scholarly journals Social Distancing during COVID-19 Pandemic among Inflammatory Bowel Disease Patients

2021 ◽  
Vol 10 (16) ◽  
pp. 3689
Author(s):  
Michał Łodyga ◽  
Katarzyna Maciejewska ◽  
Piotr Eder ◽  
Katarzyna Waszak ◽  
Kamila Stawczyk-Eder ◽  
...  

(1) Background: Social distancing rules have been widely introduced in the fight against the coronavirus disease 2019 (COVID-19) pandemic. So far, the effectiveness of these methods has not been assessed in the group of inflammatory bowel disease (IBD) patients. (2) Methods: The study included 473 patients with IBD who made 1180 hospital visits from 1 May to 30 September 2020. During each visit, the patients completed a five-step, progressive scale that was developed to assess the degree of social isolation. In parallel, other demographic data were collected and the concentrations of anti-severe acute respiratory coronavirus 2 (SARS-CoV-2) IgG and IgM+IgA antibodies were measured using the ELISA method. (3) Results: The study found a significant correlation between the degree of social distancing and the presence of anti-SARS-CoV-2 antibodies in the groups with the lowest degree of isolation (3 to 5). (4) Conclusions: Maintaining social distancing is an effective method for reducing the spread of SARS-CoV-2 virus among IBD patients.

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S583-S584
Author(s):  
D Chopra ◽  
E Kennedy ◽  
A V Weizman ◽  
A Tennakoon ◽  
L E Targownik

Abstract Background Despite advances in medical therapy for inflammatory bowel disease (IBD), surgery is required in 50–80% of patients with Crohn’s disease (CD) and 20–30% of patients with ulcerative colitis (UC). Given that fibrostenotic disease may be playing a primary role in patients undergoing resective surgery, practices around biologic administration in this setting need to be clarified. We aimed to describe the pre-operative trends in biologic utilisation for IBD patients undergoing resective surgery. Methods The University of Manitoba IBD Epidemiology Database was used to identify all persons with IBD who underwent resective surgery between April 2005 and 2018. Demographic data were extracted to explore the baseline characteristics of persons on biologic therapy prior to IBD resective surgery. Proportion calculations were used to assess how often a new biologic agent was initiated within 3, 6, and 12 months prior to resective surgery. Results were stratified by type of IBD (UC vs. CD) and disease duration (<3 or ≥3 years) for incident cases. Results A total of 1412 IBD-related resective surgeries were identified from April 2005 to 2018. 67.1% of resective surgeries were performed for CD and 32.9% for UC. Results of analysis are presented below: Conclusion Overall, in Manitoba, rates of biologic initiation or re-start in the pre-operative period for IBD resective surgery are relatively small. Biologic therapy was initiated or re-started more frequently for CD than UC, and when disease duration was less than 3 years. This is reassuring and suggests that physicians are rarely choosing to initiate biologic therapy in futile situations. Work should be performed to see if these findings can be replicated in other practice settings.


2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S192-S193
Author(s):  
A Busacca ◽  
G Ingrassia Strano ◽  
E Giuffrida ◽  
L Guida ◽  
B Scrivo ◽  
...  

