Half of patients with inflammatory bowel disease (IBD) are men, yet less attention has been focused on their sexual issues despite higher rates of sexual dysfunction and infertility than the general ...population. Depression and IBD disease activity are the most consistently reported risk factor for sexual dysfunction among men with IBD. Methotrexate and sulfasalazine have been rarely associated with impotence. Sulfasalazine reversibly reduces male fertility. No other medications used in IBD significantly affect fertility in humans. There is no increase in adverse fetal outcomes among offspring of fathers with IBD. Patients with IBD seem to be at a higher risk for prostate cancer; therefore, screening as recommended for high-risk patients should be considered.
Discussion: We observed how 5 patients with IBD and persistent defecatory symptoms were suffering from DD. Earlier diagnosis with ARM may lead to timely referral to therapy and improved quality of ...life.Table 1. Summary table of IBD patient characteristics and ARM results Crohn’s N = 3 Ulcerative Colitis N = 2 Age at IBD diagnosis (years) 33 (IQR 24-38) 33.5 (IQR 26-41) Age at ARM (years) 49 (IQR 33-51) 45.5 (IQR 45-46) Sex Female 1 2 Male 2 0 Race Non-Hispanic white 2 2 Indian 1 0 Tobacco use None 2 2 Former 1 0 Prior vaginal delivery None 1 1 Yes 0 1 Disease phenotype Penetrating/structuring 1 0 Stricturing 1 0 Inflammatory 1 2 Disease extent Large bowel 1 0 Small bowel, large bowel 2 0 Proctitis 0 2 Medications Oral 5ASA or topicals 0 2 Biologic 3 0 Presence of anorectal fistula 1 1 Presence of anal stenosis/stricture 1 0 Risk factors for pelvic floor dysfunction Prior vaginal delivery 0 1 Multiparity 1 1 Episiotomy or vaginal tears 0 0 Rectal prolapse 1 0 Principal symptoms leading to ARM Constipation 2 1 Frequent stooling 1 1 ARM results Basal sphincter pressure Normal 0 1 High 3 1 RAIR Present 3 2 Squeeze pressure Normal 1 2 High 1 0 Low 1 0 Dyssynergic puborectalis response 3 1 Dyssynergic anosphincter response 1 0 Balloon expulsion successful 3 1 Rectal sensation Normal 1 0 Increased 2 2 Author Notes *PresenterUniversity of California, San Francisco, San Francisco, CA.
Background & Aims The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. Methods A ...systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Results Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti–tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk patients. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. Endoscopy or urgent surgery should not be delayed during pregnancy if indicated. Decisions regarding cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone, with the exception of women with active perianal Crohn’s disease. With the exception of methotrexate, the use of medications for IBD should not influence the decision to breast-feed and vice versa. Live vaccinations are not recommended within the first 6 months of life in the offspring of women who were on anti-TNF therapy during pregnancy. Conclusions Optimal management of IBD before and during pregnancy is essential to achieving favorable maternal and neonatal outcomes.
Background and Aims
Lower gastrointestinal endoscopy is crucial in the diagnosis and staging of inflammatory bowel disease (IBD). However, there are limited safety data in pregnant populations, ...resulting in conservative society guidelines and practice patterns favoring diagnostic delay. We studied whether performance of flexible sigmoidoscopy is associated with adverse events in pregnant patients with known or suspected IBD.
Methods
A retrospective cohort study was conducted at the University of California San Francisco (UCSF) between April 2008 and April 2019. Female patients aged between 18 and 48 years who were pregnant at the time of endoscopy were identified. All patient records were reviewed to determine disease, pregnancy outcomes, and lifestyle factors. Two independent reviewers performed the data abstraction. Adverse events were assessed for temporal relation with endoscopy.
Results
We report the outcomes of 48 pregnant patients across all trimesters who underwent lower endoscopy for suspected or established IBD. There were no hospitalizations or adverse obstetric events temporally associated with sigmoidoscopy. 78% (38/50) of lower endoscopies performed in the patients resulted in a change in treatment following sigmoidoscopy. 12% (5/43) of the lower endoscopies performed in patients with known IBD showed no endoscopic evidence of disease activity despite symptoms.
Conclusions
Lower endoscopy in the pregnant patient with known or suspected IBD is low risk and affects therapeutic decision making. It should not be delayed in patients with appropriate indications.
PDF
