Pub Date : 2024-06-05DOI: 10.58931/cibdt.2024.2125
Laura Targownik, Pablo Olivera
Metabolic bone disease is prevalent in persons with immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD). Within these conditions the most common are osteoporosis and reduced bone mineral density (BMD), often termed osteopenia in adult patients, and refer to a decreased mineralization of the bone matrix. This decreased mineralization weakens the resistance of the bone to external forces, thus increasing the risk of fractures when external compressive or deforming forces are applied. Osteoporosis is asymptomatic in the absence of a fracture, and diagnosis generally occurs through the use of programmatic screening (most commonly dual energy x-ray absorption [DEXA]) or incidentally following the occurrence of a fracture. Osteoporosis is defined as a DEXA-measured BMD at the lumbar spine or proximal femur which falls more than 2.5 standard deviations below the mean value for healthy young adults (known as a T-score). BMD decreases of a lesser degree (a T-score falling between -1 and -2.5) are referred to as osteopenia. Osteoporosis is a major public health concern, owing to the significant morbidity and mortality that is attributed to fractures. While fractures may represent a time-limited hardship among persons in otherwise good health and function, major osteoporosis-related fractures, especially those of the femur and spine, can lead to permanent disability and premature mortality. In Canada, approximately 150 people per 100,000 suffer a hip fracture per year, which confers a 3-fold higher risk of mortality.
{"title":"Bone Health In Patients With Inflammatory Bowel Disease (IBD)","authors":"Laura Targownik, Pablo Olivera","doi":"10.58931/cibdt.2024.2125","DOIUrl":"https://doi.org/10.58931/cibdt.2024.2125","url":null,"abstract":"Metabolic bone disease is prevalent in persons with immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD). Within these conditions the most common are osteoporosis and reduced bone mineral density (BMD), often termed osteopenia in adult patients, and refer to a decreased mineralization of the bone matrix. This decreased mineralization weakens the resistance of the bone to external forces, thus increasing the risk of fractures when external compressive or deforming forces are applied. Osteoporosis is asymptomatic in the absence of a fracture, and diagnosis generally occurs through the use of programmatic screening (most commonly dual energy x-ray absorption [DEXA]) or incidentally following the occurrence of a fracture. Osteoporosis is defined as a DEXA-measured BMD at the lumbar spine or proximal femur which falls more than 2.5 standard deviations below the mean value for healthy young adults (known as a T-score). BMD decreases of a lesser degree (a T-score falling between -1 and -2.5) are referred to as osteopenia. Osteoporosis is a major public health concern, owing to the significant morbidity and mortality that is attributed to fractures. While fractures may represent a time-limited hardship among persons in otherwise good health and function, major osteoporosis-related fractures, especially those of the femur and spine, can lead to permanent disability and premature mortality. In Canada, approximately 150 people per 100,000 suffer a hip fracture per year, which confers a 3-fold higher risk of mortality.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.58931/cibdt.2024.2122
E. Kuenzig, Gilaad Kaplan, Eric Benchimol
The Impact of Inflammatory Bowel Disease report, produced by the Canadian Gastro-Intestinal Epidemiology Consortium (cangiec.ca) for Crohn’s and Colitis Canada is a serial policy report produced every 3–5 years that summarizes the existing literature on the epidemiology, burden, and impact of inflammatory bowel disease (IBD) in Canada and identifies knowledge gaps. Its goal is to inform people living with IBD and their caregivers, donors, physicians, researchers, policy makers, and other stakeholders about the current burden of IBD in Canada. It plays an integral role for Crohn’s and Colitis Canada’s advocacy efforts. In addition, the report informs the research funding policy of the health charity, which is the second largest non-governmental funder of IBD research in the world. The latest iteration of this report was released on June 1, 2023 and is available here. This article summarizes the current epidemiology of IBD in Canada and discusses its implications for clinical care in 2024 and beyond.
