Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease

Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients.

Download Full-text

Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz024 ◽

2019 ◽

Vol 13 (8) ◽

pp. 996-1002 ◽

Cited By ~ 8

Author(s):

C Chavarría ◽

M J Casanova ◽

M Chaparro ◽

M Barreiro-de Acosta ◽

E Ezquiaga ◽

...

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Disease ◽

Sleep Quality ◽

Multicentre Study ◽

Sleep Disorders ◽

Bowel Disease ◽

Factors Associated ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background and Aims The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. Methods This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. Results A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn’s disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37–45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6–3.7], depression [OR = 2.4, 95% CI = 1.4–3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1–2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4–5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3–14.2], anxiety [RC = 25.8, 95% CI = 20.0–31.5], depression [RC = 30.6, 95% CI = 24.3–37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3–20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. Conclusions The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.

Download Full-text

755. Clinical Adherence to Latent Tuberculosis Screening Recommendations in Adults with Inflammatory Bowel Disease (IBD) Prior to Biologic Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.762 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S271-S271

Author(s):

Kwadwo Mponponsuo ◽

Dina Fisher

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biologic Therapy ◽

Interferon Gamma Release Assay ◽

Inpatient Setting ◽

Factors Associated ◽

Increased Risk ◽

Latent Tb ◽

Inflammatory Bowel ◽

Latent Tb Infection

Abstract Background Biological agents have become increasingly common in the treatment of immune-mediated illnesses. Their use, however, is associated with an increased risk of progression from latent to active tuberculosis (TB) infection. The American Thoracic Society (ATS) recommends both a tuberculin skin test (TST) and an interferon gamma release assay (IGRA) be conducted to screen for latent TB prior to initiation of biologic therapy. We examined the adherence to these recommendations for adults with inflammatory bowel disease (IBD) in the Calgary region of Alberta. Methods In this retrospective cross-sectional study, we used the Alberta Health Services’ Sunrise Clinical Manager and Netcare databases to identify IBD patients initiated on biologic therapy (age >18 years) in Calgary, Alberta between 2008 and 2018. Socio-demographic and clinical characteristics of patients were described. Linear and logistic regression models were constructed to identify factors associated with screening. All analyses were conducted using Stata 15.0 (University of London, UK). Results There was a total of 247 identified cases (48.18% female). Of these 96 were Ulcerative Colitis and 151 Crohn’s Disease. The mean age was 39.5 (14.8 SD). There was a total of 210 (85%) who had documented screening with the TST and nine (3.4%) with the IGRA. In a multivariable analysis, factors associated with latent TB screening were age and outpatient setting at the time of screen. Six patients (2.43%) had positive screens and four of those six were treated for latent TB infection. Conclusion TST remains the predominant screening method for latent TB infection although the ATS recommends both IGRA and TST prior to biologic therapy. Screening varied with age and higher rates were noted in those evaluated as outpatients compared with inpatients. Further work is needed to evaluate the barriers to screening and to improve access to latent TB screening particularly in the inpatient setting. Disclosures All authors: No reported disclosures.

Download Full-text

Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz269 ◽

2019 ◽

Vol 26 (9) ◽

pp. 1394-1400 ◽

Cited By ~ 2

Author(s):

Adam S Faye ◽

Kenneth W Hung ◽

Kimberly Cheng ◽

John W Blackett ◽

Anna Sophia Mckenney ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Venous Thromboembolism ◽

Bowel Disease ◽

Hospitalized Patients ◽

High Yield ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis ◽

Factors Associated ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

Download Full-text

Clinical Outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/7591141 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Panu Wetwittayakhlang ◽

