Enfermedad Inflamatoria Intestinal al Día最新文献

Introduction

Patients with inflammatory bowel disease (IBD) may present fecal urgency, which can affect consequently their daily life. Thus, the project “No puc esperar” [I can’t wait] aimed to provide those patients a quick and free access to toilets when needed by using an access card. One year after the 1st patient was included in the project in Girona, we evaluated the efficiency of this initiative through a personal interview survey.

Materials and methods

The personal interview survey was divided into three items; first the user perception of the project was assessed. Then the user perception of how public received the project was evaluated and finally the effectiveness of the card was determined.

Results

From January 2014 to January 2015 a total of 124 cards were issued. Out of which, 68 patients (54.8%) completed the personal interview form. Among those patients, 48% had Crohn's disease, 50% had ulcerative colitis, and 2% another type of pathology. The survey results indicate that 1 to 2 out of 10 patients in the year had to use the card monthly. The use of the card demonstrated a significant improvement in the quality of life of patients, achieving faster access to the toilets. It is noteworthy to notice that even patients that had the card but did not use it, declared to have gained an improvement in their quality of life, which may be explained by the fact that the simple idea of having the card confers them security and recognition for their disease.

Conclusion

The majority of the patients (100%) considered the project as either good or excellent, but pointed out that more establishments should participate to the project. That conclusion encourages us to further promote the project either locally or reaching more towns.

Introduction

Lack of adherence to treatment with 5-ASA is a significant predictor of relapse in ulcerative colitis (UC). This study was conducted in order to investigate the perception about ulcerative colitis that have the different health professionals who interact with the patient along the course of the disease.

Material and methods

The study was designed as a qualitative research through focus groups among primary care physicians (n = 4), gastroenterologists (n = 4) and gastroenterology nurses (n = 4).

Results

Among the potential reasons for poor adherence, this study identified: lack of awareness of the patient who has no symptoms, poor communication, and psychiatric conditions such as anxiety and depression. All professional groups thought that reducing the number of daily doses could contribute to greater adherence to therapy. All of them pointed out the lack of communication between them, especially between primary care physicians and specialized care, despite being aware of its relevance.

Conclusion

The lack of adherence in ulcerative colitis is a complex problem that can involve many factors, such as the lack of patient awareness in the absence of symptoms, the fear of side effects or a deficient physician-patient communication. This study described fundamental aspects that could improve adherence, such as simplifying treatment to once daily doses, or fostering communication not only with the patient, but between different levels of care as well.

This review explains the reasons for dietary advice for patients with IBD are based, with special emphasis on demystifying some traditional concepts with little scientific basis. «bowel rest» is an outdated concept so that keeping a patient with active IBD in total fasting and fluid therapy alone should be considered bad practice. In fact, patients with an IBD outbreak should avoid only those foods, including dairy ones, who repeatedly and systematically increase their symptoms. During outbreaks a low fibre diet is recommended, particularly in patients with stenosing CD, or severe UC attacks. The probiotic cocktail VSL#3 is effective in preventing both the first episode and subsequent bouts of pouchitis. Also, the probiotic E. coli Nissle 1917 is useful in UC, particularly as maintenance therapy. However, probiotics are not useful in CD. The available clinical data do not support the use of omega-3 fatty acids in IBD, both active and inactive.

Among the commonly drugs used for the treatment of inflammatory bowel disease (IBD) we found the 5-ASA and among them there is mesalazine. Despite having a good tolerability profile and a low rate of adverse reactions, which are usually mild, they also include severe reactions such as cardiovascular ones. Although it is rare, pericarditis associated with the use of mesalazine is an entity that must be taken into account in these patients. The onset of pleuritic chest pain should alert physicians for possible complications.

Hidradenitis suppurativa, also called acne inversa, is a chronic inflammatory dermatosis characterized by recurrent presence of nodes, abscesses and fistula tracts that mostly affects sweat gland bearing areas. This condition may develop outbreaks and progress to a chronic inflammatory state with the formation of fibroid tracts and hypertrophic scars.

Over the last years several cases have been published that suggest an association between this illness and inflammatory bowel disease. This is a relevant fact because in some cases hidradenitis suppurativa involves the anal and perianal area, which could lead to confusion with the perianal form of inflammatory bowel disease.

This article aims to analyze the characteristics that define hidradenitis suppurativa as well as its association with inflammatory bowel disease.