{"title":"The Rising Burden Of Inflammatory Bowel Disease In Canada","authors":"E. Kuenzig, Gilaad Kaplan, Eric Benchimol","doi":"10.58931/cibdt.2024.2122","DOIUrl":"https://doi.org/10.58931/cibdt.2024.2122","url":null,"abstract":"The Impact of Inflammatory Bowel Disease report, produced by the Canadian Gastro-Intestinal Epidemiology Consortium (cangiec.ca) for Crohn’s and Colitis Canada is a serial policy report produced every 3–5 years that summarizes the existing literature on the epidemiology, burden, and impact of inflammatory bowel disease (IBD) in Canada and identifies knowledge gaps. Its goal is to inform people living with IBD and their caregivers, donors, physicians, researchers, policy makers, and other stakeholders about the current burden of IBD in Canada. It plays an integral role for Crohn’s and Colitis Canada’s advocacy efforts. In addition, the report informs the research funding policy of the health charity, which is the second largest non-governmental funder of IBD research in the world. The latest iteration of this report was released on June 1, 2023 and is available here. This article summarizes the current epidemiology of IBD in Canada and discusses its implications for clinical care in 2024 and beyond.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.58931/cibdt.2024.2126
Nicholas Carman
Canada has one of the highest rates of childhoodonset inflammatory bowel disease (IBD) in the world, with the recent Crohn’s and Colitis Canada’s 2023 Impact of Inflammatory Bowel Disease in Canada Report demonstrating that approximately 6,158 children and youth under 18 years are living with IBD, along with 600-650 new diagnoses under age 16 per year. This number is expected to rise to 8,079 by 2035. This represents approximately 10-20% of newly diagnosed patients. Concerningly, although still relatively uncommon compared with adolescent onset IBD, the incidence has increased most significantly in children under 5 years old. Recent health administrative data demonstrated the national incidence of IBD, overall, to be 29.9 per 100,000 (95%CI: 28.3, 31.5) in 2023, with increasing incidence in pediatrics (AAPC:1.27%; 95%CI:0.82, 1.67), despite stable incidence in adults (AAPC:0.26%; 95%CI: -0.42, 0.82). Figure 1 demonstrates that this increase in pediatric incidence is a worldwide phenomenon. Current IBD care in pediatrics is moving toward a precision medicine approach, with unique and standardized approaches to genetics, risk stratification and disease phenotype, nutritional and advanced therapies, and specialized multidisciplinary clinics with knowledge of the unique challenges pediatric patients and their families face with a diagnosis of IBD.
{"title":"Updates In The Management Of Pediatric Inflammatory Bowel Disease","authors":"Nicholas Carman","doi":"10.58931/cibdt.2024.2126","DOIUrl":"https://doi.org/10.58931/cibdt.2024.2126","url":null,"abstract":"Canada has one of the highest rates of childhoodonset inflammatory bowel disease (IBD) in the world, with the recent Crohn’s and Colitis Canada’s 2023 Impact of Inflammatory Bowel Disease in Canada Report demonstrating that approximately 6,158 children and youth under 18 years are living with IBD, along with 600-650 new diagnoses under age 16 per year. This number is expected to rise to 8,079 by 2035. This represents approximately 10-20% of newly diagnosed patients. Concerningly, although still relatively uncommon compared with adolescent onset IBD, the incidence has increased most significantly in children under 5 years old. Recent health administrative data demonstrated the national incidence of IBD, overall, to be 29.9 per 100,000 (95%CI: 28.3, 31.5) in 2023, with increasing incidence in pediatrics (AAPC:1.27%; 95%CI:0.82, 1.67), despite stable incidence in adults (AAPC:0.26%; 95%CI: -0.42, 0.82). Figure 1 demonstrates that this increase in pediatric incidence is a worldwide phenomenon. Current IBD care in pediatrics is moving toward a precision medicine approach, with unique and standardized approaches to genetics, risk stratification and disease phenotype, nutritional and advanced therapies, and specialized multidisciplinary clinics with knowledge of the unique challenges pediatric patients and their families face with a diagnosis of IBD.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"304 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.58931/cibdt.2024.2123
Barbara Bielawska
Despite significant advances in medical therapy for inflammatory bowel disease (IBD) in recent decades, surgical management remains common in the setting of both Crohn’s disease (CD) and ulcerative colitis (UC). While the risk of colectomy for UC has declined in the biologic era, most patients with CD will undergo at least one intestinal resection in their lifetime. Preoperative nutritional status is a wellestablished determinant of surgical morbidity. Surgery elicits a metabolic stress response that is proportional to the extent of surgical injury. Adequate lean body and micronutrient stores are needed for healing of surgical incisions, and the individual must be metabolically capable of anabolism for tissue repair. Deficits at any point in this process may lead to complications including anastomotic failure, surgical site infections, delayed return of gastrointestinal (GI) function, and postoperative physical disability with prolonged length of hospital stay.
