Abstract
Background
Induction and maintenance of remission is a primary treatment goal for inflammatory bowel disease (IBD). Active disease is often treated with corticosteroids (CS). Although ...effective, CS have significant negative effects, and not recommended for long term or frequent use, especially when safer medications are now available. Nonetheless, literature suggests that cumulative exposure to CS in IBD patients has not changed. Gaps in clinician adherence to international guidelines for IBD care have also been identified.
Aims
We aim to: (1) assess adherence of practitioners to guidelines for CS use and treatment of disease flares, and (2) associate guideline adherence with outcomes at 12 months.
Methods
A retrospective, single-center study using data collected from outpatients of the University of Alberta IBD Clinic, receiving >1 dispensation of CS from an IBD practitioner between March 2014–2016. Data for CS dispensations including and for 18 months following the initial dispensation were extracted from provincial databases. Other data was manually extracted from the region-specific electronic medical record (EMR). Regression analyses were performed with clinical remission as the dependent variable (95% confidence).
Results
Of 345 charts identified, 244 met inclusion. The majority, 157 (64.3%), had Crohn’s disease (CD). At the initial dispensation, median age was 40 (IQR: 28–50) years. Maintenance medications: 72 (29.5%) on no IBD medication, 75 (30.7%) 5-ASA only, 34 (13.9%) immunomodulators, and 63 (25.8%) biologic therapy. CS were prescribed in clinic for 125 (51.2%), at endoscopy for 54 (22.1%), in hospital for 29 (11.9%), and by telephone for 36 (14.8%). The majority of CS prescribed were prednisone (176, 72.1%), the remainder budesonide.
Figure 1 shows adherence to flare and CS guideline indicators. On analysis of outcomes, visit type and steroid type were not associated with increased steroid use within 12 months. In regression models for predicting clinical remission at 12 months following dispensation, the most significant predictor was <2 additional CS prescriptions (OR, 6.86; p=0.016). Interestingly, vitamin D supplementation showed increased likelihood of remission (OR, 2.61; p=0.064), while documentation of clinical scores showed decreased likelihood of remission (OR, 0.34; p=0.013).
Conclusions
There are gaps between guidelines and clinical practice for some aspects of IBD patient care, particularly documentation and fecal calprotectin. Providers seem more likely to document clinical scores when patients have severe disease. Making better use of EMR functionality may be of utility to automate and improve clinical documentation and testing. Additionally, prescribing of steroids beyond an initial flare does not appear to be associated with better outcome.
Funding Agencies
CCC, CIHRUniversity of Alberta
Abstract
Background
Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that causes inflammation of the gastrointestinal tract. C-reactive protein (CRP) is an inflammatory biomarker ...measured in the serum that is typically elevated during periods of disease activity and assists with guiding therapy. Previous studies have shown that 20–25% of CD patients do not produce CRP during IBD flares, due to genetic polymorphisms in the CRP-producing gene. It was hypothesized that this subset of patients will be on a different treatment regimen than CD patients that do produce CRP.
Aims
We conducted this case-control study to evaluate the treatment differences in CRP-non-producing CD patients as compared with CRP-producing CD patients.
Methods
Charts of outpatients seen in a GI clinic in Saskatoon over a two-year period were evaluated. Patients were assigned to two arms: CRP-producers and CRP-nonproducers. CRP-nonproducers were defined as patients with a maximum CRP level less than 10.5 mg/L with objective evidence of inflammation during a flare of CD, such as inflammation on endoscopy, imaging, or an elevated fecal calprotectin. A total of 265 CD patients were included, with 57 CRP-nonproducers (21.5%), and a mean follow-up time of 2.9 years. The primary end point was the class of IBD medication taken at the start and conclusion of the study. Secondary end points included duration and location of disease, age at diagnosis, requirement of surgical therapy for CD, follow-up time, number of visits to the IBD clinic, number of IBD-related hospitalizations, ferritin, hemoglobin, B12, and albumin levels. Results were analyzed with Fischer’s exact test and the Z-test.
Results
From the 265 CD patients reviewed, a total of 57 CRP-non-producers (21.5%) were identified. Compared to CRP-producers, CRP-nonproducers were less likely to be on biologic therapy at the start of the study (23% vs 35%, p=0.044; odds ratio 0.66) and at the conclusion of the study (47% vs 65%, p=0.007; odds ratio 0.72). CRP-nonproducers were much more likely to be on no therapy or 5-aminosalicylates at the start of the study (68% vs 43%, p=0.0006; odds ratio 1.58) and at the end of the study (44% vs 25%, p=0.005; odds ratio 1.76).
