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Bommena S, Goldberg A, Amini M, Alishahi Y. Depression in Women With Inflammatory Bowel Disease: A Multifaceted Approach for a Multidimensional Problem. Inflamm Bowel Dis 2023; 29:1957-1970. [PMID: 36472240 DOI: 10.1093/ibd/izac245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Indexed: 06/17/2023]
Abstract
The prevalence of depression is higher in patients with inflammatory bowel disease (IBD) than in the general population. Women are more significantly affected by depression among those with IBD and in the general population. This review presents evidence on sex-based differences in depression pathogenesis and the effect of depression on various factors associated with IBD that affect women's lives, including sexual dysfunction, body image dissatisfaction, fertility, and overall quality of life. We also discuss sex-specific effects on IBD treatment, disease activity, and health care costs. Interestingly, women with IBD tend to seek and are more receptive to depression-related information. Given the underdiagnosis and undertreated nature of depression in individuals with IBD, effective screening and an optimal integrative treatment approach with relevant sex-specific needs are discussed. Evidence regarding the efficacy of psychotherapy, antidepressant pharmacotherapy, and IBD-specific therapy for depression is discussed. This review summarizes evidence of the effect of depression on both personal and professional aspects of the daily lives of women with IBD, which extends beyond negative moods. It applies this information to screening and integrative treatment, resulting in a holistic approach to this multidimensional problem. We also discuss how depression affects males with IBD differently from females. Finally, we discuss the need for gender-based studies on depression in individuals with IBD.
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Affiliation(s)
- Shoma Bommena
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Banner University Medical Center-Phoenix, AZ, USA
| | - Aaron Goldberg
- Division of Gastroenterology, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, AZ, USA
| | - Mona Amini
- Psychiatry and Mental Health, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - Yasmin Alishahi
- Division of Gastroenterology, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, AZ, USA
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2
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Viser AC, Cooke AR, Herfarth HH, Anderson C, Proch C, Peery AF. Inflammatory Bowel Disease Patients in the Ambulatory Setting Commonly Screen Positive for Malnutrition. GASTRO HEP ADVANCES 2023; 3:181-183. [PMID: 38468710 PMCID: PMC10927263 DOI: 10.1016/j.gastha.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Aaron C Viser
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Adelaide R Cooke
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hans H Herfarth
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Chelsea Anderson
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christina Proch
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anne F Peery
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Scott FI, Ehrlich O, Wood D, Viator C, Rains C, DiMartino L, McArdle J, Adams G, Barkoff L, Caudle J, Cheng J, Kinnucan J, Persley K, Sariego J, Shah S, Heller C, Rubin DT. Creation of an Inflammatory Bowel Disease Referral Pathway for Identifying Patients Who Would Benefit From Inflammatory Bowel Disease Specialist Consultation. Inflamm Bowel Dis 2023; 29:1177-1190. [PMID: 36271884 PMCID: PMC10393070 DOI: 10.1093/ibd/izac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Indexed: 08/03/2023]
Abstract
BACKGROUND Recommendations regarding signs and symptoms that should prompt referral of patients with inflammatory bowel disease (IBD) to an IBD specialist for a consultation could serve to improve the quality of care for these patients. Our aim was to develop a consult care pathway consisting of clinical features related to IBD that should prompt appropriate consultation. METHODS A scoping literature review was performed to identify clinical features that should prompt consultation with an IBD specialist. A panel of 11 experts was convened over 4 meetings to develop a consult care pathway using the RAND/UCLA Appropriateness Method. Items identified via scoping review were ranked and were divided into major and minor criteria. Additionally, a literature and panel review was conducted assessing potential barriers and facilitators to implementing the consult care pathway. RESULTS Of 43 features assessed, 13 were included in the care pathway as major criteria and 15 were included as minor criteria. Experts agreed that stratification into major criteria and minor criteria was appropriate and that 1 major or 2 or more minor criteria should be required to consider consultation. The greatest barrier to implementation was considered to be organizational resource allocation, while endorsements by national gastroenterology and general medicine societies were considered to be the strongest facilitator. CONCLUSIONS This novel referral care pathway identifies key criteria that could be used to triage patients with IBD who would benefit from IBD specialist consultation. Future research will be required to validate these findings and assess the impact of implementing this pathway in routine IBD-related care.
