Crohn's & Colitis 360最新文献

{"title":"Low Occurrence of Colectomy With Long-Term (up to 4 Years) Golimumab Treatment in Patients With Moderate-to-Severe Active Ulcerative Colitis: Data From the PURSUIT Maintenance and Long-Term Extension Studies.","authors":"Cindy L J Weinstein,&nbsp;Alan G Meehan,&nbsp;Marinella Govoni,&nbsp;Jianxin Lin,&nbsp;Walter Reinisch","doi":"10.1093/crocol/otad044","DOIUrl":"https://doi.org/10.1093/crocol/otad044","url":null,"abstract":"<p><strong>Background: </strong>This analysis evaluated the incidence of all-cause colectomies (total or partial) among patients with moderate-to-severe active ulcerative colitis (UC) in the golimumab (GLM) Program of Ulcerative Colitis Utilizing an Investigational Treatment (PURSUIT)-maintenance (-M) and long-term extension (-LTE) studies.</p><p><strong>Methods: </strong>Eligible PURSUIT-M trial participants completed a 6-week GLM induction trial without requiring colectomy. Responders to GLM induction were randomized 1:1:1 to GLM 50 mg, GLM 100 mg, or placebo (PBO) maintenance for up to 1 year, administered every 4 weeks (q4w). Nonresponders to GLM or PBO induction received GLM 100 mg; responders to PBO induction received PBO (each administered q4w for up to 1 year). Participants who completed PURSUIT-M were eligible to continue their treatment in the 3-year PURSUIT-LTE study.</p><p><strong>Results: </strong>A total of 60 (4.9%) colectomies were reported among the 1228 patients who enrolled in the 1-year PURSUIT-M study, which included 672 participants who continued into the 3-year PURSUIT-LTE LTE study (of which 666 were treated). The colectomy rate during the 3-year extension was lower than that observed during the maintenance phase of the study (9/666 [1.4%] compared to 51/1228 [4.2%]). The majority (43/60 [71.7%]) of the reported colectomies occurred in patients who had not responded to induction therapy and who tended to have had more severe disease characteristics at baseline.</p><p><strong>Conclusions: </strong>This retrospective evaluation of colectomy data from the PURSUIT-M and -LTE studies in patients with moderate-to-severe active UC demonstrated a low (<5%) occurrence of colectomy with long-term (up to 4 years) GLM treatment. PURSUIT-M (NCT00488631; EudraCT, 2006-003399-37).</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e5/ac/otad044.PMC10492447.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Flexible Sigmoidoscopy Improves Clinical Outcomes in Acute Severe Ulcerative Colitis.","authors":"Shreyak Sharma, Darrick K Li, Louis J Levine, Abdelkader Chaar, Chandler McMillan, Jill K J Gaidos, Deborah D Proctor, Badr Al-Bawardy","doi":"10.1093/crocol/otad032","DOIUrl":"10.1093/crocol/otad032","url":null,"abstract":"<p><strong>Objectives: </strong>Guidelines recommend performing a flexible sigmoidoscopy in patients hospitalized with acute severe ulcerative colitis (ASUC). However, it is unclear if time to sigmoidoscopy affects relevant clinical outcomes. We aimed to assess the impact of early sigmoidoscopy on clinical outcomes using a well-characterized cohort of patients with ASUC.</p><p><strong>Methods: </strong>This is a single-center, retrospective study of all patients hospitalized with ASUC from January 1, 2012 to November 1, 2021. Early sigmoidoscopy was defined as occurring within 72 hours of admission while delayed sigmoidoscopy was defined as occurring >72 hours after admission. Primary outcomes were cumulative days of intravenous (IV) corticosteroid (CS) use, length of hospital stay, and colectomy rates. Secondary outcomes were time to infliximab (IFX) rescue and inpatient opioid medication use.</p><p><strong>Results: </strong>A total of 112 patients hospitalized with ASUC who underwent sigmoidoscopy were included in the analysis. Eighty-seven patients (78%) had early sigmoidoscopy and 25 (22%) had delayed sigmoidoscopy. Patients in the early sigmoidoscopy group were exposed to significantly fewer days of IV CS (4.5 vs 9.2 days; <i>P</i> < .001), had shorter hospital stays (6.4 vs 19.3 days; <i>P</i> < .001), and shorter time to IFX rescue (3.5 vs 6.4 days; <i>P</i> = .004). Rates of colectomy in the early and delayed sigmoidoscopy groups were 17% versus 28%, respectively (<i>P</i> = .23). Longer time to sigmoidoscopy was associated with a 16% increased risk of colectomy (HR = 1.16, <i>P</i> = .002).</p><p><strong>Conclusions: </strong>In this well-characterized cohort, early sigmoidoscopy in ASUC was associated with favorable clinical outcomes. These findings highlight the benefits of early sigmoidoscopy in patients with ASUC. Larger prospective studies are needed to corroborate these findings.