scholarly journals Aggressive Colorectal Cancer in an Inflammatory Bowel Disease Patient following Treatment with Vedolizumab: A Case Report

2021 ◽  
pp. 1-6
Author(s):  
Catarina Nascimento ◽  
Helena Oliveira ◽  
Catarina Fidalgo ◽  
Lídia Roque Ramos ◽  
Luísa Glória ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Case Report ◽  
Bowel Disease ◽  
Disease Patient ◽  
Immunosuppressive Drugs ◽  
Lymphocyte Migration ◽  
Steroid Dependent ◽  
Increased Risk ◽  
Inflammatory Bowel

<b><i>Introduction:</i></b> The increased risk of bowel cancer in patients with inflammatory bowel disease can be related with the extent, duration and severity of inflammation or with the cancer immune surveillance interference of immunosuppressive drugs used in inflammatory bowel disease treatment. Therefore, the risk-benefit ratio associated with long-term therapeutic strategies should be based on the patient’s age, sex, comorbidities and disease phenotype. <b><i>Case Report:</i></b> We present the case of a 76-year-old man with a history of melanoma stage Clark III and steroid-dependent left-sided colitis, refractory to mesalamine and thiopurines, with a diagnosis of a multifocal colorectal adenocarcinoma shortly after clinical and endoscopic remission 1 year after starting vedolizumab. <b><i>Discussion:</i></b> Vedolizumab is a gut-selective monoclonal anti-α<sub>4</sub>β<sub>7</sub>-integrin antibody that inhibits lymphocyte migration into the gastrointestinal submucosa. Its effectiveness for induction and maintenance of remission and its favorable safety profile make it an alternative in patients with chronic refractory colitis and contraindications to anti-TNF-α. However, there is the hypothesis that, by reducing the migration of activated leukocytes to the gastrointestinal tract, it may also reduce immunosurveillance, increasing the colorectal malignancy risk in the long term. More studies are necessary to address this issue.

Steroids in inflammatory bowel disease: a clinical review

2021 ◽  
Vol 3 (3) ◽  
pp. 107-111
Author(s):  
Arif Hussenbux ◽  
Aminda De Silva
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Glucose Monitoring ◽  
Vitamin D Supplementation ◽  
Blood Glucose Monitoring ◽  
Team Meetings ◽  
Steroid Dependent ◽  
Inflammatory Bowel ◽  
Intravenous Steroids

Corticosteroids are effective at inducing remission in inflammatory bowel disease (IBD). Acute severe ulcerative colitis and Crohn's disease are managed with intravenous steroids. In mild-to-moderate disease, corticosteroids can be given orally or topically. Long-term use should be limited to prevent commonly associated adverse effects. Corticosteroids should not be used to maintain remission. Blood pressure, body mass index and blood glucose monitoring are crucial while on steroids. Acid suppression along with calcium and vitamin D supplementation should be co-prescribed to all patients on long-term corticosteroids. Bridging these patients to a steroid-sparing agent early prevents steroid-refractory and steroid-dependent disease. GP education, IBD helplines, IBD clinics, multidisciplinary team meetings and regular auditing should be encouraged to prevent corticosteroid overprescribing.

Steroids in inflammatory bowel disease: a clinical review

2021 ◽  
Vol 19 (1) ◽  
pp. 28-33
Author(s):  
Arif Hussenbux ◽  
Aminda De Silva
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Glucose Monitoring ◽  
Vitamin D Supplementation ◽  
Blood Glucose Monitoring ◽  
Team Meetings ◽  
Steroid Dependent ◽  
Inflammatory Bowel ◽  
Intravenous Steroids

Corticosteroids are effective at inducing remission in inflammatory bowel disease (IBD). Acute severe ulcerative colitis and Crohn's disease are managed with intravenous steroids. In mild-to-moderate disease, corticosteroids can be given orally or topically. Long-term use should be limited to prevent commonly associated adverse effects. Corticosteroids should not be used to maintain remission. Blood pressure, body mass index and blood glucose monitoring are crucial while on steroids. Acid suppression along with calcium and vitamin D supplementation should be co-prescribed to all patients on long-term corticosteroids. Bridging these patients to a steroid-sparing agent early prevents steroid-refractory and steroid-dependent disease. GP education, IBD helplines, IBD clinics, multidisciplinary team meetings and regular auditing should be encouraged to prevent corticosteroid overprescribing.