Conclusions
Lack of a CRP response in Crohn’s disease was associated with lower rates of biologic therapy.
Funding Agencies
None
Abstract
Background
The prevalence of celiac disease is estimated to be approximately 1%. However, the rate at which diagnoses have changed over time remains unknown.
Aims
To analyze the incidence of ...celiac disease across time.
Methods
We performed a systematic review in MEDLINE and EMBASE up to 2018, to identify all population-based studies reporting the incidence of celiac disease (n = 47). Temporal trend analyses captured the average annual percent change (AAPC) in celiac disease incidence over time. Meta-analyses were performed using random-effects models to determine sex and age differences in celiac disease incidence in the 21st century, as well as temporal trends (AAPCs) from 1990 to 2016. Heterogeneity was assessed using the I2 statistic.
Results
In the 21st century, the pooled female incidence of celiac disease was 17.4 (95% CI: 13.7, 21.0) per 100,000 person-years, compared to 7.8 (95% CI: 6.3, 9.3) in males. Child-specific incidence was 20.1 per 100,000 person-years (95% CI: 16.0, 24.3) compared to 13.2 (95% CI: 8.6, 17.8) in adults. Incidence of celiac disease appeared to be relatively low and stable until the 1990s (Figure 1), wherein diagnoses started to increase annually at 8.4% (95% CI: 6.0, 10.8) per year (Table 1).
Conclusions
The incidence of celiac disease is significantly rising. Celiac disease is disproportionately diagnosed in females and children, respectively.
Table 1: Pooled AAPC of celiac disease incidence from 1990 to 2016
Study (Country)
Time Period
AAPC (95% CI)
Cook 2004 (New Zealand)
1990–1999
19.9 (13.5, 26.8)
Fowell 2006 (UK, England)
1993–2002
11.4 (2.4, 21.1)
Hawkes 2000, Hurley 2012 (UK, Wales)
1990–2005
10.5 (8.7, 12.3)
McGowan 2009 (Canada)*
1990–2006
9.9 (0.6, 20.1)
Fernandez 2010 (Spain)^
1990–2008
25.3 (14.2, 37.5)
Namatovu 2014 (Sweden)*
1990–2009
2.5 (-5.8, 11.6)
Lanzarotto 2004, Lanzini 2005 (Italy)
1996–2003
18.2 (12.8, 23.8)
Ress 2012 (Estonia)*
1990–2010
8.2 (3.1, 13.5)
Jansen 1993, Burger 2014 (Netherlands)
1990–2010
9.3 (8.2, 10.3)
Murray 2003, Ludvigsson 2010 (USA)
1990–2010
8.1 (4.6, 11.7)
West 2014 (UK, Nationwide)
1990–2011
5.5 (4.6, 6.5)
Tapsas 2015 (Sweden)*
1990–2013
2.6 (1.0, 4.3)
Perminow 2000, Beitnes 2017 (Norway)*
1993–2010
8.7 (-27.2, 62.3)
Dydensborg 2012 (Denmark)*
1996–2009
12.8 (7.2, 18.6)
Zingone 2015b (UK, Nationwide)*
1993–2012
3.9 (1.9, 6.0)
Rajani 2010 (Canada)*
1998–2007
60.8 (34.4, 92.4)
Grode 2018 (Denmark)
1990–2016
7.8 (6.9, 8.7)
White 2013, Lister 2018 (Scotland)*
1990–2016
12.8 (11.4, 14.1)
Holmes 2017 (UK, England)^
1994–2014
7.8 (-0.5, 16.8)
Angeli 2012 (Italy)
2002–2010
-1.5 (-7.8, 5.2)
Stewart 2011 (Canada)
2004–2008
10.2 (-0.9, 22.5)
Kivela 2015 (Finland)*
2001–2013
3.3 (-0.9, 7.8)
Whyte 2013 (UK, Wales)*
2005–2011
5.8 (-2.9, 15.3)
Virta 2017 (Finland)^
2005–2014
-3.4 (-4.6, -2.2)
Overall Pooled AAPC (I2 = 95.4%, p < 0.001)
8.4 (6.0, 10.8)
*Children only (I2 = 88.4%, p < 0.001)
8.1 (5.5, 10.8)
^Adults only (I2 = 97.9%, p < 0.001)
7.7 (2.6, 12.7)
Figure 1: Trends in the overall incidence of celiac disease
Funding Agencies
Canadian Celiac Association
Abstract
Background
Patients with Crohn’s disease (CD) are at risk of surgery due to refractory or penetrating disease, which may result in short bowel syndrome (SBS) that requires parenteral ...nutrition (PN). Teduglutide is a GLP2 analogue that has been approved for the treatment of SBS although there has been limited evidence for its use in CD patients. There is a theoretical risk of exacerbating mucosal inflammation with teduglutide due to intestinotrophic effects of GLP2.
