Improvements in disease management, as well as endoscopic technology and quality, have dramatically changed the way in which we conceptualize and manage inflammatory bowel disease–related dysplasia ...over the past 20 years. Based on evolving literature, we propose a conceptual model and best practice advice statements for the prevention, detection, and management of colorectal dysplasia in people with inflammatory bowel disease. This expert review was commissioned and approved by the American Gastroenterological Association Institute Clinical Practice Updates Committee and the American Gastroenterological Association Governing Board to provide timely guidance on a topic of high clinical importance to the American Gastroenterological Association membership. It underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.
We sought to determine nationwide, population-based trends in rates of venous thromboembolism (VTE) among hospitalized inflammatory bowel disease (IBD) patients in the United States and to determine ...its mortality and economic impact.
We analyzed discharges from the Nationwide Inpatient Sample and used ICD-9-CM codes to identify Crohn's disease (CD) and ulcerative colitis (UC) between 1998 and 2004. Rates of VTE were compared between those with and without IBD. The impact of VTE on in-hospital mortality and resource utilization was quantified using regression analysis.
After multivariate adjustment, both UC (OR 1.85, 95% CI 1.70-2.01) and CD discharges (OR 1.48, 95% CI 1.35-1.62) had higher rates of VTE compared to non-IBD discharges. Prevalence of VTE was greater among UC compared to CD discharges (OR 1.32, 95% CI 1.17-1.48). Among CD patients, active fistulizing disease was independently associated with greater VTE (OR 1.39, 95% CI 1.13-1.70). There was an annual 17% rise in odds of VTE among IBD admissions over 7 yr. VTE was associated with greater mortality among IBD patients (adjusted OR 2.50, 95% CI 1.83-3.43). This age- and comorbidity-adjusted excess mortality from VTE was 2.1-fold higher for IBD than for non-IBD patients (P < 0.0001). IBD patients with VTE had longer length of stay (11.7 vs 6.1 days, P < 0.0001) and incurred higher hospital charges ($47,515 vs $21,499; P < 0.0001).
VTE is increasingly prevalent among hospitalized IBD patients and has substantial mortality and economic impact. These findings drive the need for widespread prophylaxis against and early detection of VTE among IBD inpatients.
Recurrent Clostridium difficile infection (rCDI) contributes to a significant burden of disease in patients with inflammatory bowel disease (IBD). In this study, we seek to identify risk factors for ...rCDI in a population of IBD patients at the Mount Sinai Hospital IBD Centre.
In this retrospective cohort study, IBD patients with rCDI diagnosed between 2010 and 2013 were identified and compared with IBD patients with single-episode CDI. Multivariate regression was used to identify predictors of rCDI in IBD. Outcome analysis was performed for hospitalizations due to CDI, colectomy, and CDI-attributable mortality.
A total of 503 patients were included, 110 (22%) of whom had IBD (49% CD, 51% ulcerative colitis). Recurrent CDI occurred in 32% of IBD patients compared with 24% of non-IBD patients (P<0.01). IBD patients with rCDI were more likely than those without rCDI to report recent antibiotic therapy (42.9 vs. 30.7%, P<0.01), 5-aminosalicylic acid (5-ASA) use (51.5 vs. 30.7%, P<0.001), steroid use (51.4 vs. 33.3%, P<0.001), and biologic therapy (48.6 vs. 40.0%, P<0.01). Infliximab (34.3 vs. 17.3%, P<0.01) but not adalimumab was associated with more rCDI events. Using a Cox model of predictors of rCDI in IBD, significant predictors included non-ileal Crohn's disease (hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.30-6.30) and the use of 5-ASA (HR 2.15, 95% CI 1.11-4.18).
Compared with the general population, IBD patients are 33% more likely to experience rCDI. Within the IBD cohort, exposure to certain drug classes (antibiotics, 5-ASA, steroids, certain biologics) and non-ileal Crohn's disease were found to be the predictors of rCDI.
Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously ...considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and ⁄ or obstruction.
This article aims to review the evidence implicating inflammatory bowel disease (IBD) as a risk factor for the development of venous thromboembolic events (VTEs), as well as to highlight additional ...risk factors and preventative and treatment strategies relating to the VTEs in IBD patients.
Medline and Embase databases were systematically searched and all original articles pertaining to VTEs in IBD patients were evaluated for suitability of content and methodology.