尽管近几十年来炎症性肠病（IBD）的药物治疗取得了重大进展，但手术治疗在克罗恩病（CD）和溃疡性结肠炎（UC）中仍然很常见。虽然在生物制剂时代，UC 结肠切除术的风险有所下降，但大多数 CD 患者一生中至少要接受一次肠切除术。术前营养状况是手术发病率的一个既定决定因素。手术引起的代谢应激反应与手术损伤程度成正比。手术切口的愈合需要充足的瘦肉和微量元素储备，而且患者必须具备组织修复所需的新陈代谢能力。这一过程中任何一个环节出现问题都可能导致并发症，包括吻合失败、手术部位感染、胃肠道（GI）功能恢复延迟以及术后身体残疾和住院时间延长。
{"title":"Perioperative Nutritional Considerations In Patients With Inflammatory Bowel Disease","authors":"Barbara Bielawska","doi":"10.58931/cibdt.2024.2123","DOIUrl":"https://doi.org/10.58931/cibdt.2024.2123","url":null,"abstract":"Despite significant advances in medical therapy for inflammatory bowel disease (IBD) in recent decades, surgical management remains common in the setting of both Crohn’s disease (CD) and ulcerative colitis (UC). While the risk of colectomy for UC has declined in the biologic era, most patients with CD will undergo at least one intestinal resection in their lifetime. Preoperative nutritional status is a wellestablished determinant of surgical morbidity. Surgery elicits a metabolic stress response that is proportional to the extent of surgical injury. Adequate lean body and micronutrient stores are needed for healing of surgical incisions, and the individual must be metabolically capable of anabolism for tissue repair. Deficits at any point in this process may lead to complications including anastomotic failure, surgical site infections, delayed return of gastrointestinal (GI) function, and postoperative physical disability with prolonged length of hospital stay.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"16 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.58931/cibdt.2024.2124
Cathy Lu
Inflammatory bowel disease (IBD) treatment has evolved from monitoring clinical symptoms to targeting objective measurements of mucosal healing with endoscopic and radiologic imaging. It is well known that clinical symptoms do not match disease severity. Frequent evaluation with radiologic imaging is now the standard of care. Although Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) recommendations do not list radiographic targets as an endpoint due to the “limited ability of the currently available treatments to achieve transmural healing,” this will likely evolve over time particularly with the rapidly growing uptake of intestinal ultrasound (IUS) in clinical trials. For the time being, imaging is considered as an “adjuvant assessment rather than a formal treatment target.”
{"title":"Latest Intestinal Ultrasound Advancements In Inflammatory Bowel Disease","authors":"Cathy Lu","doi":"10.58931/cibdt.2024.2124","DOIUrl":"https://doi.org/10.58931/cibdt.2024.2124","url":null,"abstract":"Inflammatory bowel disease (IBD) treatment has evolved from monitoring clinical symptoms to targeting objective measurements of mucosal healing with endoscopic and radiologic imaging. It is well known that clinical symptoms do not match disease severity. Frequent evaluation with radiologic imaging is now the standard of care. Although Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) recommendations do not list radiographic targets as an endpoint due to the “limited ability of the currently available treatments to achieve transmural healing,” this will likely evolve over time particularly with the rapidly growing uptake of intestinal ultrasound (IUS) in clinical trials. For the time being, imaging is considered as an “adjuvant assessment rather than a formal treatment target.”","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"21 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-23DOI: 10.58931/cibdt.2023.1s1121
Neeraj Narula, Hasan Hamam
Inflammatory bowel disease (IBD) is a chronic disorder characterized by inflammation of the gastrointestinal tract, with two main subtypes: ulcerative colitis (UC) and Crohn’s disease (CD). The cause of IBD is not fully understood, but it involves a complex interaction between genetics and environmental factors that trigger an abnormal immune response in the gut. The immune system plays a central role in IBD, with an imbalance between pro- and anti-inflammatory mediators leading to an exaggerated immune response and infiltration of immune cells into the mucosa.2 This infiltration triggers the release of cytokines, interleukins and interferons, activating signalling pathways that