Aims
To assess the safety and efficacy of combined biologic therapy and teduglutide in patients with active CD and SBS.
Methods
We present two cases of CD patients with active inflammation and SBS treated with combination biologic therapy and teduglutide.
Results
The first case is a 38-year-old male with ileocolic stricturing CD, who previously failed methotrexate, azathioprine, infliximab and adalimumab. He underwent multiple small bowel and ileocolic resections resulting in SBS and was initiated on 7-day home parenteral nutrition (PN) in 2011 for SBS. Teduglutide was commenced in January 2017 and he was able to wean completely off PN within seven months. Ileocolic anastomotic inflammation was treated with ustekinumab in July 2017, and both treatments have been maintained for 14 months without any adverse events.
The second case is a 39-year-old male with stricturing small bowel CD, who previously methotrexate, azathioprine failed infliximab, adalimumab, , and was steroid-dependent. After multiple small bowel resections, he was left with a jejunocolic anastomosis with approximately 60 cm of residual small bowel length. Daily PN was initiated in 2003. He was initiated on vedolizumab and 6-mercaptopurine in 2016 due to pancolonic ulcerations. Teduglutide was added in August 2017 with significant clinical improvement in his oral intake, reduced stool output, and 4kg weight gain, with reduction in PN requirements to one night/week within 12 months of teduglutide.
Conclusions
These two cases suggest that teduglutide may be safe, effective and can be used with concomitant biologic agents and immunosuppressants in patients with active CD and SBS. However, longer term follow-up and more reports are needed to evaluate the safety of teduglutide in this setting.
Funding Agencies
None
Abstract
Background
Approximately up to 30–60% of ulcerative colitis (UC) patients fail to infliximab (IFX) in real-life retrospective studies. Studies investigating early markers of poor clinical ...outcomes in UC patients starting IFX remain limited.
Aims
The aim of this study was to investigate early markers of clinical outcomes in hospitalized UC patients starting IFX.
Methods
A total of 98 hospitalized UC patients (male, 55/98 56.1%; median age at first dose of IFX, 32.0 years IQR 24.5–44.0; median disease duration, 1.9 years 0.4–4.8) who started IFX from August 2010 to April 2017 at Mount Sinai Hospital, Toronto were retrospectively investigated. Variables including age, gender, family history of inflammatory bowel disease, smoking history, Mayo score, clostridium difficileinfection, serum albumin, and C-reactive protein (CRP) at the time of IFX initiation were analyzed. Cumulative event-free survivals of clinical outcomes was estimated by Kaplan-Meier curves and the association analysis by Cox proportional hazard regression.
Results
Among the 98 patients, 23 (23.5%) underwent colectomy during a median 1.2 months (IQR 0.5–2.4) and 38 (38.8%) re-admitted to the hospital during a median 1.9 months (IQR 1.1–6.1). Hypoalbuminemia (<35 g/L) at the time of IFX initiation was significantly associated with a 5-fold increased risk (aHR 4.99, 95% CI 1.16–21.53) of time to colectomy and a 2.7-fold increased risk (aHR 2.69, 95% CI 1.10–6.58) of time to re-admission, whereas CRP level was not associated with clincial outcomes. Patients with the lowest quartile of serum albumin levels (≤27 g/L) had significantly increased risks of time to colectomy and re-admission compared to the other quartiles. Clostridium difficile infection was associated with increased risk of time to re-admission (HR 2.27, 95% CI 1.04–4.98), although it was not significant in the final multivariable cox model.
Conclusions
Early albumin level at the time of IFX initiation is significantly associated with time to colectomy and re-admission risks in hospitalized UC patients, whereas early CRP level is not associated with these outcomes.
