Crohn's & Colitis 360最新文献

Background: Clostridioides difficile infection (CDI) is a well-recognized complication of inflammatory bowel disease (IBD) that has been associated with poor clinical outcomes. The objective of this study is to characterize the global incidence, risk factors and outcomes of CDI in patients with IBD.

Methods: A search of MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews was conducted for studies published between January 1960, and March 2024. Random-effect models were employed to estimate the incidence of CDI in the IBD population. Risk factors and outcomes were estimated using random effects meta-regression and subgroup analysis.

Results: Twenty-eight articles from 11 countries on 3 continents, comprising 796, 244 patients with IBD were included. The overall CDI rate was 8.84% (95% CI, 5.91%-13.03%). The rate of CDI was slightly higher in Asia at 11% (95% CI, 6.7%-18.44%) compared to the North America (USA and Canada) at 7.85% (95% CI, 3.80%-15.51%) and Europe, where the incidence, was 7.92% (95% CI, 3.87%-15.51%). A univariable random-effects meta-regression model demonstrated that male gender (odds ratio [OR], 1.18; 95% CI, 1.00-1.40) and older age (OR, 1.06; 95% CI, 0.99-1.15, per one-year increase in age) were factors associated with higher CDI incidence in the IBD population. CDI testing by PCR compared to enzyme immunoassay was associated with higher rates of CDI (OR, 4.70; 95% CI, 01.39-15.90). No association was observed between length of hospital stay and CDI.

Conclusions: One in 10 patients with IBD were positive for CDI. Increasing age and male population were associated with higher risk of CDI.

Background: Inflammatory IBD has a significant adverse influence on the physical, psychological, family, and social dimensions of patients. This research aims to compare the effectiveness of ACT and BEHI on perceived stress, quality of life, sense of coherence, and D personality type in patients with IBD.

Methods: This study used a quasi-experimental method with a pre-test, post-test, and follow-up design with a control group. A total of 37 patients were randomly selected based on a random allocation system. Data were collected by WHOQOL-BREF, the Sense of Coherence (SOC) questionnaire, the Type D Personality Questionnaire, and the Perceived Stress Scale (Perceived Stress Scale (PSS)). The first experimental group (n = 12) underwent ACT within eight 90-minute weekly sessions, which lasted eight weeks. The second group (n = 12) experienced bio-energy economy within eight 90-minute weekly sessions, lasting for eight weeks. The control group (n = 13) received no training in this period. Data was analyzed using a mixed variance analysis method.

Results: Results revealed that perceived stress, quality of life, sense of coherence, and D personality type significantly improved in the post-test and follow-up stages through the ACT and BEHI programs (P < .01). It was found that there was a significant difference between the experimental groups and the control group over time (P < .01).

Conclusions: It can be concluded the BEHI program was more effective in decreasing perceived stress and D personality type and increasing quality of life than the ACT program. Although the BEHI program improved a sense of coherence, the ACT program was more effective in increasing the sense of coherence in patients.

[This corrects the article DOI: 10.1093/crocol/otae060.].

Background: To analyze the current status of frailty and the primary factors influencing frailty in patients with inflammatory bowel disease (IBD).

Methods: We conducted a study using a fixed-point consecutive sampling method to investigate hospitalized patients with IBD aged 18 years or older in the Gastroenterology Department of a general hospital in Anhui, China, from July 2022 to July 2023. We also assessed the prevalence of frailty and malnutrition using the frailty phenotype scale (trial of fatigue, grip strength, physical activity, walking speed, and weight loss) and the Global Leadership Initiative on Malnutrition criteria to analyze the factors influencing frailty.

Results: A total of 300 patients with IBD were included. Of them, 21.67% were classified as frail, 46.67% were prefrail, 31.6% were nonfrail, 35% showed nutritional risk, and 33% were malnourished. The results of bivariate correlation analysis showed that frailty scores were correlated with age, white blood cell count, faecal calprotectin, and C-reactive protein levels and were negatively correlated with body mass index (BMI), hemoglobin, albumin (ALB), and pre-albumin (PALB) levels (r = -0.35, -0.45, -0.55, -0.44, P <.01). The results of multiple linear regression analysis showed that BMI scores, nutritional status, disease state, and ALB levels were important factors influencing frailty (P <.05).