Abstract Background Data on prevalence of extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) range from 6% up to 47%. Recently, several red flags and questionnaires have been proposed for early diagnosis of articular manifestations. Our aim was to analyse the prevalence of EIMs in a single-centre prospective cohort, using a comprehensive questionnaire developed by our group to detect all EIMs (EMAIL questionnaire). Methods Patients with IBD attending our Clinic from November 2017 to January 2019 were interviewed using a two-part questionnaire, the first part for clinical-demographic data and the second part for EIMs. Patients positive to screening were referred for multidisciplinary approach. Results Two hundred and six IBD patients were interviewed, 114 (55.3%) Crohn’s disease (CD) and 92 (44.7%) ulcerative colitis (UC), 52.4% male, mean age 46.7 years (SD ± 15,2). Sixty (53%) CD patients and 48 (52%) UC patients, in total 108, had history of at least one EIM. Articular EIMs were found in 49 patients (24%); peripheral arthritis was found in 14% (29/206), axial arthritis in 9.7% (20 patients): seven patients (3.4%) had ankylosing spondylitis, 13 (6.3%) sacroiliitis. Cutaneous EIMs were detected in 39 patients (19%), erythema nodosum in 15 patients (7.3%), pyoderma gangrenosum in 9 (4.4%), psoriasis in 15 (7.3%) and folliculitis in 7 (3.4%). Ocular EIMs were observed in 35 patients (17%): uveitis in 7 patients (3.4%), conjunctivitis in 8 (3.9%), optic neuritis in 2, glaucoma in 2 patients, cataract in 13 (6,3%), dry eye in 4 (1.9%), central serous chorioretinopathy in 1. Hepatobiliary EIMs were observed in 31 patients (15%): 26 steatosis (12.6%), 5 (2.4%) primary sclerosing cholangitis. Four (2%) patients had DVT. Articular EIMs were more frequent in CD patients (p = 0.001). Skin manifestations were more frequent in female (p = 0.002) in CD (p = 0,032) and related with IBD activity (<0.001). Hepatobiliary manifestations were more frequent in male (p = 0,017) and in UC (p = 0,044). There was a significant correlation between DVT and IBD activity (p = 0,016). Conclusion The questionnaire developed by our group proved to be a sensitive screening tool. Articular and cutaneous EIMs are more frequent in CD, hepatobiliary EIMs are more frequent in UC. A gender difference has been found since cutaneous EIMs are more frequent in females, hepatobiliary more in males. Cutaneous EIMs and DVT are related with IBD activity.


Author(s):  
Kenechukwu Chudy-Onwugaje ◽  
Alexander P Mamunes ◽  
David A Schwartz ◽  
Sara Horst ◽  
Raymond K Cross

Abstract Background A small proportion of patients with inflammatory bowel disease (IBD) consume a disproportionate amount of health care resources, with most of these spent on unplanned care in emergency room (ER) and hospital visits. Interventions in those at high risk in the outpatient setting could reduce the need for future inpatient care. We sought to describe the characteristics predictive of high health care utilization within 1 year after an initial IBD clinic encounter. Methods This was a retrospective study of new IBD patients seen at the outpatient clinics of 2 tertiary IBD centers in the United States. Baseline sociodemographic and clinical characteristics were collected, and the number of IBD-related ER and hospital visits were recorded over the 1-year period after the initial clinic encounter. Patients with ≥2 visits (high utilizers) were compared with those with no visits. Results Of the 735 patients included in the final analysis, 106 (14.4%) were high utilizers, and they had a mean of 2.9 visits (maximum = 10) in the 1 year after their initial encounter. In multivariate analysis, insurance coverage through medical assistance (odds ratio [OR] 3.57; 95% confidence interval [CI], 1.38–9.20), steroid use (OR 1.83; 95% CI, 1.11–3.04), short inflammatory bowel disease questionnaire score <50 (OR 2.29; 95% CI, 1.23–4.27), and current ostomy (OR 4.82; 95% CI, 1.51–15.37) were independently associated with high utilization. Conclusions Multidisciplinary care and resources should be preferentially channeled towards new clinic patients with severe disease and on medical assistance, as this could reduce future inpatient visits and result in cost savings.


1990 ◽  
Vol 4 (5) ◽  
pp. 187-192 ◽  
Author(s):  
Faith G Davis ◽  
Michael G Grace ◽  
Noel Hershfield

Incidence and prevalence rates of inflammatory bowel disease were estimated for 1976-81 in southern Alberta. Cases were identified using hospital and physician records and membership lists of the Canadian Foundation for Ileitis and Colitis. A mail survey was conducted to obtain demographic data. Population data were obtained from Statistics Canada. The overall prevalence rate of IBO in men was 69.1 per 105 and 97.6 per 105 in women. Incidence rates of IBD were 6.0 per 105 per year in men and 9.2 per 105 per year in women. These six differences were due to Crohn's disease as female incidence rates were twice that of male rates 6.3 per 105 per year versus 3. L per LOS per year. A bimodal age distribution and female predominance in the younger age groups was apparent for Crohn's disease.


