Crohn's & Colitis 360最新文献

Background: Recent advances in biomarkers have identified at-risk cohorts for inflammatory bowel disease (IBD), and potential interception strategies to prevent disease onset are in progress. We sought to understand patient and family members' views on IBD prevention, as they are key stakeholders in future adoption of prevention recommendations.

Methods: A workgroup of patient advocacy organizations and researchers adapted a survey for completion by the IBD community residing in the United States. All responses were anonymous. Descriptive results, and comparisons, were undertaken of pooled responses.

Results: One thousand five hundred forty-five respondents completed the survey. Most respondents (93%, n = 1,421) would be interested in taking a test to predict their or their family's risk of developing IBD in the future. Almost all respondents were interested in taking preventative treatment to prevent IBD; 40% expressed an unconditional interest in the treatment, but 59% reported it would be dependent on the risks and effectiveness of the treatment. Lifestyle measures were the most preferred option to prevent IBD. There was no significant difference in proportion of patients who were willing to take a test or prevention treatment based on relationship to IBD (have IBD, first-degree relative of someone who has IBD, or parent of someone with IBD).

Conclusions: Most people affected by IBD in the United States agree with taking proactive measures to prevent IBD. A lifestyle intervention (diet, exercise) is favored over a pharmaceutical approach by these respondents. Relationship to IBD did not influence the magnitude of the agreement.

The development of detailed surgical reports is essential for the effective management of inflammatory bowel disease, including Crohn's disease (CD) and ulcerative colitis. These reports facilitate postoperative care, multidisciplinary planning, and are critical for studies on surgical outcomes and complications. A well-structured report should include information before, during, and after surgery. Preoperative factors include team identification, surgical plan, anesthesia, patient positioning, estimated blood loss, and urinary output data. During surgery, documentation should cover unexpected findings, abnormal blood loss, and any anesthesia changes. Postoperatively, the patient's condition and transfer destination should be described. For perianal CD, reports should include details about fistulas, abscesses, and techniques such as fistulotomy and seton placement. In abdominal resections for CD, findings such as adhesions, associated complications, and disease characteristics must be outlined. For ulcerative colitis, reports should emphasize the extent of inflammation, colectomy techniques, details of anastomoses, and perfusion assessment. These structured reports are indispensable for improving care and long-term outcomes, reinforcing their importance in the evolving multidisciplinary management of inflammatory bowel disease.

Background: Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). While several studies have explored patients' general knowledge of IBD, less is known about their awareness of CRC risk and its management. This systematic review aimed to synthesize the available evidence on IBD patients' awareness of CRC risk and its related management strategies.

Methods: Medline, EMBASE, and PubMed databases were searched from inception to November 2023. All study designs and publication types were considered. Non-English studies and those assessing only general IBD knowledge were excluded. The appraisal tool for cross-sectional studies (AXIS) was used to assess the quality of studies.

Results: Twenty-three studies (17 papers and 6 conference abstracts), including 4674 participants (2481 with ulcerative colitis, 53.5% females) were included. Overall, 18 studies assessed CRC risk knowledge, 7 reported attitudes toward cancer screening, and 8 explored knowledge or attitude regarding colectomy for dysplasia. Patients demonstrated moderate awareness of CRC risk, limited knowledge of risk factors, and moderate levels of fear regarding this complication. Awareness of the diagnostic role of colonoscopy was high, but attitudes toward the procedure were mixed, largely due to concerns about complications. Awareness of appropriate screening initiation and willingness to undergo colectomy for dysplasia, regardless of the risk level, were generally low.

Conclusions: Evidence on IBD patients' awareness of CRC risk and its management remains limited, restricting firm conclusion about the extent of knowledge and educational needs. Further research is required to better characterize patients' understanding and to inform targeted education strategies.

Background: Young adults with chronic conditions are at increased risk for active disease and for poor adherence, resulting in increased emergency department utilization and hospitalizations. We aimed to evaluate whether young adults with inflammatory bowel disease (IBD) experienced more healthcare access challenges and financial distress compared to adults and pediatric patients.

Methods: A survey developed by the Crohn's & Colitis Foundation was electronically disseminated to adults with IBD and caregivers across the United States to assess healthcare access and financial challenges. Analyses were completed to evaluate differences across patient age groups (caregivers on behalf of pediatric patients <18 years, young adults 18-25 years, and adults 26-64 years) using Chi square or Fisher's exact tests.

Results: Of 1781 respondents (77% adult, 12.9% young adult, and 10.1% pediatric caregivers), there were no significant differences between groups in obtaining insurance approval and experiencing adverse health events due to treatment delays. However, young adults were more likely to experience step therapy mandates and less likely to know what questions to ask their insurer if experiencing coverage problems compared to adult and pediatric patients' caregivers. Additionally, young adult patients were more likely to take on an extra job or work more hours to afford their healthcare or insurance costs related to IBD.

Conclusion: Additional analysis from the Crohn's & Colitis Foundation access assessment highlights the need for more resources and support in navigating healthcare access for young adult patients with IBD.

