Mann–Whitney U-test was used for ordinal and continuous variables and x²-tests for categorical variables. Results with p < 0.05 were included in a multivariable analysis. To identify potential factors influencing changes in BMD, a generalized linear mixed model was applied. Results: 39.9% of the patients were diagnosed with normal BMD, 40.2% with osteopenia, and 19.8% with osteoporosis. The main risk factors for osteoporosis were low body mass index (BMI), previous bowel resections and male sex. The main risk factors for reduced BMD during further along the disease course were steroid use, history of immunomodulator treatment, female sex and decreased BMI. Conclusion: Low BMI, previous bowel resections and male sex were the main risk factors for the development of osteoporosis. Steroid use reduced BMD even under anti-inflammatory therapy, underlining that they should be used with great care in that patient group.

scholarly journals COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors

2021 ◽  
Vol 36 (3) ◽  
pp. 299-309 ◽  
Author(s):  
Joshua Elliott ◽  
Barbara Bodinier ◽  
Matthew Whitaker ◽  
Cyrille Delpierre ◽  
Roel Vermeulen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Vitamin D ◽  
Regression Models ◽  
Oral Steroid ◽  
Uk Biobank ◽  
Steroid Use ◽  
Increased Risk ◽  
Male Sex

AbstractMost studies of severe/fatal COVID-19 risk have used routine/hospitalisation data without detailed pre-morbid characterisation. Using the community-based UK Biobank cohort, we investigate risk factors for COVID-19 mortality in comparison with non-COVID-19 mortality. We investigated demographic, social (education, income, housing, employment), lifestyle (smoking, drinking, body mass index), biological (lipids, cystatin C, vitamin D), medical (comorbidities, medications) and environmental (air pollution) data from UK Biobank (N = 473,550) in relation to 459 COVID-19 and 2626 non-COVID-19 deaths to 21 September 2020. We used univariate, multivariable and penalised regression models. Age (OR = 2.76 [2.18–3.49] per S.D. [8.1 years], p = 2.6 × 10–17), male sex (OR = 1.47 [1.26–1.73], p = 1.3 × 10–6) and Black versus White ethnicity (OR = 1.21 [1.12–1.29], p = 3.0 × 10–7) were independently associated with and jointly explanatory of (area under receiver operating characteristic curve, AUC = 0.79) increased risk of COVID-19 mortality. In multivariable regression, alongside demographic covariates, being a healthcare worker, current smoker, having cardiovascular disease, hypertension, diabetes, autoimmune disease, and oral steroid use at enrolment were independently associated with COVID-19 mortality. Penalised regression models selected income, cardiovascular disease, hypertension, diabetes, cystatin C, and oral steroid use as jointly contributing to COVID-19 mortality risk; Black ethnicity, hypertension and oral steroid use contributed to COVID-19 but not non-COVID-19 mortality. Age, male sex and Black ethnicity, as well as comorbidities and oral steroid use at enrolment were associated with increased risk of COVID-19 death. Our results suggest that previously reported associations of COVID-19 mortality with body mass index, low vitamin D, air pollutants, renin–angiotensin–aldosterone system inhibitors may be explained by the aforementioned factors.

Special Considerations of Anastomotic Leaks in Crohn's Disease

2021 ◽  
Author(s):  
N. Nimalan A. Jeganathan ◽  
Walter A. Koltun
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Characteristics ◽  
Biologic Therapy ◽  
Published Data ◽  
Significant Heterogeneity ◽  
Steroid Use ◽  
Septic Complications ◽  
Increased Risk ◽  
Inflammatory Bowel

AbstractRates of anastomotic leak following intestinal resections in the setting of inflammatory bowel disease are significantly influenced by clinical characteristics. While the literature can be contradictory due to significant heterogeneity in the published data, several common themes appear to consistently arise. With respect to Crohn's disease, low serum albumin, preoperative abscess, reoperative abdominal surgery, and steroid use are associated with an increased risk of postoperative intra-abdominal septic complications. On the contrary, biologic therapy, immunomodulator use, and method of anastomosis appear not to confer increased anastomotic-related complications. Undoubtedly, a low rate of anastomotic leakage is inherent to procedures within colorectal surgery but diligent attention must be paid to identify, optimize, and, therefore, reduce known risks.

