关键词： Health-related quality of life   Pediatric Crohn's disease   Pediatric inflammatory bowel disease   Psychological distress   Psychosocial functioning  

摘要： Background: Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. Objective: This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. Method: Four international databases were consulted in March 2020: PubMed, Psychlnfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. Results: One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. Conclusions: Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.

关键词： Clostridium difficile   inflammatory bowel disease   obesity   treatment  

摘要： 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.

摘要： LINKED CONTENT This article is linked to Al‐Ani et al and Privitera et al papers. To view these articles, visit https://***/10.1111/apt.15779 and https://***/10.1111/apt.16297

关键词： Inflammatory bowel disease   Treatment   Infliximab   Immunosuppressant  

摘要： Background: Patients who receive infliximab (IFX) combined with a thiopurine, for inflammatory bowel disease, have a better clinical response and less frequent immunization towards IFX than those treated with IFX alone. The benefits of combination therapy must be weighed against the risks of infection and cancer. We studied the association between the duration of combination therapy and the risk of treatment failure by two year from initiation. Methods: Participants had Crohn's disease or ulcerative colitis and were in clinical and biological remission, 6 months after initiation of combination therapy. The risk of subsequent treatment failure (i.e., undetectable trough IFX levels and/or clinical relapse followed by surgical treatment or switch of maintenance treatment) was estimated using Kaplan-Meier method and adjusted Hazard Ratios (aHRs), in patients whohadreceived 6 to 11 months vs. 12 months or more of combination therapy. We performed a similar analysis in which the follow-up was started at discontinuation of the immunosuppressant. Results: Among 139 patients (48% women;median age 31.1), with a median follow-up of 18.9 months, we observed 26 treatment failures (including 15 patients with undetectable trough IFX levels). After adjustment for gender and type of immunomodulator, a shorter duration of combination therapy was not associated with a higher risk of treatment failure (aHR = 0.42;95% confidence interval (95%CI): 0.13-1.40;p = 0.16). When the follow-up was started at discontinuation of the immunosuppressant, a combination therapy of 6-11 months was associated with a numerically lower risk of treatment failure as compared with a longer combination therapy (HR = 0.12;95%CI: 0.01-1.05;p = 0.055). Conclusion: Our results do not show any benefit for continuation of combination therapy for more than 12 months after achieving clinical remission in IBD patients. (C) 2020 Elsevier Masson SAS. All rights reserved.

关键词： inflammatory bowel disease   pregnancy   rectal bleeding   altered bowel habit   gastroenterology   ulcerative colitis  

摘要： Worsening of disease activity during pregnancy in patients with known inflammatory bowel disease, especially ulcerative colitis (UC), is well recognised, but the diagnosis of new-onset or previously undiagnosed UC in pregnancy has been inadequately studied to date. Recognition of gastrointestinal symptoms in pregnancy as potentially indicating UC is of paramount importance, as this allows appropriate investigation and instigation of therapies to optimise maternal and foetal outcomes. Here, we report three cases of women with gastrointestinal symptoms in pregnancy with disparate outcomes.

摘要： The inflammatory bowel diseases consisting of Crohn's and ulcerative colitis have expanded into previously low incidence areas of the world. The spread follows the relatively recent pandemic of global obesity. Pathological relations have been proposed between these two diseases. Both inflammatory bowel diseases and obesity originated in wealthier western societies marked by high gross domestic product per capita. The pathogenic influence of national wealth on the inflammatory bowel diseases has been recognized but are less clear with obesity. Parallel correlations of national wealth with obesity would further strengthen relations between these two diseases. Alternatively, diverging relations could suggest that obesity is less dependent on wealth. As such it would supports another earlier hypothesis that obesity depends on adoption of western diet which precedes national acquisition of wealth. Previously ecological modifiers of global disease patterns, including latitude and lactose digestion status have shown different influences on IBD compared with obesity. We evaluate. the influence of the Gross Domestic Product on these two diseases taking into consideration the former's relationship with ecological markers. Patterns of correlations could suggest contributing mechanisms how these ecological parameters influence some disease distributions. The literature and internet were searched for national rates of obesity, inflammatory bowel diseases, national gross domestic product per capita and national lactase distribution rates. National average latitudes were calculated previously. Pearson correlations were used to compare variables in three regions;global, European and Asian theaters. SAS statistical package was used and statistical significance was accepted at p < 0.05. Globally and in Europe correlations of gross domestic product were moderate and significant r = 0.55 and r = 0.6 respectively with Crohn's disease but weaker with ulcerative colitis. The results were

摘要： Background Observational research concerning inflammatory bowel disease (IBD) is highly susceptible to spurious findings because of confounding and bias. Aim To investigate how these issues were reported in this research field. Methods We identified and appraised a random sample of 160 observational studies concerning IBD published in high-impact gastroenterology journals and the most respected specialty journals of the condition. We applied a standardised methodology to assess how confounding and bias were reported and discussed, and investigated the association between yearly citations and study characteristics using mixed-effect multivariable regression analysis. Results The authors of 67 out of 160 articles (41.9%) mentioned confounding, and in 89 cases (55.6%) reported any bias. Although most authors applied strategies to minimise confounding or bias (n = 139;86.9%) and acknowledged at least one unadjusted confounder (n = 116;72.5%), a minority commented about whether the main findings could have been affected (n = 60;37.5%). Very few authors (n = 7;4.4%) called for caution in interpreting the results in the discussion. Reporting of confounding and bias was particularly lacking for case-control studies, those not using routinely collected data, those employing laboratory analyses as the primary method of assessment and studies investigating non-modifiable exposures. In adjusted analyses, mentioning or alluding to confounding was positively associated with yearly citations (P = 0.010), whereas calling for a cautious interpretation of the findings was not. Conclusions Reporting of confounding is inadequate and its acknowledgement is often neglected in interpreting high-impact observational research in IBD. These results encourage a more careful evaluation of the consequences of confounding and bias.

摘要： In 2018, TNF alpha inhibitors were the highest cost drug class for Canadian public drug programs. In 2019, two Canadian provinces announced mandatory nonmedical switching policies in an attempt to reduce their costs by increasing biosimilar uptake. The national impact of similar policies across Canada is unknown. We conducted a cross-sectional analysis of monthly publicly funded prescription claims for infliximab, etanercept, and adalimumab between June 2015 and December 2019. We reported the market share of biosimilars for infliximab and etanercept in 2019 for each province and estimated the cost savings that public payers could have realized in 2019 if mandatory switching policies had been implemented across Canada, including a sensitivity analysis, which assumed that governments receive a 25% rebate on all biologics. Provincial drug programs spent CAD $991.84 million on infliximab, etanercept, and adalimumab in 2019, and, when biosimilars were available, they constituted only 15.5% of national utilization of these drugs. In British Columbia, the implementation of a mandatory switching policy for patients with rheumatic conditions increased the biosimilar market share of infliximab and etanercept by 299% (from 19.7% to 78.5%). If applied nationwide to all three biologics for all indications, we estimate such policies could lead to annual savings of between CAD $179.71 million and CAD $425.64 million nationally. The overall market share of biosimilars remains low in all provinces where mandatory switching policies have not been introduced. The cost implications of successfully increasing biosimilar uptake would be substantial, particularly as more biosimilars reach the Canadian market.