damage the mucosal barrier. Despite the presence of several treatment choices for individuals with inflammatory bowel diseases (IBDs), there still remain significant challenges. The symptoms associated with the disease have a detrimental impact on individuals’ quality of life, and uncontrolled inflammation can lead to complications of disease requiring surgery, further emphasizing the need for improved treatment to achieve disease control and enhance overall well-being. The involvement of the Janus kinase inhibitor (JAK) family of enzymes in the signalling pathways of several pro-inflammatory cytokines plays an important role in the pathogenesis of IBD, which makes it a potential therapeutic target. Tofacitinib, a nonselective pan-JAK inhibitor, was the first JAK inhibitor treatment approved for moderate-to-severe cases of UC. However, long-term studies on rheumatoid arthritis (RA) patients treated with tofacitinib have highlighted safety concerns including potentially higher risk of major adverse cardiovascular (CV) events and venous thromboembolism. The second generation of JAK inhibitors include selective JAK1 therapies, such as upadacitinib. Upadacitinib is a selective and reversible JAK inhibitor approved for treating UC; RA; psoriatic arthritis; ankylosing spondylitis (AS); and atopic dermatitis, and approval for Crohn’s disease is expected in the near future. This review intends to describe the mechanism of upadacitinib, evaluate the current clinical evidence of its effectiveness in treating IBD, and discuss safety considerations.
炎症性肠病（IBD）是一种以胃肠道炎症为特征的慢性疾病，主要有两种亚型：溃疡性结肠炎（UC）和克罗恩病（CD）。IBD 的病因尚不完全清楚，但它涉及遗传和环境因素之间复杂的相互作用，这些因素会引发肠道内异常的免疫反应。免疫系统在 IBD 中起着核心作用，促炎和抗炎介质之间的失衡导致免疫反应过度和免疫细胞向粘膜浸润。2 这种浸润引发细胞因子、白细胞介素和干扰素的释放，激活信号通路，从而破坏粘膜屏障。 尽管炎症性肠病（IBD）患者有多种治疗方法可供选择，但仍然面临着巨大的挑战。与疾病相关的症状会对患者的生活质量产生不利影响，而不受控制的炎症会导致需要手术治疗的疾病并发症，这进一步强调了改善治疗以实现疾病控制和提高整体健康水平的必要性。 Janus 激酶抑制剂（JAK）家族酶参与了几种促炎细胞因子的信号通路，在 IBD 的发病机制中发挥了重要作用，因此成为潜在的治疗靶点。托法替尼是一种非选择性泛 JAK 抑制剂，是首个获准用于中度至重度 UC 病例的 JAK 抑制剂疗法。然而，对接受托法替尼治疗的类风湿性关节炎（RA）患者进行的长期研究凸显了安全性问题，包括发生重大不良心血管（CV）事件和静脉血栓栓塞的潜在高风险。第二代JAK抑制剂包括选择性JAK1疗法，例如乌达替尼。乌达帕替尼是一种选择性、可逆性 JAK 抑制剂，已被批准用于治疗 UC、RA、银屑病关节炎、强直性脊柱炎（AS）和特应性皮炎，预计不久将被批准用于治疗克罗恩病。本综述旨在描述乌达替尼的作用机制，评估其治疗 IBD 有效性的现有临床证据，并讨论安全性注意事项。
{"title":"Selective JAK1 inhibition using upadacitinib for the management of inflammatory bowel diseases","authors":"Neeraj Narula, Hasan Hamam","doi":"10.58931/cibdt.2023.1s1121","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1s1121","url":null,"abstract":"Inflammatory bowel disease (IBD) is a chronic disorder characterized by inflammation of the gastrointestinal tract, with two main subtypes: ulcerative colitis (UC) and Crohn’s disease (CD). The cause of IBD is not fully understood, but it involves a complex interaction between genetics and environmental factors that trigger an abnormal immune response in the gut. The immune system plays a central role in IBD, with an imbalance between pro- and anti-inflammatory mediators leading to an exaggerated immune response and infiltration of immune cells into the mucosa.2 This infiltration triggers the release of cytokines, interleukins and interferons, activating signalling pathways that damage the mucosal barrier. Despite the presence of several treatment choices for individuals with inflammatory bowel diseases (IBDs), there still remain significant challenges. The symptoms associated with the disease have a detrimental impact on individuals’ quality of life, and uncontrolled inflammation can lead to complications of disease requiring surgery, further emphasizing the need for improved treatment to achieve disease control and enhance overall well-being. The involvement of the Janus kinase inhibitor (JAK) family of enzymes in the signalling pathways of several pro-inflammatory cytokines plays an important role in the pathogenesis of IBD, which makes it a potential therapeutic target. Tofacitinib, a nonselective pan-JAK inhibitor, was the first JAK inhibitor treatment approved for moderate-to-severe cases of UC. However, long-term studies on rheumatoid arthritis (RA) patients treated with tofacitinib have highlighted safety concerns including potentially higher risk of major adverse cardiovascular (CV) events and venous thromboembolism. The second generation of JAK inhibitors include selective JAK1 therapies, such as upadacitinib. Upadacitinib is a selective and reversible JAK inhibitor approved for treating UC; RA; psoriatic arthritis; ankylosing spondylitis (AS); and atopic dermatitis, and approval for Crohn’s disease is expected in the near future. This review intends to describe the mechanism of upadacitinib, evaluate the current clinical evidence of its effectiveness in treating IBD, and discuss safety considerations.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139244494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.58931/cibdt.2023.1212
