Crohn's & Colitis 360最新文献

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.

Background: Crohn's perianal fistula (CPF) is a debilitating disease that significantly affects patients' quality of life. Prior research revealed substantial knowledge gaps among individuals with CPF in accessing evidence-based educational resources. We evaluated the reach and engagement of two validated CPF educational videos and a companion website (HealMyFistula.org) that was disseminated through Facebook and Instagram.

Methods: A six-month social media campaign was conducted to promote the CPF educational videos and website using targeted advertising strategies to maximize reach. Primary outcomes were the proportion of users who viewed at least 50% of a video and the outbound click rate to the website. Results were stratified by age, sex, and social media platform.

Results: The CPF Overview video reached 3.1 million users and had a ≥ 50% view rate of 3.31% (n = 103 463), while the CPF Treatment video reached 1.8 million users with a 1.40% view rate (n = 25 606). Older age groups showed significantly higher engagement, while females demonstrated higher view and click rates to HealMyFistula.org than males (P < .05). Facebook outperformed Instagram for the CPF Overview video, while Instagram slightly outperformed Facebook for the CPF Treatment video.

Conclusions: Targeted social media campaigns can be effective in disseminating educational content. Engagement varied by video type, age, sex, and platform, showing the importance of demographically informed dissemination strategies. These findings suggest that health educational campaigns may benefit from tailoring content and dissemination strategies based on demographic engagement patterns.

Background: To investigate the rate of participation in a second trial among inflammatory bowel disease (IBD) patients and to identify factors influencing their likelihood of re-engagement.

Methods: Retrospective, single-center study. Multivariate logistic regression was used to identify factors associated with re-participation.

Results: A total of 29.0% participated in a second trial. In ulcerative colitis, distance >100 km from the clinic and steroid use before the first trial were associated with reduced re-participation. In Crohn's disease (CD), long-standing disease and reimbursement during the first trial were associated with increased re-participation; previous CD-related surgery was associated with reduced re-participation.

Conclusions: Understanding factors affecting re-participation in IBD trials is crucial to improving patient involvement in research.

Background: Data regarding barriers to inflammatory bowel disease (IBD) care in largely Hispanic populations is limited. This study evaluated barriers in Black/Indigenous/People of Color/Hispanics (BIPOC/H) and White/non-Hispanics (W/NH) with IBD.

Methods: An anonymous survey was administered to adult IBD patients at Keck Medical Center of the University of Southern California and Los Angeles General Medical Center between March and October 2024. Data included the Consumer Assessment of Healthcare Providers and Systems and Barriers to Care surveys, the Medication Adherence Rating Scale-4, and the Beliefs about Medicines Questionnaire. Analyses compared BIPOC/H and W/NH patients via X ² and t-tests.

Results: Included were 172 of 195 eligible patients (88% response). Compared to W/NH patients, BIPOC/Hs reported delays of longer than 1 year in receiving a diagnosis, 49.6% versus 27.8% (P = 0.015) more IBD-related financial difficulty, 55.6% versus 22.2% (P = 0.001); more difficulty obtaining emotional support (56.4% vs. 33.3%, P = 0.05); and community support for IBD (45.0% vs. 20.0%, P = 0.004). BIPOC/H patients had higher mean worries about medication harm (13.7 vs. 11.6, P < 0.001), concerns about long-term medication use (17.2 vs. 13.9, P < 0.001), and worries medications are overused (9.0 vs. 7.6, P < 0.002). Specific beliefs, including "medications are toxic" and concerns about dependency, were significantly more prevalent in BIPOC/H respondents (P < 0.05).

Conclusions: BIPOC/H patients with IBD had more delays in diagnosis, medication-related concerns, IBD-related financial difficulties, and less social/emotional support for their IBD versus W/NHs, underscoring the need for culturally sensitive care, identification and communication of emotional, and community support resources, as well as medication decision support.

Background: Globally, inflammatory bowel disease (IBD) rates have surged; however, Indigenous populations are underrepresented in research and face unique healthcare challenges due to socioeconomic barriers. We aimed to synthesize available literature on IBD in Indigenous populations worldwide, identify research gaps, and propose recommendations to improve research inclusivity.

Methods: A literature search was conducted across 8 online databases: MEDLINE, EMBASE, CINAHL, SCOPUS, and others. We included qualitative, quantitative, and mixed-method research, alongside commentaries, editorials, and abstracts published since 1962 in English focused on IBD in Indigenous populations. The studies were critically appraised and summarized. Findings and recommendations for future research from the perspective of Indigenous patient partners were presented.

Results: Eighteen publications were included in the review, with most originating from Canada (n = 7), New Zealand (n = 5), and Australia (n = 4), with single studies from Chile and the United States. Indigenous populations were found to have lower rates of IBD compared to the general population; however, some studies reported recently increasing rates, potentially resulting from urbanization, dietary changes, and other environmental factors. Canadian studies highlighted barriers faced by Indigenous peoples in accessing care. Notably, only 3 articles demonstrated Indigenous engagement.