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Affiliation(s)
- Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Dallas Wood
- RTI International, Research Triangle Park, NC, USA
| | | | - Carrie Rains
- RTI International, Research Triangle Park, NC, USA
| | | | - Jill McArdle
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Jennifer Caudle
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Sewell, NJ, USA
| | | | - Jami Kinnucan
- Section of Gastroenterology and Hepatology Mayo Clinic, Jacksonville, FL, USA
| | | | - Jennifer Sariego
- Penn Medicine At Home, University of Pennsylvania Health System, Bala Cynwd, PA, USA
| | - Samir Shah
- Division of Gastroenterology, Brown University, Providence, RI, USA
| | | | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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4
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Feasibility and impact of a quality improvement initiative to screen for malnutrition in an Inflammatory Bowel Disease clinic. Clin Nutr ESPEN 2022; 52:371-376. [PMID: 36513478 DOI: 10.1016/j.clnesp.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract that is associated with malnutrition. Malnutrition is associated with poor clinical outcomes in patients with IBD and therefore early identification of those at risk for malnutrition is crucial. We aimed to evaluate how frequently nutrition screening occurs in a large, tertiary care outpatient IBD center and to initiate an intervention to improve malnutrition screening for patients with IBD. METHODS We used a traditional plan-do-study-act quality improvement technique to understand our current malnutrition screening practices and institute an intervention to improve screening. To do this, we utilized a modified Malnutrition Universal Screening Tool (mMUST) and integrated this into the electronic health record. We then evaluated the intervention and the impact on IBD related clinical outcomes. RESULTS Prior to the intervention, few patients with IBD were screened for malnutrition. However, the number of patients screened for malnutrition significantly improved with the study intervention and those who were identified as high-risk had increased nutrition follow up including serum micronutrient evaluations and referral to a dedicated registered dietician. CONCLUSION This study demonstrated the feasibility and impact of a malnutrition screening program in ambulatory IBD patients. Those patients identified as high risk for malnutrition who engaged in nutrition care had improved clinical outcomes including reduced hospitalizations and emergency room visits.
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Haydek JP, Scott FI. Editorial: progress towards more comprehensively understanding the sources of corticosteroids for patients with IBD. Aliment Pharmacol Ther 2022; 56:896-897. [PMID: 35934853 DOI: 10.1111/apt.17137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John P Haydek
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Riskin Geuz KS, Schwartz D. Less Emergency Department Abdominopelvic Computed Tomography for Patients With Crohn's Disease: A New Scoring System. J Clin Gastroenterol 2022; 56:712-717. [PMID: 34907921 DOI: 10.1097/mcg.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 10/10/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND In recent years, the use of abdominal pelvic computed tomography (APCT) in the emergency department (ED) for patients with Crohn's disease (CD) has risen steadily. Thus, exposing these patients to recurrent radiation, despite studies showing that only 30% to 40% had significant findings in ED APCT. GOAL Our aim was to find clinical and laboratory variables that can predict substantial findings on ED APCT, which may require invasive intervention. METHODS We analyzed ED visits of patients with known CD that underwent an emergent APCT for gastrointestinal complaints, over a 10-year period. Patients with positive and negative findings in the APCT were compared in order to evaluate independent effects of different variables, including patients' characteristics, CD history, ED complaints, and laboratory tests. RESULTS In 44% of 183 ED visits, there were significant findings on ED APCT, however, only 22% of them underwent invasive intervention. Laboratory tests: C-reactive protein >50 mg/L, neutrophil count >75%, platelet count >350×10 9 /L, and ileocolon location at diagnosis were all positive predicting factors. Whereas, smoking or ED complaints of diarrhea/fever reduced the risk for significant findings. CONCLUSIONS Using the 7 most significant predicting factors, we built an easy to use scoring system-Crohn Assessment Tool for CT upon Hospitalization (CATCH) for ED clinicians. This scoring system could have prevented unnecessary ED APCT from 42% of the patients in our study, without missing those who required invasive intervention.
