Inflammatory Bowel Disease and Pregnancy Shmidt, Eugenia; Dubinsky, Marla C.
The American journal of gastroenterology,
10/2022, Letnik:
117, Številka:
10S
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A more recent study of mostly women pregnant people on antitumor necrosis factor (TNF) medications found that, throughout pregnancy, fecal calprotectin decreased in patients with IBD but increased in ...controls, suggesting a beneficial impact of pregnancy on IBD (7). A systematic review and meta-analysis of 53 studies found that delivery by cesarean (odds ratio OR 1.79, 95% confidence interval CI, 1.16–2.77), gestational diabetes (OR 2.96, 95% CI, 1.47–5.98), and preterm prelabor rupture of membranes were more common in patients with IBD compared with controls (16). IBD EVALUATION BEFORE AND DURING PREGNANCY Reliable, objective markers of IBD activity are particularly important in pregnancy because active disease is the greatest threat to optimal maternal and fetal outcomes. Laboratory evaluation Serologic changes commonly seen in pregnancy, including elevation of the sedimentation rate and decreases in hemoglobin, iron levels, and albumin, may mimic active disease and are, therefore, less accurate measures of disease activity.
Continuing Medical Education Questions: October 2022 Shmidt, Eugenia; Reau, Nancy S; Johnson, David A
The American journal of gastroenterology,
2022-Oct-01, 2022-10-00, 20221001, Letnik:
117, Številka:
10
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Article Title: The ACG Monograph on GI Diseases and Endoscopy in Pregnancy and Postpartum Period.
Response to Andrew et al Gottlieb, Zoë S; Dolinger, Michael T; Shmidt, Eugenia ...
The American journal of gastroenterology,
11/2023, Letnik:
118, Številka:
11
Journal Article
We assessed the real-world effectiveness and safety of vedolizumab (VDZ) in moderate-severe Crohn's disease (CD).
Retrospective cohort study of seven medical centers, from May 2014 to December 2015. ...Adults with moderate-severe CD treated with VDZ, with follow-up after initiation of therapy, were included. Using the multivariable Cox proportional hazard analyses, we identified independent predictors of clinical remission or mucosal healing with VDZ. Rates of serious infection (requiring antibiotics, resulting in discontinuation of VDZ, hospitalization or death) and serious adverse events (discontinuation of VDZ, hospitalization or death) were described quantitatively.
We included 212 patients with moderate-severe CD (median age 34 years; 40% male; 90% tumor necrosis factor (TNF)-antagonist exposed) with a median follow-up (IQR) of 39 weeks (25-53). Twelve-month cumulative rates of clinical remission, mucosal healing, and deep remission (clinical remission+mucosal healing) were 35%, 63%, and 26%, respectively. Individuals with prior TNF-antagonist exposure (hazard ratio (HR) 0.40; 95% confidence interval (CI): 0.20-0.81), smoking history (HR 0.47; 95% CI: 0.25-0.89), active perianal disease (HR 0.49; 95% CI: 0.27-0.88), and severe disease activity (HR 0.54; 95% CI: 0.31-0.95) were less likely to achieve clinical remission. Those with prior TNF-antagonist exposure (HR 0.29; 95% CI: 0.12-0.73), and severe disease activity (HR 0.54; 95% CI: 0.31-0.95) were less likely to achieve mucosal healing. During 160 patient years of follow-up (PYF) and 1,433 VDZ infusions, 5 patients developed infusion reactions (3.5 per 1,000 infusions), 21 developed serious infections (13 per 100 PYF), and 17 developed serious adverse events (10 per 100 PYF). A minority of adverse events required discontinuation of therapy (6 per 100 PYF).
VDZ is a safe and effective treatment option for moderate-severe CD in routine practice. Clinical remission and deep remission (clinical remission and mucosal healing) can be achieved in 1/3 of individuals, and a minority of individuals require discontinuation of therapy due to adverse events.
Starting in January 2022, we are excited to announce that Clinical and Translational Gastroenterology (CTG) will transition from a single-blind to a double-blind peer review system. Biases based on ...investigators' reputations, institutional prestige, race, and/or sex—whether conscious or not—permeate the scientific community. ...evidence suggests double-blind reviews are of higher quality than single-blind reviews (5).
Demographic data including sex, age at CD diagnosis, and CD location were similar between surgical and medical management groups (Table 1). There were no differences in length of hospital stay, ...complication rate up to 6 months post-admission, time to subsequent CD-related surgery, and time to CD recurrence/flare between the two groups. ...antibiotic therapy may be an effective and safe management strategy in the treatment of CD patients with acute appendicitis. Clinical Characteristics of Crohn's Disease Patients Presenting with Acute Appendicitis All Antibiotics (n=19) Surgery (n=33) P-value Sex, n (%) >0.05 F 25 9 (36%) 16 (64%) M 27 10 (37%) 17 (63%) Montreal Classification Age, n (%) >0.05* A1 5 3 (17%) 2 (7%) A2 23 6 (33%) 17 (59%) A3 19 9 (50%) 10 (34%) Montreal Classification Age, n (%) >0.05* L1 15 4 (21%) 11 (36%) L2 15 6 (32%) 9 (29%) L3 20 9 (47%) 11 (35%) PGA, n (%) >0.05* 0 25 8 (42%) 17 (53%) 1 5 0 5 (16%) 2 11 6 (32%) 5 (16%) 3 10 5 (26%) 5 (16%) Presence of flare during admission, n (%) < 0.01* Yes 13 9 (47%) 3 (9%) No 39 10 (53%) 30 (91%) Age at appendicitis episode, years 43 (17-73) 41 (19-90) >0.05 LOS, days 3.9 (0-14) 2.8 (0-17) >0.05 Chi-Square or *Fisher's Exact Test PGA:
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