Conclusions: The patients with IBD were frail and prefrail, with a high prevalence of malnutrition. Lower BMI scores, a poor nutritional status, a worse disease state, and lower ALB levels were risk factors for frailty. A cyclical relationship was identified between frailty and malnutrition, with each condition exacerbating the other.

Background: Janus kinase inhibitors (JAKis) have revolutionized ulcerative colitis (UC) management; however, the consequences of treatment discontinuation in patients achieving clinical remission remain poorly understood. This study investigated the clinical outcomes following JAKi discontinuation and retreatment effectiveness in patients with relapse.

Methods: In this multicenter retrospective cohort study, we analyzed 101 patients with UC who received their first JAKi treatment between 2018 and 2024. Among them, 53 who achieved remission (Patient-Reported Outcome 2 = 0) in week 8 were included. The primary endpoint was a comparison of relapse-free survival between the treatment continuation and discontinuation groups (n = 37 and 16, respectively). The secondary endpoints included assessment of post-discontinuation remission maintenance and post-retreatment remission rates.

Results: The proportion of female patients in the discontinuation group (68.8%) was higher (P = .0478) than the continuation group (40.5%). The mean relapse-free survival was significantly longer in the continuation group than in the discontinuation group (1679 vs 882 days, cumulative relapse-free rate 83.3% vs 13.6%, P < .001, respectively). In the latter, 13 patients experienced relapse during follow-up (post-discontinuation mean relapse-free survival: 326 days), although all patients remained in clinical and biological remission. Notably, among patients who received JAKi retreatment, 83.3% achieved remission in week 8.

Conclusions: To our knowledge, this is the first real-world study to evaluate the effects of JAKi discontinuation on the outcomes for patients with UC. JAKi discontinuation in patients in remission was associated with a high relapse risk. JAKi retreatment was highly effective in patients who experienced relapse after treatment discontinuation, providing valuable evidence for managing treatment interruption.

Background: Fatigue is a burdensome symptom of Crohn's disease (CD) and ulcerative colitis (UC). The Communicating Needs and Features of Inflammatory Bowel Disease Experiences (CONFIDE) study investigated how patients and health care professionals (HCPs) in the United States (US) and Europe (France, Germany, Italy, Spain, and the United Kingdom) perceived the experiences and impact of CD/UC-related symptoms.

Methods: Online, quantitative, cross-sectional surveys were conducted separately among patients with moderate-to-severe CD/UC (defined based on previous treatment, steroid use, and/or hospitalization) and HCPs who treated patients with CD/UC. US and Europe data are presented as descriptive statistics.

Results: Surveys were completed by 215 US and 547 European patients with CD, 200 US and 556 European patients with UC, and 200 US and 503 European HCPs. Overall, 35.8% US and 34.2% European patients with CD and 27.5% US and 20.9% European patients with UC reported currently experiencing fatigue (in past month). Most of these patients reported severe fatigue and indicated that CD/UC negatively affected their sleep, energy levels, and quality of life (QoL). The majority of patients currently experiencing but not discussing fatigue with their HCPs at every appointment wished they discussed it more frequently. However, most HCPs reported proactively discussing fatigue at routine appointments. Approximately 20% patients with CD/UC reported declining participation in work/school, social activities, and sports/physical exercise, and avoiding sexual activities due to fatigue.

Conclusions: US and European patients with CD/UC experienced severe burden of fatigue, which negatively affected their QoL. Assessing and discussing fatigue in routine appointments is critical for effectively managing this debilitating symptom.

Background: Although traditionally associated with White European ancestry, inflammatory bowel disease (IBD) has increased among different races and ethnicities. Large studies conducted in the United States and Canada have identified more complex disease phenotypes among Black patients. Our study aimed to investigate disparities in IBD treatments and outcomes between Black and White patients in the United States.

Methods: Using the TriNetX database, adult IBD patients were divided into 2 groups based on race: Black and White patients with IBD, Crohn's disease (CD), or ulcerative colitis (UC). Medical therapy and disease outcomes were evaluated in both groups with 1:1 propensity-score matching. Methodologic limitations include the potential for missing data, lack of information on socioeconomic strata, and patient-level medication coverage plans.