Univariable and Multivariable Cox Proportional Hazard Regression of Colectomy and Readmission
Time to Colectomy
Time to Re-admission
Univariable Cox
HR (95% CI)
Multivariable Cox
aHR (95% CI)
p
Univariable Cox
HR (95% CI)
Multivariable Cox
aHR (95% CI)
p
Male gender
1.88 (0.77–4.57)
-
-
1.93 (0.97–3.84)
-
-
Age at 1st infliximab dose
1.02 (0.99–1.05)
-
-
1.01 (0.99–1.03)
-
-
Family history of inflammatory bowel disease
1.75 (0.64–4.82)
-
-
1.19 (0.49–2.90)
-
-
Extensive colitis
0.89 (0.35–2.29)
-
-
0.96 (0.45–2.06)
-
-
Clostridium difficile infection
1.99 (0.74–5.36)
-
-
2.27 (1.04–4.98)
1.93 (0.74–5.05)
0.182
Partial Mayo score ≥7
1.74 (0.40–7.57)
-
-
0.67 (0.29–1.54)
-
-
Mayo Endoscopic Subscore ≥3
1.65 (0.56–4.87)
-
-
1.39 (0.64–3.05)
-
-
Hypoalbuminemia <35 g/L
4.99 (1.16–21.53)
4.99 (1.16–21.53)
0.031
2.70 (1.11–6.61)
2.69 (1.10–6.58)
0.030
High C-Reactive Protein ≥6 mg/L
2.72 (0.64–11.63)
-
-
1.52 (0.59–3.92)
-
-
aHR, adjusted hazard ratio; CI, confidence interval; HR, hazard ratio
Funding Agencies
None
Abstract
Background
Colorectal cancer (CRC) is the third most prevalent form of cancer worldwide and the second most diagnosed form of cancer in Canada. G protein-coupled receptors (GPCRs) are ...suspected to play a key role in CRC tumorigenesis. The tumorigenic process is divided into three steps: initiation, promotion and tumor progression. Formation of metastases is based on cell cancer capacity to migrate during early stages of tumorigenesis. Identification of new targets involved in CRC development is a major challenge to improve diagnostic and treatment of this form of cancer.
Aims
Past research has identified the GPCR P2Y6 as such innovative target. In fact, P2Y6 activities were involved in different stages of colorectal tumorigenesis. We demonstrated that P2y6-/- mice significantly develop fewer tumors than control mice in a CRC mouse model. Other studies confirmed that P2Y6 played a role in the epithelial to mesenchymal transition (EMT) and accelerated migration of breast cancer MDA-MB-468 cells. Surprisingly, there is sparse information about the potential influence of P2Y6 action in cancer cell migration and on the mechanism involved in this process. That’s why, in this study, we wanted to characterise P2Y6 signalling in cell migration.
Methods
We studied effects of this receptor on cell migration by using wound healing assays and we showed migrating structures by immunofluorescence assays and western blots.
Results
In this work, we showed that P2Y6 activation lead to cell migration using wound healing assays. This migratory stimulating effect was the result of the formation of filopodia and focal adhesions, known as migrating structures, and the cofilin phosphorylation. The formation of filopodia was associated to the P2Y6 dependent modulation of CDC42 protein expression whereas cofilin phosphorylation was correlated to the Rho/ROCK pathway.
Conclusions
These results are thus supporting the idea that the P2Y6 receptor is involved in cell migration and it could be a target for the treatment of CRC.
Funding Agencies
NoneFinancement par mes directeurs le Pr. Fernand-Pierre Gendron (50%) et le Pr. Philippe Sarret (50%).
Abstract
Background
PCB is an important colonoscopy quality indicator that is recommended to be routinely collected by colorectal cancer screening programs and endoscopy quality improvement programs.
...Aims
To create a standardized and reliable definition of PCB and set of rules for attributing the relatedness of PCB to a colonoscopy.
Methods
PCB events were identified from colonoscopies performed at the Forzani & MacPhail Colon Cancer Screening Centre. The Centre’s QI program reviews all emergency department visits and inpatient stays occuring within 30 days.
Existing definitions and relatedness rules for PCB were reviewed by the authors and a draft definition and set of rules was created. Initial testing was performed using a set of 15 bleeding events. Information available for each event included the original endoscopy report and data abstracted from the emergency or inpatient record by a trained research assistant (CMM). The other six authors, all endoscopists, independently reviewed each event to determine if it met the definition of PCB and assessed its relatedness to the colonoscopy. The authors then met to review their ratings and revisions to the definition and rules were made. A validation set of 32 bleeding events were then reviewed to assess their interrater reliability by having three authors complete independent reviews and three authors complete a consensus review. The Kappa statistic was used to measure interrater reliability.