Background: This post hoc analysis of a 60-week post-marketing surveillance (PMS) study in Japan assessed tofacitinib safety and effectiveness in patients with ulcerative colitis (UC), stratified by prior biologic exposure.

Methods: The PMS study registered all patients with UC receiving tofacitinib in Japan (May 2018-June 2021). Outcomes included the proportion of patients with clinically important adverse events (AEs), incidence rates (IR; unique patients with events/100 patient-years of exposure) of clinically important AEs, reasons for discontinuation, and effectiveness (partial Mayo score remission). Patients were stratified by prior biologic exposure (biologic-experienced/biologic-naïve). Prior biologics included infliximab, adalimumab, golimumab, and others (eg, ustekinumab/vedolizumab).

Results: Overall, 1367 biologic-experienced and 615 biologic-naïve patients were included. More biologic-naïve versus biologic-experienced patients (30.6% vs. 16.9%) had disease duration <2 years. Proportions of AEs were similar between groups, although IRs (95% confidence intervals) were numerically higher in biologic-experienced versus biologic-naïve patients for herpes zoster (HZ; 6.77 [5.30, 8.53] vs. 4.10 [2.50, 6.33]) and serious infections (SI; 1.92 [1.19, 2.94] vs. 0.60 [0.12, 1.77]). Insufficient clinical response (biologic-experienced: 53.3%; biologic-naïve: 38.9%) was the primary reason for discontinuation. At week 60, remission rates were 63.07% for biologic-naïve patients and 56.37% for biologic-experienced patients.

Conclusions: Safety was generally similar between biologic-experienced and biologic-naïve patients, although HZ and SI IRs were numerically higher in biologic-experienced patients. Remission rates were numerically higher in biologic-naïve versus biologic-experienced patients, although differences were small. Discontinuation was mostly due to insufficient clinical response. Missing concomitant corticosteroid/tofacitinib dose data and endoscopic assessment might limit the analysis.

Clinicaltrialsgov: NCT03643211.

Introduction: Patient-reported outcomes (PRO), including patient disease activity scores, quality of life, and depressive symptoms, are increasingly being used for clinical care in patients with inflammatory bowel disease (IBD). However, little is known about the performance of PROs over time in a real-world setting.

Methods: PROs were collected from a tertiary care IBD center from the electronic medical records (EMR) from 2018 to 2020. Quality of life was measured with the Simple Inflammatory Bowel Disease Questionnaire (SIBDQ). Disease activity was measured using the Harvey Bradshaw Index (HBI) for Crohn's disease (CD) and the Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8).

Results: PRO collection rate from 1373 patients was 88%. PHQ and SIBDQ were highly correlated (.718, p [Pearson's coefficient] < .05). HBI and PHQ-8 (.528, P < .05) and SIBDQ (-.676, P < .05) were moderately correlated. For CD patients, age 40-65, corticosteroid use and psychiatric medication use were associated with lower HBI and SIBDQ and higher PHQ scores. Age 40-65, corticosteroid use, and psychiatric medication use were associated with lower SCCAI and SIBDQ and higher PHQ-8 scores for CD and UC patients. Mean change [95% CI] increased for SIBDQ by 2.9 [2.3 to 3.6] in CD and 4.7 [3.8 to 5.6] in UC. Mean change [95% CI] decreased for PHQ-8: -1.0 [-1.3 to -.8] in CD and -1.7 [-2.2 to -1.3] in UC. This remained significant in both cognitive and somatic subscales.

Conclusion: High rate of PRO collection was successful using EMR implementation in a tertiary care clinic setting. Corticosteroid use and psychiatric medication use were associated with worse disease activity, depressive symptoms and quality of life scores. Moreover, PROs demonstrated depressive symptoms (both cognitive and somatic subscales), and quality of life symptom scores improved over time.

Introduction: Inflammatory bowel diseases (IBDs) are chronic conditions that negatively influence the quality of life of affected patients. IBD nurses are an essential part of the multidisciplinary team managing patients with IBD. Given the lack of studies evaluating the role of IBD nurses, this study aimed to assess the patient's perspective regarding the role and competencies of the IBD nurse.

Methods: A cross-sectional study was conducted between October and November 2024, using an online survey. The main inclusion criteria were being over 18 years old and having an established diagnosis of IBD. Subjects who fulfilled these criteria were invited to participate via email from the Italian IBD organization AMICI ITALIA. The questionnaire used for the survey, developed ad-hoc according to N-ECCO guidelines, was structured into 3 thematic sections: demographic and clinical information, patient-nurse interaction, and nursing competencies.

Results: Most patients (69.7%) reported excellent relationships with their IBD nurse, emphasizing the importance of trust in disease management. Those who could identify their dedicated IBD nurse expressed higher satisfaction regarding empathy, communication, and the nurse's influence on their treatment journey compared to those who could not identify their nurse, illustrating the positive impact the nurse had on their care. Similarly, patients who recognized their nurse demonstrated greater confidence in the nurse's competence.

