Beatriz Yuki Maruyama, Christopher Ma, Remo Panaccione, Paulo Gustavo Kotze
{"title":"Early Laparoscopic Ileal Resection for Localized Ileocecal Crohn's Disease: Hard Sell or a Revolutionary New Norm?","authors":"Beatriz Yuki Maruyama, Christopher Ma, Remo Panaccione, Paulo Gustavo Kotze","doi":"10.1159/000515959","DOIUrl":"https://doi.org/10.1159/000515959","url":null,"abstract":"<p><strong>Background: </strong>Despite reductions in surgical rates that have been observed with earlier use of biological therapy, surgery still constitutes an important tool in the therapeutic armamentarium in Crohn's disease (CD), particularly in patients with stenotic and penetrating phenotypes. In these scenarios, early surgical intervention is recommended, as bowel damage is present and irreversible, leading to lower efficacy with biologics.</p><p><strong>Summary: </strong>The concept of early surgery in CD supposes the possible advantages of better surgical outcomes in luminal CD after initial resection. Optimal timing of surgical intervention is associated with better postoperative outcomes, whilst delays can lead to more technically difficult and extensive procedures, which may result in an increase in postoperative complication rates and higher rates of stoma formation. Furthermore, data from the LIR!C trial have demonstrated that early surgery in luminal localized inflammatory ileocecal CD is an adequate alternative to medical therapy, with lower societal costs in the long term. In this review, we discuss the position of early resection in ileocecal CD by critically reviewing available data, describing the ideal patients to be considered for early surgery, and weighing the potential advantages and disadvantages of an early surgery paradigm.</p><p><strong>Key messages: </strong>While early surgery may not be the right choice for every patient, the ultimate decision regarding whether surgical or medical therapy should come first in the treatment paradigm must be individualized for each patient based on the disease characteristics, phenotype, risk factors, and personal preference. This highlights the importance of the multidisciplinary team, which remains a key pillar in deciding the overall management plan for patients with CD.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"7 1","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000515959","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197384","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":"Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients.","authors":"Jesús K Yamamoto-Furusho, Norma N Parra-Holguín","doi":"10.1159/000520522","DOIUrl":"https://doi.org/10.1159/000520522","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD) characterized by a fluctuating course with periods of clinical activity and remission. No previous studies have demonstrated the frequency of delay at diagnosis and its associated factors in Mexico and Latin America. The aim of this study was to evaluate diagnostic delay of IBD in the last 4 decades in 2 different health care systems (public vs. private) and its associated factors.</p><p><strong>Methods: </strong>This is a cohort study that included 1,056 patients with a confirmed diagnosis of IBD from public and private health care systems. The diagnostic delay was defined as time >1 year from the onset of symptoms to the confirmed diagnosis for patients with UC and 2 years for patients with CD. Statistical analysis was performed with the SPSS v.24 program. A value of <i>p</i> ≤ 0.05 was taken as significant.</p><p><strong>Results: </strong>The delay at diagnosis decreased significantly by 24.9% in the last 4 decades. The factors associated with the diagnostic delay were proctitis in UC, clinical course >2 relapses per year and IBD surgeries for CD. We found a delay at diagnosis in 35.2% of IBD patients in the public versus 16.9% in the private health care system (<i>p</i> = 0.00001).</p><p><strong>Conclusions: </strong>We found a significant diagnosis delay of IBD in 35.2% from the public health care system versus 16.9% in the private health care system.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"7 2","pages":"72-80"},"PeriodicalIF":0.0,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/0a/iid-0007-0072.PMC9294956.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706572","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}
Christine B Flicek, Nathaniel A Sowa, Millie D Long, Hans H Herfarth, Spencer D Dorn
{"title":"Implementing Collaborative Care Management of Behavioral Health for Patients with Inflammatory Bowel Disease.","authors":"Christine B Flicek, Nathaniel A Sowa, Millie D Long, Hans H Herfarth, Spencer D Dorn","doi":"10.1159/000521285","DOIUrl":"https://doi.org/10.1159/000521285","url":null,"abstract":"<p><strong>Background: </strong>Individuals with inflammatory bowel disease (IBD) are up to twice as likely to suffer from anxiety and/or depression. Collaborative care management (CoCM) is an evidence-based approach to treating behavioral health disorders that have proven effective for a range of conditions in primary care and some specialty settings. This model involves a team-based approach, with care delivered by a care manager (case reviews and behavioral therapy), psychiatrist (case reviews and psychopharmacological recommendations), and medical provider (ongoing care including psychopharmacological prescriptions). We assessed the feasibility and effectiveness of CoCM in reducing anxiety and depressive symptoms in patients with IBD.</p><p><strong>Methods: </strong>Patients with psychological distress identified by clinical impression and/or the results of the Patient Health Questionaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were referred to the CoCM program. Data from our 9-month CoCM pilot were collected to assess depression and anxiety response and remission rates. We obtained provider surveys to assess provider acceptability with delivering care in this model.</p><p><strong>Results: </strong>Though the SARS-CoV2 COVID-19 pandemic interrupted screening, 39 patients enrolled and 19 active participants completed the program. Overall, 47.4% had either a response or remission in depression, while 36.8% had response or remission in anxiety. The gastroenterologists highly agreed that the program was a beneficial resource for their patients and felt comfortable implementing the recommendations.</p><p><strong>Discussion: </strong>CoCM is a potentially feasible and well accepted care delivery model for treatment of depression and anxiety in patients with IBD in a specialty gastroenterology clinic setting.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"7 2","pages":"97-103"},"PeriodicalIF":0.0,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/b7/iid-0007-0097.PMC9294946.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706568","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}