Multiple large studies have demonstrated that IBD patients have a 1.5- to 3.5-fold higher risk of incurring VTEs when compared with non-IBD patients. A large population-based study showed that IBD activity is associated with the development of VTEs. Although the greatest relative increase in the risk of VTEs with disease activity was observed in ambulatory IBD patients, hospitalized IBD patients had a markedly higher baseline risk of VTEs than ambulatory patients. Among VTE-related hospitalizations, the presence of IBD was associated with a 2.5-fold increased risk of mortality in one population-based study. No studies have specifically evaluated the potential benefit of VTE prophylaxis in hospitalized or ambulatory IBD patients. Studies to date do not support an increased bleeding risk with moderate doses of anticoagulant medications in IBD patients with active disease.
IBD patients are at an increased risk of sustaining VTEs and may be at an increased risk of VTE-related mortality when compared with non-IBD patients. IBD activity is an independent risk factor for VTE development. Future large prospective studies are required to better assess risk factors, health outcomes, and prevention strategies associated with the development of VTEs in IBD patients.
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.
Inflammatory bowel diseases (IBDs) exist worldwide, with high prevalence in North America. IBD is complex and costly, and its increasing prevalence places a greater stress on health care systems. We ...aimed to determine the past current, and future prevalences of IBD in Canada.
We performed a retrospective cohort study using population-based health administrative data from Alberta (2002–2015), British Columbia (1997–2014), Manitoba (1990–2013), Nova Scotia (1996–2009), Ontario (1999–2014), Quebec (2001–2008), and Saskatchewan (1998–2016). Autoregressive integrated moving average regression was applied, and prevalence, with 95% prediction intervals (PIs), was forecasted to 2030. Average annual percentage change, with 95% confidence intervals, was assessed with log binomial regression.
In 2018, the prevalence of IBD in Canada was estimated at 725 per 100,000 (95% PI 716–735) and annual average percent change was estimated at 2.86% (95% confidence interval 2.80%–2.92%). The prevalence in 2030 was forecasted to be 981 per 100,000 (95% PI 963–999): 159 per 100,000 (95% PI 133–185) in children, 1118 per 100,000 (95% PI 1069–1168) in adults, and 1370 per 100,000 (95% PI 1312–1429) in the elderly. In 2018, 267,983 Canadians (95% PI 264,579–271,387) were estimated to be living with IBD, which was forecasted to increase to 402,853 (95% PI 395,466–410,240) by 2030.
Forecasting prevalence will allow health policy makers to develop policy that is necessary to address the challenges faced by health systems in providing high-quality and cost-effective care.
Background & Aims The Paris pediatric modification of the Montreal classification defines very early onset inflammatory bowel disease (VEO-IBD) as a form of IBD distinct from that of older children. ...We compared the incidence and outcomes of VEO-IBD with those of IBD in older children. Methods We performed a population-based retrospective cohort study of all children diagnosed with IBD in Ontario, Canada, from 1994 through 2009. Trends in standardized incidence were calculated using Poisson regression. We compared outpatient and emergency department visits, hospitalizations, and surgeries among children diagnosed with IBD when they were younger than age 6, ages 6–9.9, and older than age 10 years. Multivariable models were adjusted for income and stratified by sex. Results The incidence of IBD increased from 9.4 per 100,000 children (95% confidence interval CI, 8.2–10.8/100,000 children) in 1994 to 13.2 per 100,000 children (95% CI, 11.9–14.6/100,000 children) in 2009 ( P < .0001). The incidence increased by 7.4% per year among children younger than 6 years old and 6–9.9 years old, and by 2.2% per year among children ≥10 years old. IBD-related outpatient visits were less frequent among children <6 years old than ≥10 years old (odds ratio for female patients, 0.67; 95% CI, 0.58–0.78; odds ratio for male patients, 0.86; 95% CI, 0.75–0.98). Hazard ratios HRs for hospitalization were lower for children <6 years old (female HR, 0.70; 95% CI, 0.56–0.87; male HR, 1.12; 95% CI, 0.94–1.33) than for older children. HRs for surgery among children <6 years old with Crohn’s disease were 0.35 for female patients (95% CI, 0.16–0.78) and 0.59 for male patients (95% CI, 0.34–0.99). HRs for children <6 years old with ulcerative colitis were 0.88 for female patients (95% CI, 0.47–1.63) and 0.42 for male patients (95% CI, 0.21–0.85). There was no difference in hospitalization or surgery rates among children 6–9.9 years old vs those ≥10 years old. Conclusions Based on a retrospective cohort study, the incidence of VEO-IBD increased from 1994 through 2009. Children diagnosed with IBD before they were 6 years old used fewer health services and had lower rates of surgery than children diagnosed when they were 10 years or older.
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