Farah Albader ◽

Petra A Golovics ◽

Gustavo Drügg Hahn ◽

Talat Bessissow ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

General Population ◽

Bowel Disease ◽

Systemic Corticosteroid ◽

Clinical Activity ◽

Health Care Centre ◽

Factors Associated ◽

Increased Risk ◽

Inflammatory Bowel ◽

The Impact

Background and Aims. The impact of COVID-19 has been of great concern in patients with inflammatory bowel disease (IBD) worldwide, including an increased risk of severe outcomes and/or possible flare of IBD. This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD activity. Methods. A consecutive cohort of IBD patients who were diagnosed with COVID-19 infection and followed up at the McGill University Health Care Centre was obtained between March 1, 2020, and April 30, 2021. Demographics, comorbidities, IBD (type, treatments, pre- and post-COVID-19 clinical activity, biomarkers, and endoscopic activity), and COVID-19-related outcomes (pneumonia, hospitalization, death, and flare of IBD disease) were analyzed. Results. A cohort of 3,516 IBD patients was included. 82 patients (2.3%) were diagnosed with COVID-19 infection (median age: 39.0 (IQR 27.8–48.0), 77% with Crohn’s disease, 50% were female). The prevalence of COVID-19 infection in IBD patients was significantly lower compared to the general population in Canada and Quebec (3.5% versus 4.3%, p < 0.001 ). Severe COVID-19 occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID-19 infection was reported in 8 patients (9.8%) within 3 months. Biologic therapy was held during active COVID-19 infection in 37% of patients. Age ≥55 years (odds ratio (OR): 11.1, 95% CI: 1.8–68.0), systemic corticosteroid use (OR: 4.6, 95% CI: 0.7–30.1), active IBD (OR: 3.8, 95% CI: 0.7–20.8), and comorbidity (OR: 4.9, 95% CI: 0.8–28.6) were factors associated with severe COVID-19. After initial infection, 61% of IBD patients received COVID-19 vaccinations. Conclusion. The prevalence of COVID-19 infection among patients with IBD was lower than that in the general population in Canada. Severe COVID-19, mortality, and flare of IBD were relatively rare, while a large proportion of patients received COVID-19 vaccination. Older age, comorbidities, active IBD disease, and systemic corticosteroid, but not immunosuppressive or biological therapy, were associated with severe COVID-19 infection.

Download Full-text

The Effect of Dietary Glutathione and Coenzyme Q10 on the Prevention and Treatment of Inflammatory Bowel Disease in Mice

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.74.1.74 ◽

2004 ◽

Vol 74 (1) ◽

pp. 74-85 ◽

Cited By ~ 5

Author(s):

Liu ◽

Russell ◽

Smith ◽

Bronson ◽

Milbury ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Dextran Sulfate ◽

Coenzyme Q ◽

Histological Evaluation ◽

Therapeutic Effects ◽

Prevention Study ◽

Prevention And Treatment ◽

Inflammatory Bowel ◽

Pre Treatment

Because reactive oxygen species have been implicated as mediators of inflammatory bowel disease (IBD), we evaluated the potential preventive and therapeutic effects of two dietary antioxidants, glutathione (GSH) and coenzyme Q10 (CoQ10) on dextran sulfate sodium (DSS)-induced colitis in mice. Fifty female 8-wk old Swiss-Webster mice were randomly assigned to 4 groups for a pre-treatment 'prevention' study: (1) GSH (1% of diet); (2) CoQ10 (200 mg/kg/d); (3) DSS only (3% of drinking water); (4) control (no treatment). The mice in groups 1 and 2 were fed with GSH or CoQ10 for 21 wks, and the mice in groups 1, 2 and 3 were provided DSS from wk 7 for 4 cycles (1 cycle = 1 wk DSS followed by 2-wk water). Another 50 mice were randomly assigned to 4 groups for a 21-wk 'treatment' study where the mice in groups 1, 2, and 3 were administered DSS for 6 cycles (18 wks) to induce colitis. GSH and CoQ10 were added from wk 7 until the completion of the protocol. Loose stools and hemocult positivity were modestly but significantly reduced with GSH or CoQ10 at several periods during the intervention in both the prevention and treatment studies. In contrast, histological evaluation revealed increases in colonic dysplasia and ulceration with GSH or CoQ10. Thus, in this mouse model, GSH and CoQ10 appear to have a beneficial effect on acute signs of IBD, but may have an adverse impact on the chronic pathophysiology of the disease. Further studies using additional animal models are required to determine whether GSH or CoQ10 provide a favorable or unfavorable benefit:risk ratio in the prevention or treatment of IBD.

Download Full-text