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Affiliation(s)
- Kinneret S Riskin Geuz
- Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev
- Department of Gastroenterology & Hepatology, Soroka Medical Center, Beer Sheva, Israel
| | - Doron Schwartz
- Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev
- Department of Gastroenterology & Hepatology, Soroka Medical Center, Beer Sheva, Israel
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Goren I, Barkan R, Biron IA, Leibovitzh H, Golan MA, Eran HB, Snir Y, Broitman Y, Konikoff T, Amir-Barak H, Yafee H, Adani E, Shiber S, Steiner H, Drescher MJ, Dotan I, Yanai H. Specialized Emergency Department Assessment and Multidisciplinary Intervention After Discharge Improve Management of Patients With Inflammatory Bowel Diseases. J Clin Gastroenterol 2022; 56:148-153. [PMID: 33471484 DOI: 10.1097/mcg.0000000000001490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023]
Abstract
GOAL The aim was to assess proactive specialized inflammatory bowel diseases (IBD) emergency department (ED) consultation and multidisciplinary IBD team (IBD-MDT) intervention on IBD-related patient outcomes after discharge. BACKGROUND Despite advances in patient care, IBD-related ED visits have increased and substantially contribute to the IBD burden. METHODS Consecutive patients with IBD (below 50 y) who visited the ED during November 2017 to April 2018 (intervention group) were compared with patients with IBD that visited the same ED during 2014 to 2017 (standard-care group). The primary outcomes were hospitalization and ED revisits at 30, 90, and 180 days. RESULTS The intervention group (45 patients, mean age 32.43±8.6 y, 57.8% male) and the standard-care group (237 patients) had comparable baseline characteristics, including age, sex, and IBD type, and similar rates of hospital admissions from the ED (46.7% vs. 38.8%, P=0.32). The intervention group more frequently underwent computed tomography (40% vs. 8%, P<0.001) and surgical interventions (13.3% vs. 0.8%, P<0.001) within the same hospital admission, compared with the standard-care group. In the intervention group, 24 patients were discharged from the ED, of whom 17 patients visited the IBD clinic (median 5 d postdischarge) and the majority were referred to ambulatory IBD-MDT services (dietitian: 46.7%, psychologist: 6.7%, advanced endoscopist: 8.9%, and proctology services: 6.7%). The intervention group had significantly fewer ED revisits than the standard-care group (30 d: 4.4% vs. 19.8%, P=0.013; 90 d: 4.4% vs. 35.9%, P<0.001; 180 d: 6.7% vs. 43%, P<0.001). CONCLUSION Proactive specialized ED assessments and IBD-MDT interventions after a hospital discharge were preferable; they significantly reduced the ED revisit rate for at least 6 months.
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Affiliation(s)
- Idan Goren
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Irit A Biron
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Leibovitzh
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya A Golan
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar B Eran
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Snir
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Broitman
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Konikoff
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir-Barak
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Yafee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edna Adani
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikva
| | - Shachaf Shiber
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Steiner
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael J Drescher
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henit Yanai
- Division of Gastroenterology, IBD Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chen Z, Shen X, Zhou Q, Zhan Q, Xu X, Chen Q, An F, Sun J. Dietary xylo-oligosaccharide ameliorates colonic mucus microbiota penetration with restored autophagy in interleukin-10 gene-deficient mice. JPEN J Parenter Enteral Nutr 2021; 46:1130-1140. [PMID: 34618377 DOI: 10.1002/jpen.2274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is, nowadays, highly prevalent and presents a global clinical challenge. The objective of this study is to assess the effects of xylo-oligosaccharide (XOS) on Il10-/- mice, a classic animal model of IBD. METHODS Male wild-type (WT) mice were assigned to WT group, and Il10-/- mice were assigned to interleukin-10 gene-deficient (IL-10-KO) group and XOS group, respectively. There were 6-8 mice aged 8 weeks in each group. Mice in the XOS group received 1.0 g/kg/day XOS by gavage for 4 weeks. RESULTS Compared with mice in IL-10-KO group, Il10-/- mice with XOS intervention presented significant mild spontaneous colitis with lower disease activity index, histological scores, and bowel inflammatory cytokine levels. Dietary XOS downregulated bowel mucus bacterial penetration, which occurred as early as the onset of bowel colitis. The effect of XOS was associated with restored expression of LC3II/I and decreased expression of p62 and beclin-1 in colon. CONCLUSIONS Therefore, XOS decreases colonic mucus microbiota penetration with restored function of antophagy. Our findings suggest that XOS may be a potential dietary supplement or functional food for early management of IBD.