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10263117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10011471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids Increase the Risk of Invasive Fungal Infections More Than Tumor Necrosis Factor-Alpha Inhibitors in Patients With Inflammatory Bowel Disease.","authors":"Martin H Gregory,&nbsp;Andrej Spec,&nbsp;Dustin Stwalley,&nbsp;Anas Gremida,&nbsp;Carlos Mejia-Chew,&nbsp;Katelin B Nickel,&nbsp;Matthew A Ciorba,&nbsp;Richard P Rood,&nbsp;Margaret A Olsen,&nbsp;Parakkal Deepak","doi":"10.1093/crocol/otad010","DOIUrl":"https://doi.org/10.1093/crocol/otad010","url":null,"abstract":"<p><strong>Background: </strong>Invasive fungal infections are a devastating complication of inflammatory bowel disease (IBD) treatment. We aimed to determine the incidence of fungal infections in IBD patients and examine the risk with tumor necrosis factor-alpha inhibitors (anti-TNF) compared with corticosteroids.</p><p><strong>Methods: </strong>In a retrospective cohort study using the IBM MarketScan Commercial Database we identified US patients with IBD and at least 6 months enrollment from 2006 to 2018. The primary outcome was a composite of invasive fungal infections, identified by ICD-9/10-CM codes plus antifungal treatment. Tuberculosis (TB) infections were a secondary outcome, with infections presented as cases/100 000 person-years (PY). A proportional hazards model was used to determine the association of IBD medications (as time-dependent variables) and invasive fungal infections, controlling for comorbidities and IBD severity.</p><p><strong>Results: </strong>Among 652 920 patients with IBD, the rate of invasive fungal infections was 47.9 cases per 100 000 PY (95% CI 44.7-51.4), which was more than double the TB rate (22 cases [CI 20-24], per 100 000 PY). Histoplasmosis was the most common invasive fungal infection (12.0 cases [CI 10.4-13.8] per 100 000 PY). After controlling for comorbidities and IBD severity, corticosteroids (hazard ratio [HR] 5.4; CI 4.6-6.2) and anti-TNFs (HR 1.6; CI 1.3-2.1) were associated with invasive fungal infections.</p><p><strong>Conclusions: </strong>Invasive fungal infections are more common than TB in patients with IBD. The risk of invasive fungal infections with corticosteroids is more than double that of anti-TNFs. Minimizing corticosteroid use in IBD patients may decrease the risk of fungal infections.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9999356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the Management of and Biologic Use in Incarcerated Patients With Inflammatory Bowel Disease.","authors":"Sarah Barbina,&nbsp;John Romano,&nbsp;Erin Forster","doi":"10.1093/crocol/otad002","DOIUrl":"https://doi.org/10.1093/crocol/otad002","url":null,"abstract":"<p><strong>Background: </strong>Therapy and management of inflammatory bowel disease (IBD) require commitment from both the provider and patient to ensure optimal disease management. Prior studies show vulnerable patient populations with chronic medical conditions and compromised access to health care, such as incarcerated patients, suffer as a result. After an extensive literature review, there are no studies outlining the unique challenges associated with managing prisoners with IBD.</p><p><strong>Methods: </strong>A detailed retrospective chart review of 3 incarcerated patients cared for at a tertiary referral center with an integrated patient-centered IBD medical home (PCMH) and a review of literature was performed.</p><p><strong>Results: </strong>All 3 patients were African American males in their 30s with severe disease phenotypes requiring biologic therapy. All patients had challenges with medication adherence and missed appointments related to inconsistent access to clinic. Two of the 3 cases depicted better patient-reported outcomes through frequent engagement with the PCMH.</p><p><strong>Conclusions: </strong>It is evident there are care gaps and opportunities to optimize care delivery for this vulnerable population. It is important to further study optimal care delivery techniques such as medication selection, though interstate variation in correctional services poses challenges. Efforts can be made to focus on regular and reliable access to medical care, especially for those who are chronically ill.