scholarly journals Efficacy of fidaxomicin therapy, after failure of vancomycin therapy, for treating a C. difficile colitis in a patient with ulcerative colitis

2015 ◽  
Vol 9 (1S) ◽  
pp. 7-10
Author(s):  
Carlo Tascini ◽  
Federico Corti ◽  
Gualtiero Bottari ◽  
Paola Lambelet
Keyword(s):  
Ulcerative Colitis ◽  
Vancomycin Therapy ◽  
Increased Risk ◽  
Days Of Therapy ◽  
Bowel Diseases ◽  
Fluconazole Therapy ◽  
Inflammatory Bowel ◽  
Inflammatory Diarrhea ◽  
Anti Fungal

Patients with inflammatory bowel diseases (IBDs) have greater risk of developing C. difficile infection (CDI). In these patients, CDI have worse outcome, may be associated with increased risk of bacteremia and candidemia and may be misdiagnosed as relapse of IBD, also because ofthe absence of typical findings of CDI at colonoscopy.A 58-year-old man with acute ulcerative colitis treated with steroids was hospitalized for feverand recrudescence of inflammatory diarrhea. During the hospitalization, the fever was treated with broad spectrum antibiotics and systemic anti-fungal therapy. Candida mannan antigenand the molecular screening for C. difficile resulted positive. A first course of vancomycin by mouthwas unsuccessful, therefore we started a 10-day course of fidaxomicin. After five days of therapy, diarrhea disappeared. A few-week course of fluconazole therapy was performed to complete the treatment of invasive candidiasis. At six-month follow-up no relapse of CDI was documented.

The Incidence of Deep Venous Thrombosis and Pulmonary Embolism among Patients with Inflammatory Bowel Disease: A Population-based Cohort Study

2001 ◽  
Vol 85 (03) ◽  
pp. 430-434 ◽  
Author(s):  
James Blanchard ◽  
Donald Houston ◽  
Andre Wajda ◽  
Charles Bernstein
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Pulmonary Embolism ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Population Based ◽  
Incidence Rates ◽  
Increased Risk ◽  
Inflammatory Bowel

Summary Background: There is an impression mostly from specialty clinics that patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolic disorders. Our aim was to determine the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) from a population-based database of IBD patients and, to compare the incidence rates to that of an age, gender and geographically matched population control group. Methods: IBD patients identified from the administrative claims data of the universal provincial insurance plan of Manitoba were matched 1:10 to randomly selected members of the general population without IBD by year, age, gender, and postal area of residence using Manitoba Health’s population registry. The incidence of hospitalization for DVT and PE was calculated from hospital discharge abstracts using ICD-9-CM codes 451.1, 453.x for DVT and 415.1x for PE. Rates were calculated based on person-years of follow-up for 1984-1997. Comparisons to the population cohort yielded age-adjusted incidence rate ratios (IRR). Rates were calculated based on person-years of follow-up (Crohn’s disease = 21,340, ulcerative colitis = 19,665) for 1984-1997. Results: In Crohn’s disease the incidence rate of DVT was 31.4/10,000 person-years and of PE was 10.3/10,000 person-years. In ulcerative colitis the incidence rates were 30.0/10,000 person-years for DVT and 19.8/10,000 person-years for PE. The IRR was 4.7 (95% CI, 3.5-6.3) for DVT and 2.9 (1.8-4.7) for PE in Crohn’s disease and 2.8 (2.1-3.7) for DVT and 3.6 (2.5-5.2) for PE, in ulcerative colitis. There were no gender differences for IRR. The highest rates of DVT and PE were seen among patients over 60 years old; however the highest IRR for these events were among patients less than 40 years. Conclusion: IBD patients have a threefold increased risk of developing DVT or PE.

scholarly journals Articular manifestations in patients with inflammatory bowel disease treated with vedolizumab

Rheumatology ◽  
2020 ◽  
Vol 59 (11) ◽  
pp. 3275-3283 ◽  
Author(s):  
Anastasia Dupré ◽  
Michael Collins ◽  
Gaétane Nocturne ◽  
Franck Carbonnel ◽  
Xavier Mariette ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Inflammatory Bowel Diseases ◽  
Bowel Disease ◽  
Bowel Diseases ◽  
History Of ◽  
Musculoskeletal Manifestations ◽  
Inflammatory Bowel