Results
PCB was defined as “Patient- or health care provider-reported rectal bleeding (other than blood on the toilet paper) and/or hemoglobin drop >2g within 30 days of procedure resulting in an emergency/urgent care center visit or hospital admission.” The relatedness criteria are shown in the table. The panel classified 28 of 32 events as meeting the definition of PCB and rated 7, 8 and 6 events as definitely, probably and possibly related to the colonoscopy, respectively. The Kappa for the definition of PCB for the three independent reviews was 0.82 (substantial agreement). The Kappa for the attribution of the PCB to the colonoscopy was 0.47 (moderate agreement). When reclassifying events as related or unrelated to the colonoscopy the agreement was higher (0.85).
Conclusions
A standardized definition of PCB and attribution rules achieved high interrater reliability and provides a template of required data for event adjudication by QI programs.
Attribution Rules
Relatedness
Criteria
Definite
Active bleeding or adherent clot at 2nd colonoscopy
Probable
3 of
1. ≤14 days
2. hot snare polypectomy
3. visible vessel at 2nd colonoscopy
4. HRP
Possible
2 of probable criteria
Unlikely
3 of
1. > 14 days
2. biopsy, cold snare or no polypectomy
3. not HRP
4. no high risk stigmata or no 2nd colonoscopy
Unrelated
Alternate source found
HRP: High RIsk Polypectomy: size > 2 cm; 1–2 cm in right colon or pedunculated or antiplatelet/anticoagulant; immediate bleeding
Funding Agencies
None
Abstract
Background: Background
Autoimmune hepatitis (AIH) is a progressive liver disease characterized by hepatic inflammation, positive autoantibodies, and increased levels of immunoglobulin G. It ...has a broad clinical spectrum ranging from asymptomatic transaminitis to fulminant liver failure. In this case report we highlight upper gastrointestinal bleeding secondary to gastric varices as the first presentation in a child with AIH.
Case Report
A 12-year-old previously healthy girl presented to the ER with hematemesis associated with epigastric pain and nausea. She was noted to have mild jaundice a few weeks prior. She had no history of fever, melena or hematochezia. On presentation to the ER, she was tachycardic and hypotensive. She had splenomegaly but no other stigmata of chronic liver disease.She was stabilized with blood transfusion, as well as IV pantoprazole and octreotide and admitted to the PICU. Initial laboratory results were suggestive of liver failure with a Hb 73g/L, platelets 91x109/L, ALT 136 U/L, AST 213 U/L, GGT 51 U/L, direct/total bilirubin 96/37umol/l, albumin 15g/L, and INR 2.42. Abdominal ultrasound showed features suggestive of hepatic fibrosis and portal hypertension. Gastroscopy showed a normal esophagus and portal hypertensive gastropathy with a GOV2 varix with bleeding stigmata which was successfully glued with histocryl.
Investigations for chronic liver disease including viral hepatitis, and alpha 1 antitrypsin deficiency were negative. She had a positive ANA and low ceruloplasmin with a normal ophthalmologic exam. The liver biopsy showed chronic hepatitis with moderate activity and stage 4/4 fibrosis. Minimal stainable copper was seen on Orcein stain. EM showed dilatation of mitochondrial cristae and matrix densities. The biopsy thus had features suggestive of Wilson’s disease but could not exclude autoimmune hepatitis. She was therefore started on both zinc gluconate and methylprednisolone as treatment for Wilson’s disease and autoimmune hepatitis respectively on her 4thday of hospitalization. Subsequent results revealed a positive anti–liver-kidney microsomal antibody. The repeated serum ceruloplasmin was normal and subsequently the 24 hour urine copper was normal. Genetic testing for Wilson’s disease was negative. There was a clinical and biochemical response to treatment with a decrease in her bilirubin (bili-direct 4.5), INR stabilized at 1.8 and her ALT decreased initially but then started to increase gradually reaching 120 U/L. Combination therapy with azathioprine was initiated and zinc was stopped.
The endoscopy was repeated 6 weeks and 14 weeks after her initial procedure and theGOV2 varix required histocryl injection on both occasions. Her response to treatment continues to be monitored closely conjointly with the transplant centre to decide on listing for liver transplantation.
Aims
See above
Methods:
Results:
Conclusions:
Funding Agencies: None
Abstract
Background
Preferences for receipt of information vary among individuals, with many patients showing an interest in receiving via video content. Although several educational videos on ...colonoscopy are available, most of them have not been evaluated systematically.
