Ulcerative Colitis Feuerstein, Joseph D; Moss, Alan C; Farraye, Francis A
Mayo Clinic proceedings,
07/2019, Letnik:
94, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Ulcerative colitis (UC) is a chronic inflammatory bowel disease that can involve any aspect of the colon starting with mucosal inflammation in the rectum and extending proximally in a continuous ...fashion. Typical symptoms on presentation are bloody diarrhea, abdominal pain, fecal urgency, and tenesmus. In some patients, extraintestinal manifestations may predate the onset of gastrointestinal symptoms. A diagnosis of UC is made on the basis of presenting symptoms consistent with UC as well as endoscopic evidence showing continuous and diffuse colonic inflammation that starts in the rectum. Biopsies of the colon documenting chronic inflammation confirm the diagnosis of UC. Most cases are treated with pharmacological therapy to first induce remission and then to maintain a corticosteroid-free remission. There are multiple classes of drugs used to treat the disease. For mild to moderate UC, oral and rectal 5-aminosalycilates are typically used. In moderate to severe colitis, medication classes include thiopurines, biological agents targeting tumor necrosis factor and integrins, and the small-molecule Janus kinase inhibitors. However, in up to 15% of cases, patients in whom medical therapy fails or who have development of dysplasia secondary to their long-standing colitis will require surgical treatment. Finally, to minimize the complications of UC and adverse events from medications, a working collaboration between primary care physicians and gastroenterologists is necessary to make sure that vaccinations are optimized and that patients are screened for colon cancer, skin cancer, bone loss, depression, and other treatable and preventable complications.
Abstract
Purpose
While COVID-19 vaccine emergency use authorization (EUA) deemed the vaccines to be effective and safe for public use, the phase 3 trials leading to EUA predominantly excluded ...patients with immunocompromising conditions. Immunocompromised patients make up a significant proportion of the population, and in light of recent mass vaccination efforts, we aim to review current evidence and recommendations of COVID-19 vaccines in 4 patient populations with immunocompromising disorders or conditions: human immunodeficiency virus (HIV) infection, solid organ transplantation, rheumatoid arthritis, and inflammatory bowel disease.
Summary
Given the evolving data on the safety and efficacy of the approved COVID-19 vaccines in the immunocompromised population, it is vital that pharmacists and other immunizing providers understand the current data and recommendations and provide the public with accurate information. To date, the only immunocompromised subgroup included in phase 3 COVID-19 vaccine trials have been those with HIV infection. However, recent retrospective trials have provided reassuring data on the safety of the COVID-19 vaccine in immunocompromised patients, and the interim analysis of the Moderna phase 3 trial produced promising data on efficacy in HIV-infected patients. Presently, the US Centers for Disease Control and Prevention, British Society for Immunology, and various other governmental and professional societies and organizations endorse COVID-19 vaccination in the immunocompromised population.
Conclusion
While additional data is needed to determine the effects of immunocompromising medical conditions and immunosuppressing medications on the efficacy of the vaccine, the benefits of vaccination is anticipated to outweigh theoretical risks. Thus, COVID-19 vaccination is recommended for immunocompromised patients at this time, and providers should make efforts to decrease vaccine hesitancy in this population through education and reassurance.
Recent data suggest that inflammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their ...gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identification, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identification of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary.
In the ICP cohort, hesitancy regarding COVID-19 vaccines is prevalent given the exclusion of this population from clinical trials. ...studies addressing immunization efficacy, timing relative to ...taking immunosuppressive agents, need to hold immunosuppressive agents, and vaccine hesitancy when caring for ICP will be instrumental. In assuming shared vaccination responsibilities, specialists should oversee and capitalize on administering vaccines at any in-person visits within their practice, whether it be in the office, endoscopy suite, laboratory, or infusion center 8. ...specialists should optimize their practice by including several tools, such as provider reminders, standing orders (i.e., protocol in place that permits non-physician providers to order and administer vaccines), and embedded state immunization registries, to assess immunization history and needs at every encounter. ...current COVID-19 vaccine-related concerns among ICP include perception that the vaccine is not safe or may lead to disease flares. ...patients may be obtaining inadequate or unvalidated information online, which is a concern given that reliance on social media has been correlated to a lower vaccination intent 10.
Abstract
Over the last 2 decades, novel therapies targeting several immune pathways have been developed for the treatment of patients with inflammatory bowel disease (IBD). Although anti-tumor ...necrosis factor (anti-TNF) agents remain the firstline treatment for moderate to severe Crohn's disease and ulcerative colitis, many patients will require alternative agents, due to nonresponse, loss of response, or intolerance of anti-TNFs. Furthermore, patients may request newer therapies due to improved safety profiles or improved administration (ie, less frequent injection, oral therapy). This review will focus on new and emerging therapies for the treatment of IBD, with a special focus on their adverse effects. Although many of the agents included in this paper have been approved for use in IBD, a few are still in development but have been shown to be effective in phase II clinical trials.
10.1093/ibd/izy327_video1
izy327.video1
5967364908001
Abstract
Sleep deprivation and lack of sleep are a significant public health concern. Several studies have suggested an intricate relationship between sleep, inflammation, and the immune system. Poor ...sleep has been described well in subjects with inflammatory bowel disease (IBD) and has been linked to disease activity and shown as a predictor for subclinical inflammation and a risk factor for relapse and poorer outcomes. This review describes the relationship between poor sleep, inflammation, and the immune system. Furthermore, the relationship between sleep and IBD are reviewed. The causes of poor sleep in inflammatory bowel disease patient is discussed. Potential therapeutic interventions for the management of common sleep disturbances are provided.
10.1093/ibd/izy334_video1
5856716084001
izy334.video1
Abstract
Introduction
There has been growing interest in social media use in managing chronic illnesses. The aim of this study was to assess social media usage in a large sample of patients with ...inflammatory bowel disease (IBD).
Methods
We performed a cross-sectional study within the Crohn's and Colitis Foundation's IBD Partners' internet-based cohort. We used bivariate analyses to compare patient characteristics by various factors associated with social media utilization. We used logistic regression models to determine factors independently associated with using social media to obtain IBD-related information.
Results
A total of 1960 IBD patients were included. Most respondents reported spending between 30 and 60 minutes on social media sites per day. Thirty-two percent of respondents agreed that social media could be useful for disease management. Most respondents agreed that social media should be used to connect patients with IBD-related organizations and to obtain IBD-related information online. Fifty percent of respondents could not rate the quality of IBD information posted online. Concerns surrounding social media use included privacy/confidentiality and lack of trust of information posted. The most frequently used social media website was Facebook. Thirty-two percent of respondents used social media at least once in the last week to obtain or post IBD-related content. Factors independently associated with social media use for IBD included female gender (odds ratio OR 1.43; 95% CI,1.10–1.87), age (OR 0.99; 95% CI, 0.98–1.00), remission (OR 0.63; 95% CI, 0.50–0.79), and a diagnosis of Crohn's disease (CD) rather than ulcerative colitis (UC) (OR 0.74; 95% CI, 0.58–0.93).
Conclusions
Patients with IBD in this cohort expressed a substantial interest in using social media to aid in disease management. Use was higher in younger patients, females, and patients with active disease. Most patients were unsure of the quality of information posted online, which represents opportunities for clinicians to guide patients to appropriate resources.
PDF