Abstract Objective Vedolizumab (VDZ) has been incriminated in the occurrence of articular manifestations in patients with inflammatory bowel diseases (IBDs). The aim of this study was to describe musculoskeletal manifestations occurring in IBD patients treated by VDZ and to identify risk factors. Methods In this retrospective monocentric study, we included all consecutive patients treated by VDZ for IBD in our hospital. Incident musculoskeletal manifestations occurring during VDZ treatment were analysed and characteristics of patients with and without articular inflammatory manifestations were compared. Results Between 2013 and 2017, 112 patients were treated with VDZ for IBD: ulcerative colitis (n = 59), Crohn’s disease (n = 49) and undetermined colitis (n = 4). Four patients (3.6%) had a history of SpA, whereas 13 (11.6%) had a history of peripheral arthralgia. Some 102 (91.1%) patients had previously received anti-TNF. After a mean (S.d.) follow-up of 11.4 (8.6) months, 32 (28.6%) patients presented 35 musculoskeletal manifestations, of which 18 were mechanical and 17 inflammatory. Among the latter, 11 had axial or peripheral SpA, 5 had early reversible arthralgia and 1 had chondrocalcinosis (n = 1). Among the 11 SpA patients, only 3 (2.6%) had inactive IBD and may be considered as paradoxical SpA. The only factor associated with occurrence of inflammatory manifestations was history of inflammatory articular manifestation [7/16 (43.8%) vs 10/80 (12.5%), P = 0.007]. Conclusion Musculoskeletal manifestations occurred in almost 30% of IBD patients treated with VDZ, but only half of them were inflammatory. Since most of the patients previously received anti-TNF, occurrence of inflammatory articular manifestations might rather be linked to anti-TNF discontinuation than to VDZ itself.

scholarly journals P664 Adherence to mesalazine and identification of patients with ulcerative colitis in healthcare administrative databases of Tuscany (Italy)

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S588-S589
Author(s):  
L Bertani ◽  
C Bartolini ◽  
S Ferraro ◽  
I Convertino ◽  
S Giometto ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Medication Possession Ratio ◽  
Study Data ◽  
Sensitivity Analyses ◽  
Administrative Databases ◽  
Statistical Measures ◽  
Step Procedure ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Abstract Background Drug supply can be used to identify patients with a specific disease in healthcare administrative databases (HAD), particularly when they have a univocal indication. For drugs with multiple indications, other elements must be considered, such as dosing or scheduled regimen. This is the case of mesalazine (MZ), a drug indicated for ulcerative colitis (UC), but also for Crohn’s disease and other not classifiable inflammatory bowel diseases. The aim of the present study was to explore adherence trajectories to MZ, in the attempt of identifying variables useful to detect patients with UC in HAD Methods In this retrospective cohort study, data was retrieved from administrative healthcare databases in Tuscany. Patients who had at least a first MZ dispensation between 6/1/2011 and 6/30/2016 (index date, ID) were included. We performed four sub-group analyses: 1) Patients with at least 1 MZ dispensation in the follow-up (FUP); 2) Patients with at least 2 MZ dispensations in the first 3 months of FUP; 3) Patients with MZ dosage >1.5 grams between the 1st and the 2nd dispensation; 4) Patients with MZ dosage >2.5 grams between the 1st and the 2nd dispensation. Each sub-group was stratified by age: ≤65 and >65, separately. We estimated adherence to MZ monthly, through the Medication Possession Ratio and computed adherence trajectories with a 3 step-procedure: 1) computation of 24 statistical measures; 2) factor analysis; 3) cluster analysis. We performed two sensitivity analyses: 1) Patients >65 years old with UC ICD-9 code, 2) Patients ≤65 years old with the UC exemption code. Results The sub-groups 1, 2, 3 and 4 included 47.750, 34.037, 29.730 and 26.165 MZ users, respectively. In all the sub-groups and stratification by age, 3 clusters of adherence were identified: high, medium low and low. The high adherence trajectory showed a mean adherence over 40% in the FUP, while patients in the low and medium low trajectories discontinued MZ within 5 and 15 months, respectively. The first and second sensitivity analysis included 409 and 1514 patients, respectively. Two clusters were identified in both analyses: high, around 80%, and moderate, up to 30% at the end of FUP. No MZ discontinuation was observed in the sensitivity analyses on ascertained UC patients. Conclusion In the main analyses, two out of three trajectories were characterized by MZ discontinuation, while in the trajectories calculated for the patients with UC codes, no MZ use interruption was detected. This finding could help the identification of true UC patients in the overall population of MZ users.

