scholarly journals Corticosteroid and Biologic Use Not Associated With Adverse Outcomes for Inflammatory Bowel Disease Patients Hospitalized With COVID-19

2021 ◽  
Vol 14 (6) ◽  
pp. 324-333
Author(s):  
Keith Sultan ◽  
Laura Durbin ◽  
Richa Bhardwaj ◽  
James Mackey ◽  
Noah Becher ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Inflammatory Bowel

scholarly journals The interplay of Clostridioides difficile infection and inflammatory bowel disease

2021 ◽  
Vol 14 ◽  
pp. 175628482110202
Author(s):  
Kanika Sehgal ◽  
Devvrat Yadav ◽  
Sahil Khanna
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Molecular Tests ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Pros And Cons ◽  
Inflammatory Bowel ◽  
High Index Of Suspicion

Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatments for the management of CDI in IBD. Microbiota restoration therapies effectively prevent recurrent CDI in IBD patients. Immunosuppression for IBD in IBD patients with CDI should be managed individually, based on a thorough clinical assessment and after weighing the pros and cons of escalation of therapy. This review summarizes the epidemiology, pathophysiology, the diagnosis of CDI in IBD, and outlines the principles of management of both CDI and IBD in IBD patients with CDI.

scholarly journals The Natural History, Treatments, and Outcomes of Portal Vein Thrombosis in Patients With Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Leonard Naymagon ◽  
Douglas Tremblay ◽  
Nicole Zubizarreta ◽  
Erin Moshier ◽  
Steven Naymagon ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bowel Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Vein Thrombosis ◽  
Inflammatory Bowel

Abstract Background Portal vein thrombosis (PVT) is a poorly described complication of inflammatory bowel disease (IBD). We sought to better characterize presentations, compare treatments, and assess outcomes in IBD-related PVT. Methods We conducted a retrospective investigation of IBD-related PVT at our institution. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios across treatments. Results Sixty-three patients with IBD-related PVT (26 with Crohn disease, 37 with ulcerative colitis) were followed for a median 21 months (interquartile ratio [IQR] = 9-52). Major risk factors included intra-abdominal surgery (60%), IBD flare (33%), and intra-abdominal infection (13%). Primary hematologic thrombophilias were rare and did not impact management. Presentations were generally nonspecific, and diagnosis was incidental. Ninety-two percent of patients (58/63) received anticoagulation (AC), including 23 who received direct oral anticoagulants (DOACs), 22 who received warfarin, and 13 who received enoxaparin. All anticoagulated patients started AC within 3 days of diagnosis. Complete radiographic resolution (CRR) of PVT occurred in 71% of patients. We found that DOACs were associated with higher CRR rates (22/23; 96%) relative to warfarin (12/22; 55%): the hazard ratio of DOACs to warfarin was 4.04 (1.83-8.93; P = 0.0006)). Patients receiving DOACs required shorter courses of AC (median 3.9 months; IQR = 2.7-6.1) than those receiving warfarin (median 8.5 months; IQR = 3.9-NA; P = 0.0190). Incidence of gut ischemia (n = 3), symptomatic portal hypertension (n = 3), major bleeding (n = 4), and death (n = 2) were rare, and no patients receiving DOACs experienced these adverse outcomes. Conclusions We show that early and aggressive use of AC can lead to excellent outcomes in IBD-associated PVT and that DOACs are associated with particularly favorable outcomes in this setting.