Introduction

Inflammatory bowel disease (IBD) are chronic and recurrent diseases with great medical, social and economic impact and need a constant and multidisciplinary care. IBD Units emerged in order to coordinate the available resources and telemedicine appeared as an important tool for doctor-patient communication. Our purpose is to analyze how patients use the communication systems with our IBD Unit, as well as patients’ opinion about the current systems and the association with clinical outcomes.

Methods

we performed a cross-sectional study in which a survey was conducted to IBD patients who came to the IBD Unit between February and March of 2015. The survey consists of demographic and illness information, clinical activity, use and assessment of the communication systems, treatment adherence and quality of live.

Results

A total of 128 patients were included in the study. Among these, 126 (98.4%) knew and 94 (73.4%) used communication systems. In particular, 38 (40.4%) used the telephone (average score 4.45/5); 50 (53.2%) used the email (average score 4.75/5); and 6 (6.4%) used both. 24 patients (25.5%) contacted monthly, 19 (20.2%) half-yearly, and 51 (54.3%) annually. Comparing by frequency of communication, patients who contact monthly are significantly younger (38.13 vs. 40.16 vs. 48.49 years; P = .005), have worse quality of live (41.58 vs. 53.79 vs. 51.57; P = .002) and use more the email (87.5%; P = .001).

Conclusions

Most patients use the communication systems, and have a high opinion about them. Younger patients with worse quality of life contact more frequently with the IBD Unit, mainly by email.

Introduction

Steroid dependency develops frequently (more than 30%) with regards to ulcerative colitis (UC) patients. Our aim was to evaluate the clinical efficacy of ADA in steroid-dependent UC patients.

Methods

Open-label, retrospective, consecutive, and multicentre study. Inclusion criteria were patients over 18 years old with UC and ECCO criteria of steroid-dependency. All patients received ADA treatment for induction (160/80 mg) at weeks 0 and 2 and 40 mg every 2 weeks thereafter. The main endpoint was clinical remission without steroids. Clinical response, mucosal healing and levels of C-reactive protein and calprotectine were also evaluated. Results are shown in percentages; associations were analyzed by multiple regression whenever appropriate.

Results

Thirty-seven steroid-dependent UC patients treated with ADA: 65% E3. Twelve patients (32%) naive to anti-TNF and 25 (68%) had previously received infliximab. Forty-three percent needed ADA intensification. After induction 35% of patients were in remission and after 12 months 40% of patients were in remission without steroids. The mean partial Mayo score was 6.89 basal, 3.13 at month 6 and 2.33 at month 12 (P < .01). Mucosal healing was achieved in 48% of patients. Only 3 patients (8%) needed a colectomy. We did not observe any association between clinical characteristics and response to ADA, but after multivariate analysis patients with loss of response to ADA had a lower remission rates (HR = 12.8; CI 95% 2.24-73.54; P = 0.004).

Conclusions

Adalimumab can be effective for clinical remission without steroids and mucosal healing in steroid-dependent UC. Loss of response to ADA is a predictive factor of poorer efficacy.

Introduction

Inflammatory and postsurgical stenosis of Crohn's disease (EC) can cause occlusive symptoms difficult to manage. Optimizing medical treatment and endoscopic dilatation is usually necessary; although sometimes the definitive treatment is surgery. The objective of this study is to evaluate the efficacy of local infliximab injection in patients with Crohn's disease with inflammatory stenosis (primary or postsurgical) in our center.

Material and methods

17 patients were included prospectively. Inclusion criteria: Crohn's disease with occlusive symptoms, inflammatory stenosis less than 5 cm length studied by MR, non permeable with normal colonoscopy. 30 mg of infliximab were injected in each endoscopic session, in all 4 sides of stenosis. The sessions were repeated with a median of 6 weeks.

Results

17 patients (12 male, 5 female). Median age: 44.1 years old. Median evolution of disease: 12.2 years. Stenosis of the anastomosis: 64.7%, primary stenosis: 35.3% (2 ileal, 2 colon, 1 pyloric, 1 stoma). 88.2% were treated with biological drugs. Median number of endoscopic sessions: 4, R (1-12). 3 pneumatic dilatation. Complete response: 35.3%; partial response: 41.1%; non response: 23.5%. Responders have maintain sustained response along a median follow up of 23.3 months. No adverse events have been registered.

Conclusion

Topical injection of infliximab in luminal stenosis of Crohn's disease can be a complementary therapy to endoscopic dilatation and an alternative for surgery; safe and well tolerated.