2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
Urszula Grzybowska-Chlebowczyk ◽  
Halina Woś ◽  
Aleksander L. Sieroń ◽  
Sabina Więcek ◽  
Aleksandra Auguściak-Duma ◽  
...  

The aim of the study was the evaluation of frequency and titre of IgA ASCA and IgG ASCA and p-ANCA, c-ANCA in children with IBD and occurrence of ASCA antibodies in relation to coexistence of FA. Patients and methods. The study comprised 95 children at the ages of 2 to 18 years. The diagnosis of IBD was established on the basis of Porto criteria. Tests of blood serum were performed in all children: IgA and IgG ASCA, p-ANCA, c-ANCA using ELISA method. Results. IgE-dependent FA was found in 32.5% children with UC and in 21% with CD. We did not observe any relation between the occurrence of FA and the frequency and ASCA titre. p-ANCA were significantly more frequent in the group of children with UC. The occurrence of ASCA antibodies was observed in 73.7% of children with CD, 17.5% with UC and almost 30% with allergic colitis. Conclusions. Patients with CD and the presence of ASCA revealed a significantly more frequent localization of lesions within the small bowel and a tendency towards older age. We observed a connection between the occurrence of antibodies and the examined mutations of gene NOD2/CARD15.


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S506-S507
Author(s):  
M Calafat Sard ◽  
C González-Muñoza ◽  
M Fortuny ◽  
C Roig ◽  
A Calm ◽  
...  

Abstract Background Older age has been confirmed as a risk factor for severe clinical presentation of SARS-CoV-2 disease (COVID-19). The prevalence of confirmed SARS-CoV-2 infection in Catalonia among people over 60 years is 6.6%. Biological agents have not been associated with a higher incidence nor a worse prognosis of COVID-19. However, the role of immunosuppressants (IMS) on this issue is still to be elucidated. Moreover, there are scarce data related about COVID-19 in inflammatory bowel disease (IBD) patients under IMS, and none focusing in elderly IBD. Our aim was to describe and to compare the incidence and severity of COVID-19 in patients over 65 years of age with IBD, particularly in relation to the use of IMS. Methods We performed a retrospective cohort study including IBD patients over 65 years since January 2020, from two referral centres in the Barcelona metropolitan area (Catalonia, Spain). Patients were grouped in two cohorts regarding the use or not of IMS (thiopurines or methotrexate). Patients on biological treatment were excluded. We identified those cases with confirmed infection with SARS-CoV-2 (positive PCR) during the period from 1st of March 2020 (the beginning of the pandemic in Catalonia) to 1st March 2021 (the beginning of vaccination in the elderly). Demographic data, IBD comorbidities, concomitant non-IBD related treatments, and SARS-CoV-2 infection outcomes were recorded. Results Four-hundred and eighteen elderly IBD patients were included. The median age was 74 years (IQR 69–78), 52% were male; 70% had ulcerative colitis, 28% Crohn’s disease and 2% IBD unclassified, 62% had arterial hypertension, 22% diabetes mellitus, 22% cardiovascular disease, 15% chronic obstructive pulmonary disease, 10% chronic renal disease, 5% were active smokers. There were no differences regarding comorbidities and non-IBD treatments between the two study groups. From the whole cohort, 89 (21.3%) patients were on IMS (86 with thiopurines, 3 with methotrexate). The median time on IMS was 121 months (IQR 60–162). During the study period, 32 patients (7.7%) had confirmed SARS-CoV-2 infection (7 of whom were on IST; 7.6% not on IMS vs. 7.9% on IMS, P=0.933). Seventeen (53%) patients required hospital admittance (4% not IMS vs. 4.5% on IMS; P=0.818); 4 of them developed COVID-19 related complications (3 patients not on IMS vs. 1 on IMS), and 7 (22%) patients died (6 not on IMS vs. 1 patient on IMS). Conclusion The rate of SARS-CoV-2 infection among elderly IBD patients is quite similar to that reported in the elderly background population. In elderly IBD patients, SARS-CoV-2 infection was associated with a high admission rate and mortality, regardless of the use of IMS.