scholarly journals Minerals and Bone Mineral Density in Inflammatory Bowel Diseases

2020 ◽  
Author(s):  
Alicja Ewa Ratajczak ◽  
Anna Maria Rychter ◽  
Agnieszka Zawada ◽  
Agnieszka Dobrowolska ◽  
Iwona Krela-Kaźmierczak
Keyword(s):  
Bone Mineral Density ◽  
Ulcerative Colitis ◽  
Bone Mass ◽  
Bone Mineral ◽  
Inflammatory Bowel Diseases ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium is the most often discussed minerals with regard to bone mineral density. Moreover, phosphorus; magnesium and sodium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals  or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. 

Tacrolimus Therapy in Steroid-Refractory Ulcerative Colitis: A Review

2019 ◽  
Vol 26 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Biyu Wu ◽  
Jinglu Tong ◽  
Zhihua Ran
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Process ◽  
Calcineurin Inhibitor ◽  
Efficacy And Safety ◽  
Chronic Inflammatory Process ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Tacrolimus Therapy ◽  
Inflammatory Bowel ◽  
Steroid Refractory

AbstractInflammatory bowel diseases are known for a chronic inflammatory process of the gastrointestinal tract and include Crohn’s disease and ulcerative colitis (UC). Patients who are dependent on or resistant to corticosteroids account for about 20% of severe UC patients. Tacrolimus is a calcineurin inhibitor that has recently been used in the treatment of steroid-refractory ulcerative colitis. Tacrolimus has been demonstrated to have remarkable therapeutic efficacy in UC patients, without increased risk of severe adverse effects such as induction of remission and maintenance therapy. This article reviews the mechanism of action, pharmacogenetics, efficacy, and safety of tacrolimus for patients with steroid-refractory ulcerative colitis.

scholarly journals Frailty and Risk of Serious Infections in Biologic-treated Patients With Inflammatory Bowel Diseases

2020 ◽  
Author(s):  
Siddharth Singh ◽  
Herbert C Heien ◽  
Lindsey Sangaralingham ◽  
Nilay D Shah ◽  
Jennifer C Lai ◽  
...  
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Frailty Index ◽  
Administrative Claims ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections ◽  
Comorbidity Burden ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Abstract Background Identifying biologic-treated patients with inflammatory bowel diseases (IBDs) at higher risk of serious infections is a priority. We conducted a retrospective cohort study evaluating frailty and risk of serious infections in biologic-treated patients with IBD. Methods Using an administrative claims database, we identified biologic-treated patients with IBD between 2014 and 2018 with follow-up 1 year before and after treatment initiation. Using a validated claims-based hospital frailty risk scoring system, patients were classified as frail and nonfrail. We compared the risk of serious infections (infections requiring hospitalization) between frail and nonfrail patients using Cox proportional hazard analysis adjusting for age, comorbidities, disease characteristics, health care utilization, use of corticosteroids, immunomodulators, and opiates. Results We included 5987 biologic-treated patients with IBD (4881 on TNFα antagonists, 1106 on vedolizumab), of whom 2350 (39.3%) were classified as frail; over 7115 person-years of follow-up was included, and 520 patients developed serious infection. Frailty was not associated with increased risk of serious infection (adjusted hazard ratio [aHR], 1.12; 95% CI, 0.93–1.36), whereas advanced age (older than 60 years), high comorbidity burden, corticosteroid use, opiate use, and prior serious infection were associated with increased risk of serious infection. On stratified analysis, frailty was associated with increased risk of serious infections in vedolizumab-treated patients (aHR, 1.69; 95% CI, 1.03–2.79) but not in TNFα antagonist-treated patients (aHR, 1.03; 95% CI, 0.83–1.27). Conclusions In biologic-treated patients with IBD, frailty assessed using a claims-based frailty index was not independently associated with increased risk of serious infections. Future studies evaluating objective and biological measures of frailty are warranted to risk-stratify older patients with IBD.