Results: In comparison to White patients, Black patients with CD were less likely to receive advanced therapies; Adalimumab (adjusted odds ratio- aOR 0.89), Certolizumab (0.81), Vedolizumab (0.66), Ustekinumab (0.82), or Tofacitinib (0.58). Black patients with UC were less likely to receive advanced therapies; Adalimumab (0.83), Golimumab (0.62), Vedolizumab (0.69), Ustekinumab (0.73), or Tofacitinib (0.55). Black patients with IBD were at higher odds of utilizing corticosteroids (CD 1.18 and UC 1.20) and opioids (CD 1.26 and UC 1.09). Black patients with CD had higher rates of hospitalization (1.35) and perianal abscess (1.56), perianal fistula (1.28), and intestinal fistula (1.38). Black patients with UC had higher rates of hospitalization (1.29), Clostridioides difficile infection (1.11), and toxic megacolon (1.34).

Conclusions: There were racial disparities in IBD medical therapy and disease outcomes. Black IBD patients had lower treatment with advanced therapies, higher opioid and corticosteroid use, and higher IBD-related complications.

Background: There is limited patient involvement in radiological research for perianal fistulizing Crohn's disease (pfCD), despite magnetic resonance imaging (MRI)'s critical role in diagnosis and management. Patient and public involvement is essential for aligning research with patient priorities. This study aimed to gather patient perspectives on the use of MRI in pfCD.

Methods: A mixed-methods approach was used, following Guidance for Reporting Involvement of Patients and the Public (GRIPP2) guidelines. An online survey, co-developed with a patient representative, included open and closed questions on MRI experiences, advantages, challenges, and the potential for Artificial Intelligence (AI)-generated reports. This was followed by a virtual session for further exploration of patient views. Thematic analysis was conducted on the data.

Results: Forty-seven patients with Crohn's disease (37 with pfCD) from 6 countries participated, with 28/37 (76%) completing the survey. Key themes included patient expectations for MRI, preferences for scan intervals, and report content. Most (93%) wanted MRI reports to compare with previous scans, highlighting fistula changes and new abscesses. A majority (57%) preferred MRI scans annually when well, and more frequently after surgery (64.3% preferred scans at 3 months). Emotional relief was associated with MRI improvements, though access to services and report clarity remained challenging. Interest in AI-generated reports was expressed if clearly explained and validated by professionals.

Conclusions: This is the first study exploring patient views on MRI use in pfCD, emphasizing the need for patient-centred MRI reporting and clearer communication. Future work should enhance patient access and validate AI-generated MRI reports.

Background: Anemia is a common complication of inflammatory bowel disease (IBD), impacting patient quality of life and clinical outcomes. This study examines anemia management practices and clinical outcomes in a national cohort of veterans with IBD.

Methods: A retrospective cohort study of 89 687 veterans with IBD from 2000 to 2017 was conducted using Veterans Health Administration data. We assessed anemia screening, iron store assessments, and iron therapy. Primary outcomes included anemia resolution within 12 months. Secondary outcomes included IBD-related hospitalizations, steroid use, and surgery within five years. Multivariate logistic regression models assessed associations between patient characteristics and clinical outcomes.

Results: Among 89 687 VA patients with IBD, 56% experienced anemia, but only 36% received iron testing. Only 23% of patients with iron deficiency received iron therapy within 6 months. Hemoglobin normalization occurred in 19% within a year. IBD patients with comorbidities had lower resolution rates (1-2 comorbidities: OR 0.89). Over five years, 30% were hospitalized, with lower rates for nonsmokers (OR 0.81) and higher for those with comorbidities (OR 1.10) or on biologics (OR 1.91). Steroid use was 17.5%, higher in those with comorbidities (OR 1.20) or on biologics (OR 4.11), and lower in Black patients (OR 0.78). Only 2% had surgery, less common among Black patients (OR 0.69) and non-smokers (OR 0.72).

Conclusions: Anemia is underdiagnosed and undertreated in veterans with IBD, leading to poor clinical outcomes. Enhanced screening and treatment protocols are essential to improve anemia resolution rates and reduce IBD-related complications.