2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S398-S398
Author(s):  
F Mesonero Gismero ◽  
C Fernández ◽  
E Sánchez-Rodríguez ◽  
A García-García de Paredes ◽  
A Albillos ◽  
...  

Abstract Background Polymedication (PM) can complicate course and management of chronic diseases, and is currently a poorly explored issue in patients with inflammatory bowel disease (IBD). Our aims were to determine the prevalences of PM, and of inappropriate and high-risk drugs use (APINCH) in a clinical series of IBD patients, describing epidemiological factors associated with PM, and evaluating a possible association of PM with poor disease outcomes. Methods A retrospective observational study of a unicentric series, including patients with IBD visited at our Unit (September-October 2018). Prescriptions, demographic data, and clinical features were collected reviewing clinical files and electronic drug prescriptions. PM was defined as the simultaneous use of more than 5 drugs (Gnjidic D, J Clin Epidemiol. 2012). APINCH drugs included insulin, antibiotics, anticoagulants, chemotherapies, narcotics, and potassium supplements (Clinical Excellence Australian Commission 2017). Disease outcomes (flares, hospitalisations, surgeries), non-adherence to treatment and undertreatment were evaluated 12 months after the index visit. Results We included 407 patients (56% males, median age 48 yo, range 17–92, 60.2% Crohn′s disease, 38.8% ulcerative colitis). Chronic comorbidity was present in 54% (29% metabolic, 25.5% cardiovascular, 12.8% psychiatric), and 27% presented multiple comorbidities (≥3). Median patient number of prescriptions was 3 (r 0–15); 14.3% were on more than three drugs, and 15.7% between four and five drugs. Most frequent prescriptions are represented in Figure 1. PM was identified in 18.4% of cases, inappropriate medication in 8.8%, and high-risk drugs in 6.1% (mainly opioids). In multivariate analysis, factors significantly associated with PM were chronic comorbidity (OR 11, CI 2.3-51,2, p˂0.002), multiple comorbidities (OR 4.02, CI 1.93–8.38, p˂0.001), and age >62 years (OR 3.66, CI 1.7–7.7, p˂0.001). In univariate analysis, both undertreatment (54% vs. 16%, p˂0.01) and non-adherence (26% vs. 12%, p˂0.02) were associated with PM after 12 months. No association of PM with poor disease outcomes was found. In multivariate analysis, only undertreatment was significantly associated with PM (OR 5.9, CI 1.4–29.4, p˂0.014). Conclusion PM occurs in around one of the five patients with IBD, mainly in the elderly and in those with comorbidity. This scenario could interfere with appropriate IBD treatment and therapeutic success.


1997 ◽  
Vol 11 (8) ◽  
pp. 681-685 ◽  
Author(s):  
Robert G Maunder ◽  
Elizabeth C de Rooy ◽  
Brenda B Toner ◽  
Gordon R Greenberg ◽  
A Hilary Steinhart ◽  
...  

BACKGROUND: People with inflammatory bowel disease (IBD) cope with a number of disease-specific concerns, which may result in referrals for supportive counselling.OBJECTIVE: To determine differences between the health-related concerns of people with IBD who seek counselling or are referred for psychiatric assessment and those who have no recent contact with counselling or psychiatry.METHODS: Forty-five consecutive patients with IBD referred for psychiatric consultation and 31 IBD out-patients who had recent counselling were compared with 190 IBD out-patients at the same hospital with no recent history of counselling. Disease-related concerns, demographic data and perceived symptom severity were assessed with self-report instruments.RESULTS: Counselling patients had greater overall intensity of concern. Counselling patients differed from noncounselling patients on several measures related to illness severity and were more likely to be female. Correcting statistically for illness severity and sex, the counselled patients had significantly higher levels of concern about being a burden, pain and suffering, feeling out of control, financial difficulties, feeling alone, sexual performance, feeling dirty or smelly and being treated as different.CONCLUSIONS: Beyond the intensity of their physical suffering, patients who seek counselling report a pattern of concern in which interpersonal and emotional concerns are prominent compared with those of out-patients who do not seek counselling. Clinicians should be aware of interpersonal concerns, which may increase the need for empathic support. Psychosocial interventions in IBD may be indicated without respect to psychiatric comorbidity.