scholarly journals P453 Comparison of therapeutic effects between groups of thiopurine alone and combination of thiopurine with 5-ASA after remission introduced by oral tacrolimus for patients with severe ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S405-S406
Author(s):  
T Sato ◽  
K Kojima ◽  
R Koshiba ◽  
K Fujimoto ◽  
M Kawai ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Rank Test ◽  
Therapeutic Effects ◽  
Aminosalicylic Acid ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Time To Relapse

Abstract Background Although thiopurine is recommended to be used for maintenance after remission, the reliable data of maintenance introduced by tacrolimus is limited for patients with ulcerative colitis (UC). 5-aminosalicylic acid (5-ASA) is reported to induce 6-thioguanine nucleotides (6-TGN) levels higher in patients with inflammatory bowel diseases. However, the data of 5-ASA are few reported among East Asians. Methods A retrospective cohort study was conducted evaluating the 70 patients with severe UC who were primary responders to oral tacrolimus from April 2015 to March 2018. Twenty-seven patients were administered maintenance treatment with thiopurine. We evaluated the efficacy of thiopurines with and without 5-ASA in these patients, using ΔMCV, lowest WBC, highest 6TGN between groups of thiopurine alone and thiopurine+ 5-ASA. Kaplan–Meier analysis was used to assess time to relapse between groups of thiopurine and thiopurine+5-ASA. Results The median follow-up period was 430 days (interquartile range 207–952 days). The statistical significances were not found in patients background between groups of thiopurine and thiopurine+5-ASA. ΔMCV were significantly greater (p < 0.01), lowest WBC were significantly lower (p = 0.02) in the thiopurines+5-ASA group than in thiopurines alone group. The highest 6-TGN levels tended to be higher in thiopurine+5-ASA group than in thiopurine alone group (p = 0.09). The rate of relapse was significantly higher in the thiopurine alone group than in thiopurines+5-ASA group (p = 0.03). Kaplan–Meier curves confirmed that thiopurine+5-ASA group appeared to protect against relapse (log-rank test, p < 0.01). Conclusion Thiopurine+5-ASA induced significantly lower relapse than thiopurine alone after remission introduced by tacrolimus in the patients with severe UC, along with significantly greater the ΔMCV and lower the lowest WBC.

Effectiveness and Safety of Golimumab in Treating Outpatient Ulcerative Colitis: A Real-Life Prospective, Multicentre, Observational Study in Primary Inflammatory Bowel Diseases Centers

2017 ◽  
Vol 26 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Antonio Tursi ◽  
Leonardo Allegretta ◽  
Nello Buccianti ◽  
Nicola Della Valle ◽  
Walter Elisei ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Diseases ◽  
Real Life ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Background & Aims: Golimumab (GOL) has been recently approved in Italy for the treatment of ulcerative colitis (UC) unresponsive to standard treatments. Our aims were to assess the real-life efficacy and safety of GOL in managing UC outpatients in Italian primary Inflammatory Bowel Diseases (IBD) centres.Methods: Consecutive UC outpatients with at least 3-months follow-up were enrolled. Primary end-point was the induction and maintenance of remission in UC, defined as Mayo score ≤2, at 6-month follow-up.Results: Ninety-three patients were enrolled. At 6-month follow-up, remission was obtained in 34 (36.5%) patients. Shorter duration of disease was the only significant predictive factor of remission. Clinical response was achieved in 60 (64.5%) patients, while mucosal healing (MH) was obtained in 18 (19.3%) patients. Sixteen (47.0%) patients under remission were still under therapy with steroids. C-reactive protein and fecal calprotectin significantly dropped during the follow-up (p<0.001 for both proteins). Adverse events occurred in 4 (4.3%) patients and 3 of them stopped treatment. Colectomy was performed in only one patient (1.1%).Conclusions: Golimumab seems to be safe and effective in inducing and maintaining remission in real life UC outpatients.Abbreviations: ADA: Adalimumab; CRP: C-reactive Protein; GOL: Golimumab; FC: Fecal calprotectin; IBD: Inflammatory Bowel Diseases; IFX: Infliximab; IQR: Interquartile range; MH: Mucosal Healing; SC: Subcutaneously; TBC: Tuberculosis; TNFα: Tumor necrosis factor α; UC: Ulcerative Colitis.    