Conclusion: This study emphasized the crucial role of the IBD nurse in the care journey of IBD patients. Although most patients reported an excellent relationship with their IBD nurse, many still struggle to identify their nurse. Larger studies are needed to confirm these findings further.

Introduction: Crohn's disease (CD) in the Middle East is often aggressive, yet regional patients are underrepresented in pivotal trials for new therapies. This study is the first real-world evaluation of risankizumab's effectiveness, safety, and dose optimization in a predominantly Emirati cohort with moderate-to-severe CD.

Methods: This prospective cohort included 60 UAE patients with moderate-to-severe CD initiating risankizumab. Endpoints included clinical remission (CDAI <150) and biochemical remission (normalised C-reactive protein <5 mg/L and faecal calprotectin <250 µg/g), assessed post-induction (weeks 12-20) and at maintenance (10-14 months). Logistic regression models were used to identify predictors of remission and the need for dose intensification.

Results: The median age was 33 years, and 61.7% were advanced therapy (AT)-exposed. Post-induction, clinical remission was achieved in 46.7% of patients, with significantly higher rates in AT-naïve vs AT-exposed patients (69.6% vs 32.4%, P = .011). Biochemical remission was achieved in 53.3% overall, again favouring the AT-naïve group (78.3% vs 37.8%, P = 0.005). At maintenance (n = 48), clinical and biochemical remission rates were 72.9% and 70.8%, respectively. Later-line risankizumab use was a significiant predictor of lower odds of post-induction remission (OR 0.27, P = .001). In AT-exposed patients, prior ustekinumab exposure was associated with lower remission rates (OR 0.11, P = .021) and a higher likelihood of dose intensification (OR 5.67, P = .045). Dose intensification recaptured clinical response in 62.5% (5/8) of patients. No new safety signals were identified.

Conclusion: This first Middle Eastern real-world study confirms risankizumab is effective and safe for complex CD and supports its use across different treatment lines.

Objectives: Diet is important in inflammatory bowel disease (IBD) management, but dietary assessments for clinic use are lengthy and not readily interpretable. The aim of our study was to assess the ability of a short Dietary Screener Questionnaire (DSQ) to capture food items and dietary patterns that are associated with IBD-related inflammation.

Methods: We performed a retrospective study in adult patients with IBD who completed the DSQ from January 2019 to June 2021. Biomarkers C-reactive protein (CRP) and fecal calprotectin (Fecal Cal) were captured within 60 days of DSQ completion. General estimating equations examined relationships between food items and CRP or Fecal Cal. Machine learning was performed to develop dietary patterns.

Results: A total of 1067 patients completed the DSQ, and 577 had biochemical data; 40% were Hispanic. Several food items on the DSQ were associated with inflammatory markers on repeated measures. For instance, red meat [OR: 2.57 (1.19-5.56), P = .02], pastry desserts [OR: 2.13 (1.04-4.36), P = .04], and beans [OR: 4.2 (1.23-12.51), P = .02] were associated with higher inflammation (CRP). High vegetable intake [OR: 0.44 (0.22-0.88), P = .02] and baked whole grain goods [OR: 0.15 (0.03-0.67), P = .014] were associated with lower inflammatory markers (Fecal Cal). A dietary pattern defined by the lowest fruit and vegetable intake had the highest CRP levels (P < .001).

Conclusions: The DSQ is a short dietary screener that can identify food items that associate with inflammation in IBD. Our findings suggest that the DSQ is a feasible tool for use in clinical practice to assess, guide, and track dietary recommendations in a practical way.

Introudction: Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), requires complex self-care behaviors to manage symptoms and maintain quality of life. Despite its importance, self-care in IBD remains poorly understood. This study aims to investigate self-care practices and the sociodemographic and clinical determinants of self-care among patients with IBD.

Methods: A multicenter cross-sectional study was conducted in nine IBD units in Italy. Patients were enrolled between April and June 2024. Self-care was assessed using the Self-Care of Chronic Illness Inventory, covering self-care maintenance, self-care monitoring, and self-care management. Socio-demographic and clinical data were collected through structured questionnaires. Multiple linear regressions examined the relationships between patient characteristics and self-care dimensions. The N-ECCO Research Grant supported the study.

Results: Among 452 patients (49.3% CD, 50.7% UC), mean self-care scores were 72.84 ± 12.57 (self-care maintenance), 81.14 ± 17.94 (self-care monitoring), and 67.73 ± 16.99 (self-care management). Ulcerative colitis patients demonstrated significantly better self-care management than CD patients (P = .002). Higher disease activity was associated with worse self-care maintenance (β = -.11, P = .030), while supplement use predicted better self-care maintenance (β = .10, P = .028). For self-care monitoring, female gender (β = .11, P = .020) and supplement use (β = .13, P = .005) were positively associated with higher scores.

Conclusion: Inflammatory bowel disease patients demonstrated adequate self-care maintenance and monitoring, but their self-care management was suboptimal. Female gender and supplement use were associated with better self-care monitoring; disease activity worsened self-care maintenance. Ulcerative colitis patients had better self-care management than CD, highlighting the need for tailored interventions to improve self-care.