P079 ISOLATION OF GASTROINTESTINAL PATHOGENS AFFECTS MEDICAL MANAGEMENT OF OUTPATIENTS WITH RELAPSE OF INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S37-S38
Author(s):  
Soonwook Hong ◽  
Timothy Zaki ◽  
Michael Main ◽  
Ashley Hine ◽  
Shannon Chang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Abdominal Imaging ◽  
Enteric Infection ◽  
Initial Visit ◽  
Medication Regimen ◽  
Presenting Symptoms ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Introduction Evaluating for the presence of gastrointestinal infection is a critical component of the workup for relapse of inflammatory bowel disease (IBD). With the advent of stool multiplex gastrointestinal pathogen panels (GI PCR), infections are increasingly identified. Prior research has shown that detection of enteric infection significantly affects the management of IBD in the inpatient setting. We aimed to characterize the impact of enteric infection detection on the management of IBD therapy in outpatients with relapse of IBD. Methods In a cross-sectional study of IBD outpatients at an academic medical center presenting with acute gastrointestinal symptoms from September 2015 to April 2019 who received GI PCR testing, we recorded pathogens detected, demographic data, biomarkers of inflammation, presenting symptoms, IBD subtypes, and IBD therapy. Our primary outcome was dose escalation in IBD therapy, defined as the addition of a new therapeutic agent or an increase in the dose or frequency of an existing medication. Secondary outcomes included rates of endoscopy, abdominal imaging, and antibiotics in the 30-day period after the initial visit and rates of adverse outcomes, i.e. emergency room (ER) visits, hospitalizations, and abdominal surgeries in the 90-day period after the initial visit. Results We identified 134 IBD outpatients tested with GI PCR. A pathogen was identified in 35 (26%) patients, of whom 9 (27%) had an increase in their medication regimen; 2 (22%) were prescribed an additional mesalamine, 3 (33%) a biologic, and none glucocorticoids. In contrast, 49/99 (45%, p=0.03) patients without an infection had an increase in their medication regimen, with 3 (7%, p=0.49) prescribed mesalamines, 11 (24%, p=0.67) biologics, and 7 (16%, p=0.04) glucocorticoids (Table 1). No patient received immunomodulators. Patients with an infection received more antibiotics (49% vs. 12%, p<0.01). They were also more likely to present with vomiting (11% vs. 3%, p=0.06) and undergo less post-visit endoscopy (6% vs. 16%, p=0.13), but these differences were near significant. There were no significant differences in demographics, initial IBD medications on testing, presenting symptoms, lab markers, abdominal imaging, or adverse outcomes. The most commonly isolated organisms were Escherichia coli subtypes, with 22/35 (63%) patients having at least one species isolated on testing (Table 2). Conclusion Detection of an enteric infection in outpatients with relapse of IBD was associated with significantly fewer dose escalations in IBD therapy, including glucocorticoids, and increased exposure to antibiotics, and a marginal decrease in endoscopy. These changes in management were not associated with a difference in adverse outcomes.

scholarly journals A164 PATTERNS IN MEDICAL THERAPY AND CLINICAL OUTCOMES IN PATIENTS WITH CONCOMITANT INFLAMMATORY BOWEL DISEASE AND PRIMARY SCLEROSING CHOLANGITIS: A SINGLE CENTRE RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 173-174
Author(s):  
K Donaldson ◽  
R A Mitchell ◽  
R A Enns ◽  
B Bressler ◽  
G Rosenfeld ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Primary Sclerosing Cholangitis ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
Adverse Outcomes ◽  
Low Grade ◽  
Strict Adherence ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) in patients with primary sclerosing cholangitis (PSC) is characterized by pancolitis with rectal sparing and is associated with an increased risk of colorectal and biliary malignancies. Currently, pharmacologic management of IBD in the setting of PSC is the same as in IBD alone. Aims To assess patterns in medical therapy, and incidence of adverse outcomes in patients with concomitant IBD and PSC. Methods A retrospective review was conducted on all PSC-IBD patients followed between January 2010 and June 2018. The Endoscopic Mayo Score was used to grade IBD severity in PSC-ulcerative colitis (UC). Results 69 patients were identified, 44 (63.8%) were male. The mean ages of IBD and PSC diagnosis were 28.6 (SD 14.9) and 37.0 (SD 18.9) years, respectively. The median length of follow up was 12 (range 2–49) years. 52 (75.4%) patients had UC, and 17 (24.6%) had Crohn’s disease (CD). 28 (87.5%) PSC-UC patients had pancolitis, and 4 (12.5 %) had proctitis. Among those with pancolitis, 8 (28.6%) had relative rectal sparing. 4 (14.3%) patients had more severe inflammation proximally, whereas only 1 (3.6%) had more severe distal inflammation. 23 (82.1%) patients had the same degree of inflammation throughout. 14 (93.3%) PSC-CD patients had colitis/ileocolitis and 1 (6.7%) had ileitis. Among those with PSC-UC, 16 (50.0%), 12 (37.5%), and 4 (12.5%) patients had grade 1, 2, and 3 disease, respectively. 62 (89.9%) PSC-IBD patients were treated with aminosalicylates, and 26 (37.7%) with biologics at some point in their IBD course. 26 (37.7%) were treated with aminosalicylates alone. 4 (5.8%) did not require any IBD therapy. Cholangiocarcinoma, colorectal cancer, and gallbladder cancer developed in 8 (11.6%), 1 (1.4%), and 1 (1.4%) PSC-IBD patients, respectively. 16 (23.2%) patients required partial or total colectomy. Indication for surgery was inflammation or stenosis, dysplasia, and neoplasia in 13 (81.3%), 2 (12.5%), and 1 (6.3%) patients, respectively. Conclusions The majority of this cohort had UC with mild disease activity. Pancolitis was common, with frequent rectal sparing and more severe right-sided inflammation. Despite the predominance of low-grade colitis, a large portion of patients required treatment with biologics. The incidence of adverse outcomes underscores the need for strict adherence to recommended surveillance practices. Low grade endoscopic activity, typical of the quiescent IBD course in PSC-IBD, may mask low grade histologic inflammation, which in turn may contribute to the increased risk of colonic neoplasia. Further studies are needed to determine the best management strategy for IBD in patients with PSC. Funding Agencies None

scholarly journals Novel risk factors and outcomes in inflammatory bowel disease patients with Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482199779
Author(s):  
Elida Voth ◽  
Dipesh Solanky ◽  
Edward V. Loftus ◽  
Darrell S. Pardi ◽  
Sahil Khanna
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel ◽  
Antidepressant Use ◽  
Statin Use

