Advanced age is an Independent Predictor of Infections Among Inflammatory Bowel Disease Patients: A Retrospective Database Analysis

Abstract Background Bowel ultrasonography (BUS) is an accurate imaging method for detecting and monitoring inflammatory bowel disease (IBD) patients. This technique is recommended by current guidelines besides gold standard endoscopic assessment in managing IBD patients. Several BUS characteristics strongly correlate with biological markers of inflammation suggesting that these tests could be used in monitoring IBD patients but is yet unknown how these features predict the patient’s evolution. Methods Our study included 95 consecutive IBD patients (24 diagnosed with ulcerative colitis, 71 with Crohn’s disease) with both active and inactive disease at presentation. IBD diagnosis was established endoscopically and histologically. Patients with superimposed infection (viral or bacterial) and patients that had solely rectal involvement of the disease were excluded. BUS was conducted at baseline by one skilled examiner blinded to biological data. Biological markers were evaluated at baseline and all cases were prospectively followed-up for the need of therapy escalation during the next 6 months. The following BUS characteristics were registered in every patient: bowel wall thickness, alteration of wall structure, thickened mucosa or submucosa, presence of hyperechoic spots in the mucosal wall, irregularity of the external wall, Doppler signal, presence of mesenteric hypertrophy, presence of lymph nodes, and an overall assessment of the examination. No special preparation was needed before BUS. Results Of all the monitored sonographic features, the following characteristics correlated with the need of increasing treatment in the following 6 months: bowel wall thickness, altered structure of the wall, hypertrophic mucosa, Doppler signal, and the overall assessment of the examination (p < 0.001). The presence of the lymph nodes, hyperechoic spots in the mucosa, thickened submucosa and the irregularity of the external wall were not statistically significant correlated with the need for treatment escalation. The strongest correlation with the need for increasing treatment was documented for a mean bowel wall thickness > 5 mm and for Doppler signal presence in the bowel wall (p < 0.00001). In the multivariate analysis, Doppler signal presence was the only independent predictor for the need treatment escalation during a 6-month follow-up. Conclusion The most important sonographic features with an impact on therapeutic decision making in IBD patients are: bowel wall thickness, Doppler signal, altered stratification of the wall and mesenteric hypertrophy. In our analysis, the Doppler signal was the only independent predictor for the need for step-up therapy.

Download Full-text

Sarcopenia as an independent predictor of the surgical outcomes of patients with inflammatory bowel disease: a meta-analysis

Surgery Today ◽

10.1007/s00595-019-01893-8 ◽

2019 ◽

Vol 50 (10) ◽

pp. 1138-1150 ◽

Cited By ~ 4

Author(s):

Adrienn Erős ◽

Alexandra Soós ◽

Péter Hegyi ◽

Zsolt Szakács ◽

Márton Benke ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Postoperative Complications ◽

Early Detection ◽

Confidence Interval ◽

Bowel Disease ◽

Surgical Outcomes ◽

Independent Predictor ◽

Meta Analysis ◽

Random Effects Models ◽

Inflammatory Bowel

Abstract Patients with inflammatory bowel disease (IBD) are at risk of sarcopenia, which is associated with poor clinical outcomes. We conducted this study to assess whether sarcopenia predicts the need for surgery and postoperative complications in patients with IBD. We performed a systematic search of four electronic databases, last updated in March, 2019. Data from studies comparing rates of surgery and postoperative complications in sarcopenic IBD patients versus non-sarcopenic IBD patients were pooled with the random-effects models. We calculated the odds ratios (OR) with a 95% confidence interval (CI). Ten studies with a collective total of 885 IBD patients were included in our meta-analysis. Although the analysis of raw data did not reveal significant differences between the two groups with respect to the rate of surgery and postoperative complications (OR = 1.826; 95% CI 0.913–3.654; p = 0.089 and OR = 3.265; 95% CI 0.575–18.557; p = 0.182, respectively), the analysis of adjusted data identified sarcopenia as an independent predictor for both of the undesirable outcomes (OR = 2.655; 95% CI 1.121–6.336; p = 0.027 and OR = 6.097; 95% CI 1.756–21.175; p = 0.004, respectively). Thus, early detection of sarcopenia in patients with IBD is important to prevent undesirable outcomes.