Conclusions: This review highlights gaps in the literature about IBD in Indigenous populations. While the prevalence of IBD among Indigenous peoples is low, rates may be rising. Further research should continue studying the rising rates of IBD in Indigenous populations, alongside contributing genetic and environmental factors. Indigenous peoples must be included as research partners, and Indigenous research methodologies must be adhered to.

Introduction: Acute severe ulcerative colitis (ASUC) typically requires hospitalization for intravenous (IV) corticosteroid treatment and monitoring. In response to the need to reduce inpatient stays, especially during the COVID-19 pandemic, outpatient treatment models have gained interest. This study evaluated the feasibility, safety, and patient satisfaction of outpatient IV corticosteroid treatment for ASUC.

Methods: We conducted a prospective cohort feasibility pilot study at a single academic center between May 2021 and October 2022. Fifteen adults with ASUC were enrolled and self-selected either outpatient or inpatient IV corticosteroid treatment. All participants received daily laboratory monitoring and symptom assessments for 14 days, with follow-up for 1 year. Primary outcomes included 90-day colectomy and 30-day readmission rates. Secondary outcomes included clinical activity scores, symptom and care satisfaction, and feasibility metrics.

Results: Ten patients received outpatient care, and 5 were hospitalized. No patients in either group required colectomy within 90 days. One outpatient and no inpatients required colectomy within 1 year. Thirty-day readmission occurred in 30% of outpatients and 40% of inpatients. Clinical activity scores and satisfaction with food and sleep were similar between groups at baseline and on day 14. Initial care satisfaction was lower in the outpatient group but equalized by day 14. Outpatient care required significant coordination but was successfully delivered without adverse safety outcomes.

Discussion: Outpatient IV corticosteroid treatment for select patients with ASUC is feasible, safe, and associated with comparable clinical outcomes and patient satisfaction compared to inpatient care. This model may offer a cost-effective alternative to hospitalization.

Background: Contemporary characteristics of hospitalized patients with ulcerative colitis (UC) may differ from historic standards in terms of prior drug exposure and disease severity. The impact of these differences on outcomes is unclear. This study aimed to assess inpatient UC outcomes according to prior outpatient drug exposure and measures of disease severity.

Methods: This was a multicenter, retrospective study of adult patients (age ≥ 18 years) hospitalized for severe UC. The primary outcome was the colectomy rate among outpatient advanced therapy exposed (ATE) vs advanced therapy naïve (ATN) patients. Secondary outcomes included length of hospitalization and need for rescue medical therapy.

Results: A total of 370 patients were included with 86 (23%) in the ATE group and 284 (77%) in the ATN group. In the ATE group, 21 patients (25%) required colectomy vs 26 (9%) in the ATN group (P < .001). Median hospital length of stay was 6 days (IQR: 4-9) in both groups (P = .96). Rescue medical therapy was required in 107 (38%) patients in the ATN group vs 36 (42%) in the ATE group (P = .49).Colectomy was associated with ATE status (P = .0002), Mayo UC endoscopic sub-score of 3 (P = .002), higher C-reactive protein (P = .04), lower albumin (P = .0002), and female sex (P = .03). On multivariable analysis, only low albumin was independently associated with colectomy (P = .001).

Conclusions: Outpatient ATE was associated with an increased risk of colectomy among hospitalized patients with severe UC. On multivariable analysis, low albumin was independently associated with the risk of colectomy. This suggests that higher colectomy rates observed in ATE patients may reflect underlying differences in disease severity.

Background: Proactive therapeutic drug monitoring (TDM) for tumor necrosis factor alpha antagonist (anti-TNF) therapy in adult inflammatory bowel disease (IBD) remains controversial, with inconsistent findings from clinical trials and meta-analyses. Pediatric societal guidelines endorse the implementation of proactive TDM. However, the integration of TDM into clinical practice by pediatric gastroenterologists has not been characterized. This study was undertaken to delineate the practice patterns, attitudes, and barriers associated with anti-TNF TDM among pediatric gastroenterologists across the United States.

Methods: A 28-item questionnaire was developed based on prior adult surveys and current pediatric literature, undergoing 3 rounds of iteration. The survey was comprised of physician demographics, center demographics, TDM practice behavior questions and case-scenarios. The survey was deployed through the ImproveCareNow Learning Health System Network between February and June 2023.

Results: Among 380 invitees, 256 (77%) completed the questionnaire. Among respondents, 67% (171) were academic-affiliates, and 55% (140) were female. There was notable variability in the number of patients with IBD seen per practice. All respondents reported using TDM for infliximab, and the majority for adalimumab, and the vast majority utilizing a proactive TDM approach. The principal barriers to TDM implementation were insurance denials, cost, and logistical challenges. More respondents indicated they would initiate TDM during infliximab induction for severe ulcerative colitis than for Crohn's disease.

Conclusions: In contrast to the adult literature, most pediatric gastroenterologists report undertaking proactive TDM for anti-TNF agents in IBD management. Precision dosing tools reflective of an individual's pharmacokinetics are desired and need to be further studied.