P129 INPATIENT OUTCOMES OF SEPSIS IN INFLAMMATORY BOWEL DISEASE PATIENTS: A 2016 NATIONWIDE INPATIENT SAMPLE ANALYSIS

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S25-S26
Author(s):  
Ishaan Vohra ◽  
Bashar Attar ◽  
Sachit Sharma ◽  
Vatsala Katiyar ◽  
Manthan Jaiswal
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Charlson Comorbidity Index ◽  
Immunosuppressive Drugs ◽  
Primary Diagnosis ◽  
Chi Square ◽  
Predictors Of Mortality ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Inflammatory Bowel

Abstract Introduction Patients with inflammatory bowel disease are at increased risk of infections due to the immunosuppressive drugs used for its treatment and by the virtue of the disease itself. The risk of infection is further exacerbated by decreased host response to vaccines. Objective The objective of this study is to determine the outcomes of sepsis in patients with Inflammatory bowel disease (IBD). Methods The 2016 National Inpatient Sample database was used to identify patients admitted with primary diagnosis of sepsis using ICD 10 code. The subgroup analysis was done to identify patients with IBD. IBD patients were further subdivided into Ulcerative colitis and Crohn’s disease. We analyzed inpatient demographics using chi-square. Predictors of inpatient mortality were calculated using univariate and multivariable regression models. Results 1,899,169 patients were admitted for sepsis in 2016. 10,485 UC and 13,879 CD patients with sepsis were identified. UC patients admitted with sepsis had a higher mortality (47.9%) compared to CD patients (37.8%). After adjusting for potential confounders, CD was associated lower odds of mortality as compared to UC (aOR 0.77, 95% CI 0.60–0.97, P=0.031). Independent predictors of mortality were Age (aOR 1.02, 95% CI 0.60–0.97, P=0.031) and increased Charlson comorbidity index (aOR 1.76, 95%CI 1.27–2.44 P=0.001). Acute renal failure patients requiring inpatient hemodialysis (aOR 2.8, 95% CI 1.9–4.1,P=0.000) and patients with septic shock requiring pressor support(aOR 1.6 95% CI 1.01–2.51, P=0.044) were also associated with higher odds of mortality. Severe malnourishment (aOR 0.005, 95% CI 1.18–2.62, P=0.005) and patients who developed obstruction (aOR 1.9, 95% CI 1.3–2.7, P=0.001) were also associated independent predictors of mortality on multivariate logistic regression. Conclusions Sepsis admissions in CD patients had better outcomes compared with UC patients. Age, Charlson comorbidity index, renal function and nutritional status of patient were useful tools to predict mortality. Further, research is needed to identify other predictors and to determine the mechanisms of underlying clinical differences.

scholarly journals P36 A case of refractory IBD-related scleritis

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Lucy Paterson-Brown ◽  
Alexandra Jones ◽  
Nick Wilkinson
Keyword(s):  
Inflammatory Bowel Disease ◽  
Case Report ◽  
Anterior Uveitis ◽  
Bowel Disease ◽  
Posterior Uveitis ◽  
Topical Steroids ◽  
Posterior Scleritis ◽  
Caucasian Girl ◽  
Steroid Dependent ◽  
Inflammatory Bowel