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9994588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Medication Access and Use in Inflammatory Bowel Disease: The Roles and Impact of Clinical Pharmacists and Pharmacy Technicians.","authors":"Shubha Bhat","doi":"10.1093/crocol/otad014","DOIUrl":"https://doi.org/10.1093/crocol/otad014","url":null,"abstract":"Inflammatory bowel disease (IBD), a relapsing chronic inflammatory disease of the gastrointestinal tract, is anticipated to affect 3 million adults in the United States.1 However, the prevalence of IBD may be greater, as Ye et al identified an increase in IBD diagnoses by 123% over 9 years.2 Presently, there are several treatment options available for IBD management, including biologics and small molecules.3,4 Despite representing a milestone in IBD management, these treatments are considered a significant driver of IBD-related direct costs due to their price.5 Given the growing IBD prevalence and use of effective, but costly pharmacotherapies, many payors have implemented prior authorization and step therapy processes in place to help control healthcare-related expenditure. Unfortunately, these processes have led to increased burdens and medication-related access challenges.6 For example, prior authorizations may not be reviewed by payors in a timely manner or may be denied and subjected to several levels of appeals, ultimately leading to delayed treatment initiation and/or changes to the original treatment plan. Alternatively, insurance coverage for the requested medication may be approved, but may not be financially feasible for the patient, necessitating the identification of other venues to assist with medication affordability and access. Choi et al highlight the prevalence of processes relating to IBD medication access, noting that of the 1800 referrals received by the tertiary academic institution’s specialty pharmacy to initiate, dose adjust, or continue biologic or small molecule treatment, 94% required a prior authorization.7 Unfortunately, 297 prior authorization requests were denied, with 77% being approved after 1 round of appeals, and the remaining requiring a second or third level of appeal. Of all the referrals, only 2% had to switch to an alternative treatment. Additionally, 69 patients were enrolled into a manufacturer patient assistance program. Unique to this manuscript, however, is the description of the clinical pharmacy team’s role and impact in the prior authorization service and patient access to treatment. Consisting of (1) IBD clinical pharmacists, who primarily provided appeal and coordination of care services once authorization approval was obtained, such as pending prescriptions for signature with correct pharmacy selected for e-prescribing and medication education, and (2) pharmacy technicians, who completed benefits investigation, submitted prior authorization, and identified patient assistance programs, the clinical pharmacy team was able to design and execute a streamlined and efficient workflow that resulted in 98% of patients successfully starting on the intended IBD therapy. Given that the IBD medication arsenal is projected to grow with more complex therapies and medication access barriers are anticipated to remain prevalent, IBD centers should consider embedding or partnering with a clinical pharmacy team.8 ","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role and Impact of a Clinical Pharmacy Team at an Inflammatory Bowel Disease Center.","authors":"David K Choi,&nbsp;David T Rubin,&nbsp;Archariya Puangampai,&nbsp;Monika Lach","doi":"10.1093/crocol/otad018","DOIUrl":"https://doi.org/10.1093/crocol/otad018","url":null,"abstract":"<p><strong>Background: </strong>There is limited literature describing the role of a clinical pharmacy team within a tertiary academic inflammatory bowel disease (IBD) center. The goal of this paper is to describe and showcase the clinical and operational impact of an integrated clinical pharmacy team.</p><p><strong>Methods: </strong>This was a retrospective study evaluating the referral outcomes for all patients referred to University of Chicago Medicine Specialty Pharmacy for self-administered advanced IBD therapies covered by prescription insurance from October 1, 2020 to October 31, 2021.</p><p><strong>Results: </strong>A total of 1800 referrals were received for advanced IBD therapies. Prior authorizations (PAs) were required and submitted for 1700 referrals. Of those 1700 PA submissions, 297 (17%) were denied by insurance. To overturn the denials, 344 appeals, including second-level appeals and external reviews, were submitted. Manufacturer patient assistance programs were obtained for 69 patients. From the 1800 referrals, 98% of patients were successfully started on the intended therapy. Clinically, there were 2141 pharmacist-initiated interventions by 2 IBD pharmacists. The most common interventions were prevention in interruption of therapy and providing patient education.</p><p><strong>Conclusions: </strong>Clinical pharmacy teams are well positioned to streamline care within a tertiary academic IBD center. Their unique skillset and ability to provide high yield medication access supports the use of this model as a best practice in IBD centers.