TNF Inhibitors and Risk of Malignancy in Patients with Inflammatory Bowel Diseases: A Systematic Review

2020 ◽  
Author(s):  
Marie Muller ◽  
Ferdinando D’Amico ◽  
Stefanos Bonovas ◽  
Silvio Danese ◽  
Laurent Peyrin-Biroulet
Keyword(s):  
Real Life ◽  
Skin Cancers ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Risk Of Malignancy ◽  
Observational Cohort ◽  
Inflammatory Bowel ◽  
Digestive Malignancies ◽  
The Impact

Abstract Background and Aims The association between tumour necrosis factor inhibitors [TNFi] and malignancy in patients with inflammatory bowel disease [IBD] is not well understood. Our aim was to systematically evaluate the impact of TNFi use on risk of malignancy in IBD patients in daily clinical practice. Methods We searched Pubmed, Embase and Scopus until March 1, 2020 for observational cohort studies on adult IBD patients reporting malignancy occurrence and TNFi use. Results Twenty-eight studies [20 retrospective and eight prospective] were included, involving 298 717 IBD patients. Mean age at inclusion ranged from 28 to &gt;65 years. Mean follow-up varied from 7 to 80 months. Infliximab was the most frequently used TNFi [13/28 studies, 46.4%], followed by adalimumab [3/28, 10.7%], while both infliximab and adalimumab were evaluated in five studies [17.8%]. In total, 692 malignancies were diagnosed in IBD patients treated with TNFi, accounting for an overall occurrence of 1.0%. The most frequent malignancies were non-melanoma skin cancers [123/692, 17.8%], digestive malignancies [120/692, 17.3%] and haematological malignancies [106/692, 15.3%]. The association between TNFi and malignancy was evaluated in 11 studies [39.3%]: no significant association was found in ten studies, while an increased risk of lymphoma in patients exposed to TNFi was reported in one study. Conclusion TNFi treatment is not associated with an increased risk of malignancy in IBD patients in real-life settings. Further large studies are needed to assess the prognosis of patients exposed to TNFi and risk of recurrence or new cancers in subjects with personal malignancy history.

scholarly journals Clinical and epidemiological characteristics and outcomes of inflammatory bowel diseases according to 8-year follow-up in a cohort of patients in the North-West region

2019 ◽  
pp. 24-33
Author(s):  
I. V. Gubonina ◽  
V. B. Grinevich ◽  
E. I. Tkachenko ◽  
N. B. Volga ◽  
O. S. Sharap ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Bowel Diseases ◽  
North West ◽  
The North ◽  
West Region ◽  
Bowel Diseases ◽  
Inflammatory Bowel

The 8-year observation data of patients with ulcerative colitis and Crohn’s disease in the North West region are presented in the article. The patients were observed in the scientific and clinical center of Military Medical academy named after S. M. Kirov, specialized in the inflammatory bowel diseases (IBD). The aim of study is to assess the gender, age and clinical characteristics of patients with inflammatory bowel diseases, epidemiological features: factors of employment and place of residence, to study the outcomes of ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. Retrospective analysis of 485 patient’s medical charts (373 patients with ulcerative colitis and 112 patients with Crohn’s disease) in the period from 2010 to 2018 was performed. Results. The onset of inflammatory bowel diseases is most common in the age group up to 40 years. The duration of the period before the diagnosis of ulcerative colitis and Crohn’s disease averaged 2.3 years. In UC the most frequent localization of the pathological process was left-side colon (51%), in CD - terminal ileitis (29%) and ileocolitis (27%). The anemia was the most frequent complication in both form of IBD, but structuring and penetrating complications were characteristic of CD. The most of patients (80.6%) had recurrent or continuous course of IBD. Small proportion of patients (19.4%) had sustained remission throughout the follow-up period. The frequency of surgical interventions in CD (27.6%) was comparable with the registers of the European study groups of IBD. In contrast, the frequency of colectomy in UC was significantly lower (0.8%) than in the published data of European countries, due to the predominance of mild and moderate forms of UC in the observed cohort. Mortality of patients with IBD was higher than in the General population of St. Petersburg due to the contribution of mortality from complicated forms of IBD (15.7%), while the structure of other causes of death was comparable to the General population

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