V. Solitano, V. Jairath
Conventional combination therapy in inflammatory bowel disease (IBD), which consists of an immunosuppressant agent and an anti-TNF agent, is a well-integrated strategy in clinical practice. The landmark SONIC and UC SUCCESS trials demonstrated that combining a thiopurine and infliximab was more effective than monotherapy and was associated with higher corticosteroid-free remission and mucosal healing rates. The primary advantage of this traditional combination therapy derives from the immunomodulator’s effect on the pharmacokinetics of anti-TNFs, with a lower rate of anti-drug antibodies detected in subjects administered combination therapy. Despite the growing therapeutic armamentarium and clinical study development pipeline for IBD, clinical remission rates at one year continue to range from 30% to 50%, indicating that a therapeutic ceiling may have been reached with the use of single agents. In addition, agents that have proven effective for luminal disease may not be helpful for extraintestinal manifestations (EIMs) or for concurrent immune-mediated diseases (IMIDs). In light of this, the concept of advanced combination treatment (ACT), which entails the simultaneous administration of at least two biologic agents, or a biologic and a small-molecule drug, is emerging as a therapeutic approach for patients with refractory IBD, as well as for those with IBD and a concurrent IMID, or IBD with EIMs.
{"title":"Advanced combination therapy in IBD","authors":"V. Solitano, V. Jairath","doi":"10.58931/cibdt.2023.1212","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1212","url":null,"abstract":"Conventional combination therapy in inflammatory bowel disease (IBD), which consists of an immunosuppressant agent and an anti-TNF agent, is a well-integrated strategy in clinical practice. The landmark SONIC and UC SUCCESS trials demonstrated that combining a thiopurine and infliximab was more effective than monotherapy and was associated with higher corticosteroid-free remission and mucosal healing rates. The primary advantage of this traditional combination therapy derives from the immunomodulator’s effect on the pharmacokinetics of anti-TNFs, with a lower rate of anti-drug antibodies detected in subjects administered combination therapy. Despite the growing therapeutic armamentarium and clinical study development pipeline for IBD, clinical remission rates at one year continue to range from 30% to 50%, indicating that a therapeutic ceiling may have been reached with the use of single agents. In addition, agents that have proven effective for luminal disease may not be helpful for extraintestinal manifestations (EIMs) or for concurrent immune-mediated diseases (IMIDs). In light of this, the concept of advanced combination treatment (ACT), which entails the simultaneous administration of at least two biologic agents, or a biologic and a small-molecule drug, is emerging as a therapeutic approach for patients with refractory IBD, as well as for those with IBD and a concurrent IMID, or IBD with EIMs.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129523283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.58931/cibdt.2023.1211
A. de Buck van Overstraeten
Virtually one-third of patients with Crohn’s disease (CD) develop anal symptoms. In addition to the typical skin tags and chronic fissures, 50% of these patients develop perianal abscesses and fistulas, which are among the most challenging CD phenotypes to treat. They can significantly affect patients’ quality of life (QOL) and result in a significant amount of lost days at school or work, as they often occur in a young, active population.