Background: Patients with inflammatory bowel disease (IBD) are at significantly increased risk for Clostridioides difficile infection (CDI) with an increased risk of adverse outcomes including increased in-hospital mortality, IBD treatment failure, re-hospitalization, and high CDI recurrence rates. The existing literature on predictors of these adverse outcomes is limited. We evaluated four potentially modifiable novel risk factors [body mass index (BMI), statin use, opioid use, and antidepressant use] on CDI risk and adverse outcomes in these patients. Methods: Using a retrospective design, variables were abstracted from records for patients with IBD and CDI from 2008 to 2013. Statistical analysis comprised descriptive statistics and univariate and multivariate logistic regression analyses. Results: There were 137 patients with IBD and CDI included in this study. On multivariate analysis controlling for age, 43% of patients in the overweight BMI category had severe or severe, complicated CDI, compared with 22% of patients in the underweight/normal BMI [odds ratio (OR) 2.85, p = 0.02] and 19% in the obese category (OR 3.95, p = 0.04). Statin use was associated with severe or severe, complicated CDI when controlling for age and BMI (OR 5.66, p = 0.01). There was no association between statin use and IBD exacerbations following CDI. Opioid and antidepressant use were not associated with disease severity or frequency of IBD exacerbations following CDI. Conclusions: An overweight BMI and statin use were associated with severe or severe, complicated CDI in IBD patients. Further studies are needed to better understand how these factors impact management of patients with IBD to improve clinical outcomes and potentially reduce the risk of complications from CDI.

scholarly journals OP06 5-aminosalicylates are not associated with adverse outcomes in Inflammatory Bowel Disease patients with COVID-19: Analysis from an international registry

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S006-S007
Author(s):  
R Ungaro ◽  
E Brenner ◽  
M Agrawal ◽  
R B Gearry ◽  
G G Kaplan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Random Effect ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Physician Global Assessment ◽  
Tnf Antagonists ◽  
Increased Risk ◽  
Tnf Antagonist ◽  
Inflammatory Bowel

Abstract Background Prior data have suggested that 5-aminosalicylates (5-ASA) may be associated with an increased risk of severe COVID-19 among inflammatory bowel disease (IBD) patients. We aimed to evaluate the association of 5-ASA with severe COVID-19 in a large cohort of IBD patients. Methods We analyzed data from the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry, a large, international database of IBD patients with confirmed COVID-19. The primary outcome was severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death. Hospitalization due to COVID-19 was a secondary outcome. We performed multivariable regression modeling with a generalized estimating equation accounting for country as a random effect to analyze the association of 5-ASA with severe COVID-19. Models a priori included age, sex, race, disease phenotype (CD or UC/IBD-U), corticosteroid use, azathioprine/6-mercaptopurine use, TNF antagonist use, disease activity by physician global assessment, number of comorbidities, and days from SECURE-IBD inception to reporting. We constructed three models examining 5-ASA use as binary covariate using 1) all patients, 2) only patients on any biologic, and 3) only patients on TNF antagonists. Results 5,174 patients were included with 212 (4.1%) severe COVID-19 events. At the time of COVID-19 infection, 1,504 patients were taking 5-ASA. 5-ASA patients were older (mean age 44 vs. 38.3 years, p<0.001), more likely to have UC (70.7% vs. 27.7%, p<0.001), less likely to be in remission (49.6% vs. 57.2%, p<0.001), and more likely to have at least one comorbidity (33.6% vs. 26.7%, p<0.001) compared to patients not on 5-ASA. 3,325 patients were on any biologic and 2,216 were on a TNF antagonist. Among all patients, 5-ASA was not associated with severe COVID-19 (adjusted OR [aOR] 1.14, 95% confidence interval [CI] 0.86–1.52) (Table 1). Prior associations of age, comorbidities, TNF antagonists, and corticosteroids with severe COVID-19 were similar to prior analyses (Table 1). In analyses restricting to those on any biologic or only TNF antagonists, there was also no significant association between 5-ASA and severe COVID-19 (aOR 0.76, 95% CI 0.38–1.50 and aOR 0.99, 95% CI 0.43–2.32, respectively). Use of 5-ASA was not associated with risk of COVID-19 related hospitalization in any analysis. Conclusion In an analysis of updated data from the SECURE-IBD registry, 5-ASA use was not associated with worse outcomes among IBD patients with COVID-19.

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