119 Crohn's Disease, Surgery and Male Sex Are Risk Factors for Radiation Exposure in Patients with Inflammatory Bowel Disease

2008 ◽  
Vol 134 (4) ◽  
pp. A-20
Author(s):  
Zohar Levi ◽  
Rivka Krongrad ◽  
Rachel Hazazi ◽  
Ofer Benjaminov ◽  
Joseph Meyerovitch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Radiation Exposure ◽  
Bowel Disease ◽  
Inflammatory Bowel ◽  
Male Sex

scholarly journals Fractal-Based Analysis of Bone Microstructure in Crohn’s Disease: A Pilot Study

2020 ◽  
Vol 9 (12) ◽  
pp. 4116
Author(s):  
Judith Haschka ◽  
Daniel Arian Kraus ◽  
Martina Behanova ◽  
Stephanie Huber ◽  
Johann Bartko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bone Loss ◽  
Bone Structure ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Mineral Density ◽  
Glucocorticoid Treatment ◽  
History Of

Crohn’s disease (CD) is associated with bone loss and increased fracture risk. TX-Analyzer™ is a new fractal-based technique to evaluate bone microarchitecture based on conventional radiographs. The aim of the present study was to evaluate the TX-Analyzer™ of the thoracic and lumbar spine in CD patients and healthy controls (CO) and to correlate the parameters to standard imaging techniques. 39 CD patients and 39 age- and sex-matched CO were analyzed. Demographic parameters were comparable between CD and CO. Bone structure value (BSV), bone variance value (BVV) and bone entropy value (BEV) were measured at the vertebral bodies of T7 to L4 out of lateral radiographs. Bone mineral density (BMD) and trabecular bone score (TBS) by dual energy X-ray absorptiometry (DXA) were compared to TX parameters. BSV and BVV of the thoracic spine of CD were higher compared to controls, with no difference in BEV. Patients were further divided into subgroups according to the presence of a history of glucocorticoid treatment, disease duration > 15 years and bowel resection. BEV was significantly lower in CD patients with these prevalent risk factors, with no differences in BMD at all sites. Additionally, TBS was reduced in patients with a history of glucocorticoid treatment. Despite a not severely pronounced bone loss in this population, impaired bone quality in CD patients with well-known risk factors for systemic bone loss was assessed by TX-Analyzer™.

Risk factors for low bone mineral density in children and young adults with Crohn’s disease

1999 ◽  
Vol 135 (5) ◽  
pp. 593-600 ◽  
Author(s):  
Edisio J. Semeao ◽  
Abbas F. Jawad ◽  
Nicole O. Stouffer ◽  
Babette S. Zemel ◽  
David A. Piccoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Young Adults ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bone Mineral ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Children And Young Adults

scholarly journals P651 Diagnostic delay, effectiveness and safety outcomes in a real-world cohort of patients with Crohn’s disease: data from administrative databases in Tuscany, Italy

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S582-S582
Author(s):  
L Bertani ◽  
S Ferraro ◽  
C Bartolini ◽  
I Convertino ◽  
S Giometto ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Real World ◽  
Diagnostic Delay ◽  
Administrative Databases ◽  
Categorical Variables ◽  
Ileocecal Resection ◽  
Increased Risk ◽  
Safety Outcomes ◽  
Biologic Drug

Abstract Background Diagnostic delay (DD) of Crohn’s disease (CD) is poorly investigated in the real-world setting, and could affect significantly the outcome of CD. The aim of the present study was to quantify the possible DD of CD in CD patients in Tuscany region of Italy, evaluating effectiveness and safety outcomes in CD patients with DD. Methods We conducted a retrospective cohort study on data extracted from administrative databases of Tuscany. We included patients &gt;18 years old (yo) with a record of ICD-9 diagnosis for CD or disease exemption or a dispensation of oral budesonide from 6/1/2011 to 6/30/2016 (index date, ID) whichever came first. Patients with a look-back period (time before ID) &lt; 5 y and follow-up (FUP) &lt; 3 y were excluded. Patients with at least one Emergency Department (ED) access or hospitalisation for gastrointestinal causes in the lookback period (excluding 6 months before ID) could have a possible DD. DD was classified in short (up to 18 months) and long (up to 60 months). We performed survival analyses (Kaplan-Meier curves) for effectiveness (time free from the first: dispensation of azathioprine, biologic drug and ileocecal resection surgery) and safety outcomes (time free from first: ED access and/or hospitalization for any cause). Hazard ratio (HR) was calculated by using Cox models adjusted for age, gender and number of concomitant drugs in the month before ID. Both outcomes were evaluated for dichotomous (No DD and DD) and categorical variables of DD (No DD, short DD and long DD). Results Among 3342 CD patients, 584 (17,5%) had a suspected DD: 212 and 372 patients had short and long DD, respectively, p&lt;0.001. The effectiveness analysis revealed that about the 20% of patients with long DD were treated with a biologic within 3 years, as compared with those with short DD or no DD (10%), p=0.0007. The adjusted (a)HR for biologic drug was 1.30 (Confidence Interval, CI 95%: 1.12–1.56) for patients with long DD and 1.02 (CI 95%:0.82–1.30) for those with short DD. No significant aHRs were found for the other effectiveness outcomes. The safety analysis showed that 75% of patients with DD had first ED access or hospitalization for any causes with the FUP, as compared with those without (about 60%), p&lt;0.001. The aHR showed an increased risk for safety outcomes in patients with DD: 1.71 (CI 95%:1.61–1.91) for the ED accesses, 1.31 (CI 95%:1.19–1.49) for hospitalization, and 1.54 (CI 95%:1.41–1.71) for the composite outcome. Conclusion More than 17% of patients had a putative DD (mostly long DD). A risk of treatment with biologic drug, ED accesses and hospitalizations for any cause was found for patients with DD compared with those timely diagnosed.