G. Rogler, T. Hibi, S. Danese, M. Scharl, S. Shinzaki, B. Ye
{"title":"Contents Vol. 6, 2021","authors":"G. Rogler, T. Hibi, S. Danese, M. Scharl, S. Shinzaki, B. Ye","doi":"10.1159/000521119","DOIUrl":"https://doi.org/10.1159/000521119","url":null,"abstract":"Silvio Danese – Humanitas University, Rozzano (MI), Italy Hans Herfarth – University of North Carolina, Chapel Hill, NC, USA Beat Müllhaupt – University Hospital, Zurich, Switzerland Choon Jin Ooi – Gleneagles Medical Centre, Singapore, Singapore Masakazu Nagahori – Tokyo Medical and Dental University, Medical Hospital, Tokyo, Japan Zhihua Ran – Shanghai Jiao Tong University, Shanghai, China Florian Rieder – Lerner Research Institute, Cleveland, OH, USA Ala Sharara – American University of Beirut Medical Center, Beirut, Lebanon Stephan Vavricka – Zentrum für Gastroenterologie und Hepatologie, Zurich, Switzerland Kenji Watanabe – Hyogo College of Medicine, Nishinomiya, Japan Mamoru Watanabe – Tokyo Medical and Dental University, Tokyo, Japan Gillian Watermeyer – Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa Ming-Shiang Wu – National Taiwan University, Taipei, Taiwan Suk-Kyun Yang – University of Ulsan College of Medicine, Seoul, Korea","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"12 1","pages":"I - IV"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80831988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alain M Schoepfer, Vu Dang Chau Tran, Jean-Benoit Rossel, Christiane Sokollik, Johannes Spalinger, Ekaterina Safroneeva, Thea von Graffenried, Sébastien Godat, Dieter Hahnloser, Stephan R Vavricka, Christian Braegger, Andreas Nydegger
{"title":"Impact of Diagnostic Delay on Disease Course in Pediatric- versus Adult-Onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort.","authors":"Alain M Schoepfer, Vu Dang Chau Tran, Jean-Benoit Rossel, Christiane Sokollik, Johannes Spalinger, Ekaterina Safroneeva, Thea von Graffenried, Sébastien Godat, Dieter Hahnloser, Stephan R Vavricka, Christian Braegger, Andreas Nydegger","doi":"10.1159/000520995","DOIUrl":"https://doi.org/10.1159/000520995","url":null,"abstract":"<p><strong>Introduction: </strong>Given the lack of data, we aimed to assess the impact of the length of diagnostic delay on the natural history of ulcerative colitis (UC) in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years).</p><p><strong>Methods: </strong>Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed. Diagnostic delay was defined as the interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extraintestinal manifestations (EIMs).</p><p><strong>Results: </strong>A total of 184 pediatric and 846 adult patients were included. The median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (<i>p</i> = 0.873). In both, pediatric- and adult-onset groups, the length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIMs were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay than in the adult-onset group with short diagnostic delay (<i>p</i> = 0.022). In the long term, the length of diagnostic delay was associated in the adult-onset group with colorectal dysplasia (<i>p</i> = 0.023), EIMs (<i>p</i> < 0.001), and more specifically arthritis/arthralgias (<i>p</i> < 0.001) and ankylosing spondylitis/sacroiliitis (<i>p</i> < 0.001). In the pediatric-onset UC group, the length of diagnostic delay in the long term was associated with arthritis/arthralgias (<i>p</i> = 0.017); however, it was not predictive for colectomy and UC-related hospitalization.</p><p><strong>Conclusions: </strong>As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.</p>","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"7 2","pages":"87-96"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9294935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706570","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":"Stopping Anti-TNF in Crohn’s Disease Remitters: Pros and Cons: The Pros","authors":"E. Louis","doi":"10.1159/000520942","DOIUrl":"https://doi.org/10.1159/000520942","url":null,"abstract":"Background: There is no cure for Crohn’s disease (CD). Available treatments and treatment strategies, particularly anti-TNF, allow healing intestinal lesions and maintaining steroid-free remission in a subset of patients. Having in mind the remitting/relapsing nature of the disease, patients and health care providers often ask themselves whether the treatment could be withdrawn. Several studies have demonstrated a risk of relapse of CD after anti-TNF withdrawal, which varies from 20 to 50% at 1 year and from 50 to 80% beyond 5 years. These numbers clearly highlight that stopping therapy should not be a systematically proposed strategy in those remitting patients. Summary: Nobody would argue for anti-TNF withdrawal in patients with a high risk of short-term relapse. Nevertheless, they also indicate that a minority of patients may not relapse over midterm and that those who have relapsed may have benefited from a drug-free period before being again treated for a new cycle of treatment. The most relevant question is thus whether in those patients with a low to medium risk of disease relapse, treatment withdrawal could be contemplated. In this specific setting, there may be pros and cons for anti-TNF withdrawal. Among the pros are the potential side effects and toxicity of anti-TNF, the risk of loss of response over time, the patient preference allowing the patient to regain control of one’s health and investing in it, also improving adherence, the absence of a negative impact on disease evolution of a transient anti-TNF withdrawal, and finally the cost. Key Messages: Although anti-TNF withdrawal in patients with sustained clinical remission is associated with a high risk of relapse, this risk seems to be much lower in a subgroup of patients, particularly in endoscopic and biologic remission. Stopping anti-TNF in this subgroup of patients may be associated with a favorable benefit/risk ratio.","PeriodicalId":13605,"journal":{"name":"Inflammatory Intestinal Diseases","volume":"12 1","pages":"64 - 68"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75808634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}