Author(s):  
JOHANNES HEGNER ◽  
JANKI PATEL ◽  
STEVEN FONG ◽  
SIMON JEFFS

Objective: The management of inflammatory bowel disease (IBD) patients on complex medications such as biologic disease-modifying anti-rheumatic drugs (DMARD) requires close supervision. At East Sussex NHS Healthcare Trust (ESHT), the multi-disciplinary team (MDT) already looking after these patients could benefit from the additional knowledge and support from a specialist pharmacist (SP). Methods: To assess if the MDT could benefit from an SP, all IBD patients on the DMARD adalimumab were identified. The patient records were screened for patient demographic data, clinical assessment and investigations, treatment, and follow-up clinics. Results: 162 patients at ESHT were identified as being on adalimumab treatment for either Crohn’s Disease (77%) or Ulcerative Colitis (23%). Disease activity scores, a clinical measure of IBD severity, were infrequently recorded (1%) on patient letters. Evidence of a biologic screen, a series of investigations to ensure safety in a biologic treatment, was only evident in one-third of patients. Clinic review of patients recently started on adalimumab and annual review of stable patients occurred 43% and 26% respectively. Conclusion: The results indicate that there is a need for an additional member to support the IBD MDT in managing this cohort of patients. An SP is uniquely positioned to fill this gap. They have extensive knowledge in drug indication, therapeutic drug monitoring, and side-effect profiles. Similar studies have been identified that support SP in this role.


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S438-S439
Author(s):  
L Grinsted Tate ◽  
L Johnson ◽  
G Jones ◽  
A Lobo

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic relapsing-remitting inflammatory condition. Due to its long-term, multifaceted nature, patients will need to make many complex decisions during their treatment. The Melbourne Decision Making Questionnaire (MDMQ) assesses the use of four decision-making styles. Vigilance is the only style considered adaptive, with a thorough, analytical approach. Buck-passing (avoiding responsibility), procrastination and hypervigilance (a hurried, anxious approach) are considered maladaptive. This study aimed to assess the impact of psychological morbidity, health-related quality of life (HRQoL) and demographic/disease factors on decision-making in IBD. Methods People over the age of 16 with IBD completed the MDMQ. Psychological morbidity was assessed by the DASS-21 questionnaire, and HRQoL by the EQ-5D-3L/EQ-5D-Y. Demographic data included age, gender, ethnicity, Index of Multiple Deprivation quintile, educational level and employment status. Diagnosis, disease duration and age at diagnosis were also recorded. Exploratory analysis of all variables against scores for each of the four decision-making styles was conducted. Significant results were used to perform multivariate analysis. All statistical analysis was performed using IBM SPSS Statistics software (v26). Results 172 patients were studied (94 CD, 75 UC, 3 IBD-U, 68 (39.5%) male), median age 46.5 (16-83). Median MDMQ scores for vigilance, buck-passing, procrastination and hypervigilance were 10/12, 3/12, 2/10 and 3/10 respectively. Multivariate analysis showed strong positive associations between psychological morbidity scores and all three maladaptive decision-making styles: buck-passing (F(1, 95)=12.512, p=0.001), procrastination (F(1, 115)=35.009, p<0.001) and hypervigilance (F(1, 114)=34.342, p<0.001). Age and duration of disease were not associated with decision making style. Current employment and higher HRQoL scores were significantly associated with greater degrees of buck-passing (F(3,95)=5.100, p=0.003; and F(1, 95)=6.351, p=0.013 respectively). A diagnosis of CD was associated with lower vigilance score (F(2, 133)=3.224, p=0.043). Conclusion People with IBD are likely to have an adaptive decision-making style, demonstrated by a high median vigilance score. However, psychological morbidity is associated with maladaptive decision-making – an important consideration for clinicians and in shared decision making. Further studies are required to determine whether interventions for psychological morbidity can improve maladaptive decision-making.


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