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9739623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crohn's Disease Patient Experiences and Preferences With Disease Monitoring: An International Qualitative Study.","authors":"Noelle Rohatinsky,&nbsp;Sandra Zelinsky,&nbsp;Michael Dolinger,&nbsp;Britt Christensen,&nbsp;Rune Wilkens,&nbsp;Shellie Radford,&nbsp;Marla Dubinsky,&nbsp;Kerri Novak","doi":"10.1093/crocol/otad012","DOIUrl":"https://doi.org/10.1093/crocol/otad012","url":null,"abstract":"<p><strong>Background: </strong>Strategies incorporating objective disease monitoring in Crohn's disease (CD), beyond clinical symptoms are important to improve patient outcomes. Little evidence exists to explore patient understanding of CD treatment goals, nor preferences and experiences with monitoring options. This qualitative study aimed to explore patient experiences and preferences of CD monitoring to inform monitoring strategies, improve patient engagement, and optimize a patient-centered approach to care.</p><p><strong>Methods: </strong>This study used a patient-oriented, qualitative descriptive design. Convenience and snowball sampling were used to recruit adult participants diagnosed with CD who had experience with at least 2 types of disease monitoring. Online focus groups were conducted and data were analyzed using thematic analysis.</p><p><strong>Results: </strong>This international study included 37 participants from Australia, Canada, United Kingdom, and the United States. Overall, participants preferred more noninvasive types of monitoring [eg, intestinal ultrasound (IUS)] but were willing to undergo more invasive monitoring (eg, colonoscopy) if required. To improve disease monitoring, participants wanted increased access to IUS, establishment of a patient-centered interdisciplinary team and access to information and self-testing. Participants identified challenges with communication between patients and providers and stressed the importance of participating in shared decision making and being equal team members in their care.</p><p><strong>Conclusions: </strong>It is imperative to incorporate patient-driven preferences into how we can best structure monitoring strategies, to ensure equitable access to those preferred modalities and embrace a shared decision-making approach to disease management in CD.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/e2/otad012.PMC10022708.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9145716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Real-World Global Use of Patient-Reported Outcomes for the Care of Patients With Inflammatory Bowel Disease.","authors":"Jamie M Horrigan,&nbsp;Edouard Louis,&nbsp;Antonino Spinelli,&nbsp;Simon Travis,&nbsp;Bjorn Moum,&nbsp;Jessica Salwen-Deremer,&nbsp;Jonas Halfvarson,&nbsp;Remo Panaccione,&nbsp;Marla C Dubinsky,&nbsp;Pia Munkholm,&nbsp;Corey A Siegel","doi":"10.1093/crocol/otad006","DOIUrl":"https://doi.org/10.1093/crocol/otad006","url":null,"abstract":"<p><strong>Background: </strong>Many patient-reported outcomes (PROs) have been developed for inflammatory bowel disease (IBD) without recommendations for clinical use. PROs differ from physician-reported disease activity indices; they assess patients' perceptions of their symptoms, functional status, mental health, and quality of life, among other areas. We sought to investigate the current global use and barriers to using PROs in clinical practice for IBD.</p><p><strong>Methods: </strong>A cross-sectional survey was performed. An electronic questionnaire was sent to an international group of providers who care for patients with IBD.</p><p><strong>Results: </strong>There were 194 respondents, including adult/pediatric gastroenterologists, advanced practice providers, and colorectal surgeons from 5 continents. The majority (80%) use PROs in clinical practice, 65% frequently found value in routine use, and 50% frequently found PROs influenced management. Thirty-one different PROs for IBD were reportedly used. Barriers included not being familiar with PROs, not knowing how to incorporate PRO results into clinical practice, lack of electronic medical record integration, and time constraints. Most (91%) agreed it would be beneficial to have an accepted set of consistently used PROs. The majority (60%) thought that there should be some cultural differences in PROs used globally but that PROs for IBD should be consistent around the world.</p><p><strong>Conclusions: </strong>PROs are used frequently in clinical practice with wide variation in which are used and how they influence management. Education about PROs and how to use and interpret an accepted set of PROs would decrease barriers for use and allow for global harmonization.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/c8/otad006.PMC10022710.