Download Full-text

Management of Rectal Stump During Laparoscopic Subtotal Colectomy for Inflammatory Bowel Disease: A Comparative Cohort Study from Six Referral Centres

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa046 ◽

2020 ◽

Vol 14 (9) ◽

pp. 1214-1221 ◽

Cited By ~ 1

Author(s):

Diane Mege ◽

Merel E Stellingwerf ◽

Adeline Germain ◽

Francesco Colombo ◽

Gianluca Pellino ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Subtotal Colectomy ◽

Rectal Stump ◽

Best Management ◽

Comparative Cohort Study ◽

Laparoscopic Subtotal Colectomy ◽

Inflammatory Bowel ◽

The Impact ◽

Retrospective Database

Abstract Background and Aims There is no consensus on the best management of the rectum after subtotal colectomy for refractory colitis complicating inflammatory bowel disease [IBD]. The objective was to evaluate the impact of rectal stump management during laparoscopic subtotal colectomy [LSTC] for IBD. Methods Patients who underwent LSTC with double-end ileo-sigmoidostomy [Gr.A] or end ileostomy with closed rectal stump [Gr.B] for IBD were included from a retrospective database of six European referral centres. Results In total, 314 patients underwent LSTC and were allocated to Gr.A [n = 102] and B [n = 212]. After LSTC, stoma-related complications occurred more frequently in Gr.A [12%] than in Gr.B [4%, p = 0.01]. Completion proctectomy with ileal pouch-anal anastomosis [IPAA] was performed as a three-stage procedure in all patients from Gr.A, and in 88 patients from Gr.B [42%; Gr.B1]. The other 124 patients from Gr.B underwent a modified two-stage procedure [58%; Gr.B2]. The second stage was performed laparoscopically in all patients from Gr.A compared with 73% of Gr.B1 [p < 0.0001] and 65% of Gr.B2 patients [p < 0.0001]. When laparoscopy was intended for 2nd stage IPAA, conversion to laparotomy occurred less frequently in Gr.A when compared with B1 [0 vs 5%, p = 0.06] or B2 [10%, p = 0.001]. When all surgical stages were included [LSCT and IPAA], cumulative stoma-related complications occurred more frequently in Gr.A [n = 19] than in Gr.B1 [n = 6, p = 0.02] and Gr.B2 [n = 6, p = 0.001]. Conclusion This study suggests that both techniques of double-end ileosigmoidostomy and end ileostomy with closed rectal stump are safe and effective for rectal stump management after laparoscopic subtotal colectomy.

Download Full-text

Advanced Age Does Not Negatively Impact Health-Related Quality of Life in Inflammatory Bowel Disease

Digestive Diseases and Sciences ◽

10.1007/s10620-018-5076-6 ◽

2018 ◽

Vol 63 (7) ◽

pp. 1787-1793

Author(s):

Lilani P. Perera ◽

Sanjay Bhandari ◽

Roy Liu ◽

Corinne Guilday ◽

Yelena Zadvornova ◽

...

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Advanced Age ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Inflammatory Bowel

Download Full-text

Prospective Study of Psychological Morbidity and Illness Perceptions in Young People With Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz028 ◽

2019 ◽

Vol 13 (8) ◽

pp. 1003-1011 ◽

Cited By ~ 8

Author(s):

Alenka J Brooks ◽

Paul Norman ◽

Emily J Peach ◽

Anna Ryder ◽

Alexander J Scott ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Young People ◽

Bowel Disease ◽

Illness Perceptions ◽

Independent Predictor ◽

Psychological Morbidity ◽

Inflammatory Bowel ◽

Lower Hrqol ◽

Anxiety Depression

Abstract Background and Aims Psychological morbidity is increased in young people with inflammatory bowel disease [IBD]. Illness perceptions may be an important factor. This study aimed to describe the prevalence and severity of psychological morbidity and to examine relationships between baseline illness perceptions and anxiety, depression, and health-related quality of life [HRQoL], at baseline and 12 months later, in 16–21 year olds with IBD. Methods IBD patients [n = 121] completed measures of anxiety, depression, HRQoL, and illness perceptions [IPQ-R] at baseline and follow-up [n = 100, 83%]. Results Among the 121 patients at baseline [median age 19.3 years, 40% female, 62% Crohn’s disease, 73% in clinical remission], 55% reported elevated symptoms of anxiety/depression and 83% reported low HRQoL. Negative illness perceptions at baseline were significantly correlated with greater anxiety, depression, and lower HRQoL at baseline and follow-up. In regression analysis at baseline, the IPQ-R domain of greater perception of a cyclical nature of IBD was an independent predictor of anxiety, and a greater perceived emotional impact of IBD was an independent predictor of anxiety, depression, and HRQoL. Female gender and clinical relapse were also independent predictors of lower HRQoL. After controlling for baseline measures, clinical risk factors and illness perceptions did not explain additional variance in psychological morbidity at follow-up. Conclusions A high prevalence of psychological morbidity, stable over 1 year, was demonstrated in young people with IBD. Having negative illness perceptions, being female, and having active disease predicted those at greatest risk of psychological morbidity. Illness perceptions may be an appropriate target for psychological interventions.

Download Full-text