{"title":"Surgical approaches to perianal Crohn's disease","authors":"A. de Buck van Overstraeten","doi":"10.58931/cibdt.2023.1211","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1211","url":null,"abstract":"Virtually one-third of patients with Crohn’s disease (CD) develop anal symptoms. In addition to the typical skin tags and chronic fissures, 50% of these patients develop perianal abscesses and fistulas, which are among the most challenging CD phenotypes to treat. They can significantly affect patients’ quality of life (QOL) and result in a significant amount of lost days at school or work, as they often occur in a young, active population.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129350789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.58931/cibdt.2023.1214
M. Delisle
Numerous treatment options for Crohn’s disease (CD) have been developed since infliximab was approved in 1998. Treatment practices for CD have also evolved: therapeutic drug monitoring and a treat-to-target approach have replaced symptom control. Despite a decline in surgery rates in Canada and elsewhere in the world, bowel resection is still required for patients with refractory, fistulizing or fibrostenosing CD. Unfortunately, postoperative recurrence (POR) is common; endoscopic recurrence affected 70–90% of patients at the five-year point. However, it is important to note that variations in recurrence were observed between randomized clinical trials (RCTs), referral centre studies and population-based studies. This article will provide an overview of the current monitoring strategies and therapies for CD patients who have undergone a bowel resection.
{"title":"Post-operative Crohn's disease: Current and emerging management techniques","authors":"M. Delisle","doi":"10.58931/cibdt.2023.1214","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1214","url":null,"abstract":"Numerous treatment options for Crohn’s disease (CD) have been developed since infliximab was approved in 1998. Treatment practices for CD have also evolved: therapeutic drug monitoring and a treat-to-target approach have replaced symptom control. Despite a decline in surgery rates in Canada and elsewhere in the world, bowel resection is still required for patients with refractory, fistulizing or fibrostenosing CD. Unfortunately, postoperative recurrence (POR) is common; endoscopic recurrence affected 70–90% of patients at the five-year point. However, it is important to note that variations in recurrence were observed between randomized clinical trials (RCTs), referral centre studies and population-based studies. This article will provide an overview of the current monitoring strategies and therapies for CD patients who have undergone a bowel resection.","PeriodicalId":104720,"journal":{"name":"Canadian IBD Today","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122304974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.58931/cibdt.2023.1215
Felix Zhou, Kyle Kilby, Jennifer L Jones
The increasing prevalence of vaccine-preventable diseases (VPDs) in patients with inflammatory bowel disease (IBD) has given rise to increased awareness of the need to educate clinicians and patients about the critical role of immunization in this patient population. In 2023, it was estimated that in the Canadian population, 320,000 individuals (0.83%) were affected by IBD. Patients with IBD are at risk of vaccine-preventable diseases as the result of several factors, including potentially reduced efficacy and safety of vaccinations in the context of systemic immunosuppressive therapies administered for the management of IBD2 and a state of malnutrition caused by the disease. Barriers to the administration of vaccinations include: Clinicians’ reluctance to immunize patients with IBD; patient lack of awareness regarding the critical importance of a structured vaccination protocol; gastroenterologists’ assumption that immunization falls under the auspices of the primary care provider (PCP); and limited time and resources. The objective of this paper is to highlight the need for broader implementation of the 2021 Canadian Association of Gastroenterology (CAG) Guidelines concerning both live and inactivated vaccines in patients with IBD. This overview focuses on commonly encountered VPDs for which administration of live and non-live vaccines may be required and for which an IBD-specific deviation from the NACI recommendations have been made. The vaccines selected for this brief overview are also commonly administered in clinical practice. Clinicians may experience uncertainty in relation to management of these vaccinations in practice.
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