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9145713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Confounders on Symptom-Endoscopic Discordances in Crohn's Disease.","authors":"Anjana Rajan,&nbsp;Yushan Pan,&nbsp;Prerna Mahtani,&nbsp;Rachel Niec,&nbsp;Randy Longman,&nbsp;Juliette Gerber,&nbsp;Dana Lukin,&nbsp;Ellen Scherl,&nbsp;Robert Battat","doi":"10.1093/crocol/otad017","DOIUrl":"https://doi.org/10.1093/crocol/otad017","url":null,"abstract":"<p><strong>Background: </strong>Discordances between clinical and endoscopic Crohn's disease (CD) activity indices negatively impact the utility of clinic visits and efficacy assessments in clinical trials. Bile acid diarrhea (BAD) and small intestinal bacterial overgrowth (SIBO) mimic CD symptoms. This study quantified the impact of BAD and SIBO on the relationship between clinical and endoscopic disease activity indices.</p><p><strong>Methods: </strong>CD patients with 7α-hydroxy-4-cholesten-3-one (7C4) serum measurements and/or SIBO breath tests and matched clinical and endoscopic scores were included. Clinical remission (stool frequency [SF] ≤ 1 and abdominal pain score ≤ 1) rates were compared between those with and without (1) endoscopic remission, (2) BAD (7C4 > 55 ng/mL), and (3) SIBO.</p><p><strong>Results: </strong>Of 295 CD patients, 219 had SIBO testing and 87 had 7C4 testing. Patients with elevated 7C4 had lower proportions with clinical remission (14% vs 40%, <i>P</i> = .007) and SF ≤ 1 (14% vs 42%, <i>P</i> = .004) compared to those with normal 7C4. In patients with normal 7C4, higher rates of clinical remission (65% vs 27%, <i>P</i> = .01) and SF ≤ 1 (71% vs 27%, <i>P</i> = .003) existed in patients with endoscopic remission compared to those without endoscopic remission. Conversely, among the entire 295 patient cohorts, nearly identical clinical remission rates existed between those with and without endoscopic remission (25% vs 24%, <i>P</i> = .8), and the Crohn's Disease Patient-Reported Outcome-2 score was not accurate for predicting endoscopic remission (Area Under the Curve (AUC): 0.48; 95% CI, 0.42-0.55). SIBO status did not impact clinical remission rates (<i>P</i> = 1.0).</p><p><strong>Conclusions: </strong>BAD, but not SIBO, contributed to symptom scores. A relationship between endoscopic inflammation and clinical remission rates only existed in patients without 7C4 elevations.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10066840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease.","authors":"Alexander Booth,&nbsp;Henry Colorado,&nbsp;Gayenell Magwood,&nbsp;Erin Forster,&nbsp;Robert N Axon,&nbsp;Thomas Curran","doi":"10.1093/crocol/otad015","DOIUrl":"https://doi.org/10.1093/crocol/otad015","url":null,"abstract":"<p><strong>Background: </strong>Fragmented care for inflammatory bowel disease (IBD) is known to correlate negatively with outcomes, but it is unclear which aspects of care fragmentation are relevant and potentially modifiable. Furthermore, there is little data on the relationship between travel distance and the benefits of integrated care models. Hypothesizing care coordination in the preoperative period may have a significant impact on surgical outcomes, we explored associations between integrated care, travel distance, and surgical outcomes.</p><p><strong>Methods: </strong>A single-center retrospective cohort study of patients undergoing index abdominal surgery was done to compare the rate of surgical complications with and without long travel distance and nonintegrated preoperative care. Multivariable logistic regression was used to identify factors independently associated with complications.</p><p><strong>Results: </strong>One hundred and fifty-seven patients were included. Complications were more common among patients with travel distance >75 miles (47.6% vs 27.4%, <i>P</i> = .012). Integrated preoperative care was not significant on bivariate (<i>P</i> = .381) or multivariable analysis but had a stronger association among patients with travel distance <75 miles (20.9% integrated vs 36.7%, <i>P</i> = .138). After adjustment, new ileostomy, open surgical approach, and distance >75 miles were independently associated with complications.</p><p><strong>Conclusions: </strong>Patients with longer travel distances to the hospital were twice as likely to have a surgical complication after adjusting for other risk factors. Without significant accommodations for remote patients, potential benefits of an integrated model for IBD care may be limited to patients who live close to the medical center. Future efforts addressing continuity of care should consider tactics to mitigate the impact of travel distance on outcomes.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bb/5f/otad015.PMC10066839.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}