Aims
To develop and compare a colonoscopy video educational resource to a previous video on similar subject matter.
Methods
We developed a new video resource, based on feedback from patients and health care providers and recommended content in literature. A similar content video from the web was identified as the most highly rated by an advisory group. Individuals attending gastroenterology clinics, blinded to the source of videos, were recruited to watch both the New Video and the Similar Video. The order of watching the videos was randomly assigned to allow the assessment of order effects. After watching, participants were asked to rate each video based on: amount of information, clarity, trustworthiness, ease of watching/understandability, familiarity, reassurance, information learned, understanding from the patient’s point of view, appeal, and if they would recommend the video. Participants were then asked which video they preferred and why they preferred it based on clarity, trustworthiness, ease of watching/understandability, and reassurance. Participants were also asked to explain what they liked/disliked about the videos and if they had any suggestions for improving the material.
Results
232 participants viewed both videos. When the New Video was viewed first 64% preferred the New Video and 31% preferred the Similar Video. When the Similar Video was viewed first 78% preferred the New Video and 20% preferred the Similar Video. Of the participants that had not had a previous colonoscopy, 66% preferred the New Video, while 74% of the participants with previous colonoscopy experience preferred the New Video. Multivariable logistic regression analysis also suggested that participants prefer the New Video if they saw it second. Participants rated the New Video as clearer and more trustworthy than the Similar Video. Many participants specified in the open-ended questions they liked New Video better because it was clearer, it was more informative, and was more visually appealing.
Conclusions
We have developed and validated a new colonoscopy video educational material, which is freely available on the web. Our study suggests that in information evaluation studies, it is important to consider order effects. We have developed a process to appraise and compare different video information materials against each other.
Funding Agencies
None
Abstract
Background
Patients from lower vs. higher socioeconomic classes may have less opportunity to participate in health research due to: less flexible work hours, working multiple jobs, less ...likely to be self-employed, less education and lower understanding of the importance of research.
Aims
To increase our understanding of the concerns and preferences for care of patients with inflammatory bowel disease (IBD) with less than a university degree.
Methods
A cross-sectional study was undertaken at the McGill University Health Centre IBD Clinic (July-August 2018). Inclusion criteria were: out-patients, aged 18 years or older, English- or French-speaking, less than a university degree and diagnosed with ulcerative colitis or Crohn’s Disease for at least one year. A research assistant conducted semi-structured interviews using a questionnaire that addressed: 1) characteristics of health care providers and the system, 2) what health care providers do in delivering care and 3) patient outcomes and goals. The questionnaire was created based on a focus group guide that had been developed for our larger study aimed at eliciting patient preferences for care in IBD. Descriptive statistics were used to characterize the study population and to quantify the number of participants who endorsed various elements of care. Qualitative data were analyzed by identifying themes and selecting exemplars to support them.
Results
In total, 23 individuals (median age=41; 12 females) participated, of whom 21 (91.3%) did not attend university and 2 (8.7%) attended university without completion. Fifteen (65.2%) participants rated access to an IBD specialist as the most important aspect of care; 8 (34.8%) and 9 (39.1%) participants said holistic and complementary and alternative medicine, respectively, were important for their care. The 3 most commonly reported experiences in the health care system were: good care (52.2%), lengthy delay until diagnosis (26.1%) and non-receptive staff (13.0%). The 3 most commonly reported experiences with health care providers were: kind staff (34.8%), receptive IBD doctor (26.1%) and non-receptive IBD doctor (21.7%). The 3 most helpful aspects in managing IBD were: IBD specialist, family and friends and treatment that reduces symptoms. The 3 most difficult aspects of living with IBD were: urges/pain/anxiety, social aspect and medications and side effects.The top-ranked goal was reducing symptoms.
Conclusions
Access to a receptive IBD specialist was the most important aspect of receiving good quality care. Many patients used a multidisciplinary approach to achieve disease remission that included use of non-traditional therapies. These findings may be used to enhance the quality of patient care.
THEMES & EXEMPLARS
Non-traditional therapies
I wish western medicine, nutrition and holistic medicine could be integrated and provided by the treating physician
Delayed diagnosis
It took 4.5 months to receive a diagnosis after going to the ER four times. I was misdiagnosed with stomach cancer initially
Most helpful in managing disease
Funding Agencies
Ferring Canada
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