Abstract Case report - Introduction Scleritis is severe vision-threatening scleral inflammation, commonly presenting with a red, painful eye and can be classified using the Watson system. Posterior scleritis may present with associated anterior uveitis in many cases. Steroid therapy is often successful initially; however, further immunomodulation is usually required to control subsequent episodes which can be challenging. We present an 18-year-old, Caucasian girl with a left eye, sight-threatening, steroid-dependent posterior uveitis who required escalation of treatment to tocilizumab before inflammation could be suppressed. Case report - Case description Our patient was diagnosed elsewhere with ulcerative colitis at the age of 12 and subsequently developed recurrent episodes of uveitis and scleritis which could be controlled with topical steroids. At the age of 16 she presented with an inflammatory arthritis and was treated with intravenous methylprednisolone before commencing sulfasalazine therapy. Due to persistent systemic and ophthalmic inflammation she was changed to adalimumab; however, this was also unsuccessful and methotrexate was added. By the age of 18 she had been steroid-dependent for 2 years and could not reduce daily prednisolone below 15mg without a deterioration in her left eye posterior scleritis with visual acuity compromise including episodes of complete visual loss causing high levels of anxiety. Due to the pain and deterioration in vision she struggled with her studies and school attendance, and withdrew from her passion for competitive sailing. With ongoing sight-threatening inflammatory changes she was referred for further tertiary assessment in 2019. During the following 4 months treatment was escalated rapidly. Methotrexate dose was increased, and adalimumab frequency reduced to weekly. There was a limited response, with further episodes of sight deterioration as a result of flares in inflammation. Response to tocilizumab treatment was seen after only two doses with good control of scleritis by 3 months of treatment when steroids were successfully weaned and stopped. Over 18 months of tocilizumab therapy the patient has only required one course of topical steroids for mild ocular inflammation which resolved without any other treatment required. She has successfully completed her degree, can complete daily gym training sessions and participate in regular sailing competitions. Case report - Discussion Posterior scleritis is the most common scleritis in children and can be associated with anterior uveitis, concurrent anterior scleritis, disc swelling or retinal striae. Posterior scleritis has a higher rate of complications therefore is treated aggressively. Refractory cases such as this require biologic therapy and rituximab is often used. Despite the preference of two adult eye units for treatment with rituximab the rationale for tocilizumab included; recent high quality studies showing successful treatment of inflammatory bowel disease, its known benefit for anterior uveitis and case studies in adults with posterior scleritis. Tocilizumab is a recombinant monoclonal antibody that causes a blockade of interleukin-6 receptors. It is currently only approved by the Food and Drug Administration (FDA) for use in children with polyarticular or systemic onset Juvenile Idiopathic Arthritis (JIA). Our patient had a very positive experience with this drug, no side effects and rapid clinical improvement seen. As a result her quality of life and mental health improved quickly. Case report - Key learning points This is a case of refractory, sight-threatening, steroid-dependent posterior scleritis on a background of inflammatory bowel disease and arthritis. As a result of this case our team reviewed current literature from other paediatric populations and adults with scleritis, informing the clinical decision to proceed with tocilizumab after control was unsuccessful with previous agents. The remarkable response demonstrated for our patient highlights the value tocilizumab can offer to the treatment options for similar refractory cases. This adds to the growing positive data published surrounding tocilizumab in children but further studies in paediatric populations are required to evaluate this in greater detail.

scholarly journals Ulcerative colitis has an aggressive course after orthotopic liver transplantation for primary sclerosing cholangitis

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 639-644 ◽  
Author(s):  
G V Papatheodoridis ◽  
M Hamilton ◽  
P K Mistry ◽  
B Davidson ◽  
K Rolles ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
De Novo ◽  
Increased Risk ◽  
Inflammatory Bowel

Background—The course of inflammatory bowel disease after liver transplantation has been reported as variable with usually no change or improvement, but there may be an increased risk of early colorectal neoplasms. In many centres steroids are often withdrawn early after transplantation and this may affect inflammatory bowel disease activity.Aims—To evaluate the course of inflammatory bowel disease in primary sclerosing cholangitis transplant patients who were treated without long term steroids.Methods—Between 1989 and 1996, there were 30 patients transplanted for primary sclerosing cholangitis who survived more than 12 months. Ulcerative colitis was diagnosed in 18 (60%) patients before transplantation; two had previous colectomy. All patients underwent colonoscopy before and after transplantation and were followed for 38 (12–92) months. All received cyclosporin or tacrolimus with or without azathioprine as maintenance immunosuppression.Results—Ulcerative colitis course after transplantation compared with that up to five years before transplantation was the same in eight (50%) and worse in eight (50%) patients. It remained quiescent in eight and worsened in four of the 12 patients with pretransplant quiescent course, whereas it worsened in all four patients with pretransplant active course (p=0.08). New onset ulcerative colitis developed in three (25%) of the 12 patients without inflammatory bowel disease before transplantation. No colorectal cancer has been diagnosed to date.Conclusions—Preexisting ulcerative colitis often has an aggressive course, while de novo ulcerative colitis may develop in patients transplanted for primary sclerosing cholangitis and treated without long term steroids.