scholarly journals Longer Diagnosis-surgery Duration Is Associated With an Increased Risk of Early Postoperative Complications for Crohn's Disease: A Retrospective Study

2021 ◽  
Author(s):  
Xuanyi Chen ◽  
Siqi Zhang ◽  
Fanru Shen ◽  
Yuan Shi ◽  
Sailiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Crohn’S Disease ◽  
Retrospective Study ◽  
Crohn's Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Early Postoperative Complications ◽  
Increased Risk ◽  
Surgery Duration

Abstract Background: Early postoperative complications(ePOCs) frequently occur in Crohn’s patients after surgery. The risk factors of ePOCs for Crohn’s disease (CD), however, remain controversial. We aimed to assess the incidence and risk factors of ePOCs in CD patients after surgical resection.Methods: The retrospective study was conducted on 97 patients undergoing surgeries between January 2010 and September 2019 for Crohn’s disease in a tertiary hospital in China. Results: In total, 33 patients (34.0%) experienced ePOCs, including 11 intra-abdominal septic complications (11.3%) and 1 postoperative death (1.0%). Severe complications (Dindo–Clavien III–IV) were seen in 8 patients (8.2%). In multivariate analysis, diagnosis-surgery duration exceeding 6 months(odds-ratio [OR]=4.07; confidence interval [CI] 95%[1.10-15.09], P=0.036), serum platelet count <300*1000/mm3(odds-ratio [OR]=6.74; confidence interval [CI] 95%[1.58-28.71], P=0.01) and serum gamma-glutamyl transpeptidase(GGT) level >10U/L(odds-ratio [OR]=9.22; confidence interval [CI] 95%[1.23-68.99], P=0.031)were identified as independent risk factors for ePOCs. Preoperative exposure to anti-tumor necrosis factor (TNF) agents (P=1.00) were not associated with a higher risk of ePOCs. 34.0% of CD patients developed ePOCs after surgical resection.Conclusions: Diagnosis-surgery duration exceeding 6 months, serum platelet count <300*1000/mm3, and serum GGT level >10U/L were associated with an increased risk of ePOCs. Preoperative exposure to anti-TNF agents were not associated with a higher risk of ePOCs.

Risk Factors for Postpartum Disease Activity in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Gurpreet Malhi ◽  
Parul Tandon ◽  
Jonah Wiseman Perlmutter ◽  
Geoffrey Nguyen ◽  
Vivian Huang
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Mode Of Delivery ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Women with inflammatory bowel disease (IBD) have an increased risk of postpartum disease activity. We aimed to systematically determine the effect of various risk factors on postpartum IBD disease activity. Methods Electronic databases were searched through January 2021 for studies that reported risk of postpartum disease activity in women with IBD. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the impact of IBD phenotype, disease activity, therapy de-escalation, mode of delivery, and breastfeeding on postpartum disease activity. Study bias was determined using the Quality in Prognostic Studies tool. Results Twenty-seven observational studies (3825 patients) were included, 15 of which had a high risk of confounding bias. The pooled incidence of women with postpartum active IBD was 31.9% (95% CI, 25.6–38.1). Similar results were seen with ulcerative colitis and Crohn’s disease (CD; OR, 0.96; 95% CI, 0.58–1.59). Those with stricturing (OR, 3.64; 95% CI, 1.31–10.08) and penetrating (OR, 4.25; 95% CI, 1.11–16.26) CD had higher odds of postpartum active IBD. Active disease at conception (OR, 10.59; 95% CI, 1.48–76.02) and during pregnancy (OR, 4.91; 95% CI, 1.82–13.23) increased the odds of postpartum disease activity. Similarly, biologic discontinuation in the third trimester (OR, 1.77; 95% CI, 1.01–3.10) and therapy de-escalation after delivery (OR, 7.36; 95% CI, 3.38–16.0) was associated with postpartum disease activity. Conclusions Complicated Crohn’s disease, disease activity at conception and during pregnancy, and de-escalation of biologics during pregnancy or after delivery are associated with postpartum disease activity in women with IBD.

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