scholarly journals Microscopic Ileitis in Clinically Suspected Inflammatory Bowel Disease Patients- Can It Predict the Future?

2019 ◽  
Author(s):  
Fadi Abu Baker ◽  
Jesus Alonso Z'cruz De La Garza ◽  
Smadar Nafrin ◽  
Amir Mari ◽  
Muhammed Suki ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clinical Outcome ◽  
Bowel Disease ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
And Gender ◽  
Diagnostic Work ◽  
Work Up

Abstract Background: The implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease is not well defined and its correlation with clinical outcome has not been fully studied. The current study aims to determine the prognostic yield of biopsies in this setting, and to evaluate the correlation of microscopic ileitis with long-term clinical outcome. Methods: Endoscopic reports of patients referred to our department for ileocolonoscopy in the years 2010-2016, as part of a diagnostic work-up for suspected IBD were revised. Patients with normal ileocolonoscopy were included, provided that terminal ileum biopsies were performed. Accordingly, patients were divided into normal (normal or reactive changes) and microscopic ileitis (inflammation or ileitis of any severity) groups. Both groups were followed prospectively to determine clinical outcome. Results: 439 patients met the inclusion criteria. 64 (14.6%) had inflammation on biopsy and were included in the microscopic ileitis group. Age and gender didn't differ significantly between groups. Overall follow up period was 6.1±2.3 years. Patients in the microscopic ileitis group were significantly associated with Crohn's diagnosis during follow-up period compared to normal (19% vs 2%, OR=11.98, 95%CI=4.48-32.01; p<0.01). Patients with granuloma or moderate-severe ileitis on biopsy were significantly associated with Crohn's development (100% vs 11%; P<0.01) compared to mild or nonspecific inflammation. Conclusion: Microscopic ileitis finding in clinically suspected IBD is associated with increased risk of future diagnosis of crohn's disease.

scholarly journals Vaccination in Inflammatory Bowel Disease: Utility and Future Perspective

2020 ◽  
Vol 2 (2) ◽  
pp. 175-192
Author(s):  
Giovanni Casella ◽  
Fabio Ingravalle ◽  
Adriana Ingravalle ◽  
Claudio Monti ◽  
Fulvio Bonetti ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Primary Care Physicians ◽  
Immunosuppressive Drugs ◽  
Future Perspective ◽  
Vaccination Rates ◽  
Immune Mediated ◽  
Increased Risk ◽  
Immunosuppressed Patients ◽  
Inflammatory Bowel

Inflammatory bowel disease (IBD) is an immune-mediated disease, which often require lifetime treatment with immunomodulators and immunosuppressive drugs. Both IBD and its treatments are associated with an increased risk of infectious disease and mortality. Several of these diseases are vaccine preventable and could be avoided, reducing morbidity and mortality. However, vaccination rates among patients with IBD are lower than in the general population and both patients and doctors are not fully aware of the problem. Education campaigns and well planned vaccination schemes are necessary to improve vaccination coverage in patients with IBD. Immunomodulators and immunosuppressive drugs may reduce the seroprotection levels. For this reason, new vaccination schemes are being studied in patients with IBD. It is therefore important to understand which and when vaccines can be administrated based on immunocompetence or immunosuppression of patients. Usually, live-attenuated vaccines should be avoided in immunosuppressed patients, so assessing vaccination status and planning vaccination before immunosuppressive treatments are pivotal to reduce infection risk. The aim of this review is to increase the awareness of the problem and provide a quick reference for vaccination plan tailoring, especially for gastroenterologists and primary care physicians, who have the skills and knowledge to implement vaccination strategies.

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