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Affiliation(s)
- Zhongxia Chen
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Xiao Shen
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qunyan Zhou
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Qiang Zhan
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Xingwen Xu
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Qiuyu Chen
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Fangmei An
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Jing Sun
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
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Choe MY, VanGraafeiland B, Parian A. Improving Follow-ups With Gastroenterologists Utilizing an Appointment Scheduling Protocol in Inflammatory Bowel Disease: A Quality Improvement Project. Gastroenterol Nurs 2021; 44:E91-E100. [PMID: 34411015 DOI: 10.1097/sga.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022] Open
Abstract
Approximately one in four patients with inflammatory bowel disease are readmitted within 90 days. To reduce hospitalizations, regular follow-up appointments with gastroenterologists are essential. However, the mean wait time for gastroenterology clinic appointments significantly exceeded the target goal of 14 days in North America. Based on literature review, we developed and implemented a new appointment scheduling protocol. The inclusion criteria were adult patients with inflammatory bowel disease who were recently hospitalized or newly referred to a gastroenterology clinic. At weeks 0 and 12, wait times were extrapolated from chart review, and patient satisfaction rates were collected via surveys. Patient demographics and outcome data were examined using descriptive statistics. A total of 16 patients were included. Following the intervention, the mean wait time decreased from 40.4 (SD = 31.9) to 21.9 days (SD = 11.4), but the change was statistically insignificant (p = .408). Poor response rates (47%) limited the interpretation of the patient satisfaction data. Despite the small sample size, our project was the first quality improvement initiative that implemented an evidence-based appointment scheduling protocol among adult patients with inflammatory bowel disease. Further studies are warranted with a larger sample size to better evaluate its efficacy in achieving timely outpatient gastroenterology care.
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Affiliation(s)
- Monica Y Choe
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Brigit VanGraafeiland
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Basso D, Padoan A, D'Incà R, Arrigoni G, Scapellato ML, Contran N, Franchin C, Lorenzon G, Mescoli C, Moz S, Bozzato D, Rugge M, Plebani M. Peptidomic and proteomic analysis of stool for diagnosing IBD and deciphering disease pathogenesis. Clin Chem Lab Med 2021; 58:968-979. [PMID: 32229654 DOI: 10.1515/cclm-2019-1125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
Abstract
Background The sensitivities and specificities of C-reactive protein (CRP) and faecal calprotectin (fCal), as recommended for inflammatory bowel diseases (IBD) diagnosis and monitoring, are low. Our aim was to discover new stool protein/peptide biomarkers for diagnosing IBD. Methods For peptides, MALDI-TOF/MS (m/z 1000-4000) was performed using stools from an exploratory (34 controls; 72 Crohn's disease [CD], 56 ulcerative colitis [UC]) and a validation (28 controls, 27 CD, 15 UC) cohort. For proteins, LTQ-Orbitrap XL MS analysis (6 controls, 5 CD, 5 UC) was performed. Results MALDI-TOF/MS spectra of IBD patients had numerous features, unlike controls. Overall, 426 features (67 control-associated, 359 IBD-associated) were identified. Spectra were classified as control or IBD (absence or presence of IBD-associated features). In the exploratory cohort, the sensitivity and specificity of this classification algorithm were 81% and 97%, respectively. Blind analysis of the validation cohort confirmed 97% specificity, with a lower sensitivity (55%) paralleling active disease frequency. Following binary logistic regression analysis, IBD was independently correlated with MALDI-TOF/MS spectra (p < 0.0001), outperforming fCal measurements (p = 0.029). The IBD-correlated m/z 1810.8 feature was a fragment of APC2, homologous with APC, over-expressed by infiltrating cells lining the surface in UC or the muscularis-mucosae in CD (assessed by immunohistochemistry). IBD-associated over-expressed proteins included immunoglobulins and neutrophil proteins, while those under-expressed comprised proteins of the nucleic acid assembly or those (OLFM4, ENPP7) related to cancer risk. Conclusions Our study provides evidence for the clinical utility of a novel proteomic method for diagnosing IBD and insight on the pathogenic role of APC. Moreover, the newly described IBD-associated proteins might become tools for cancer risk assessment in IBD patients.
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Affiliation(s)
- Daniela Basso
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences - DISCOG, University Hospital, Padova, Italy
| | - Giorgio Arrigoni
- Department of Biomedical Sciences - BIOMED, University of Padova, Padova, Italy.,Proteomic Center, University of Padova, Padua, Italy
| | - Maria Luisa Scapellato
- Department of Cardiologic, Thoracic and Vascular Sciences, Preventive Medicine and Risk Assessment Unit, University Hospital of Padova, Padova, Italy
| | - Nicole Contran
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Cinzia Franchin
- Department of Biomedical Sciences - BIOMED, University of Padova, Padova, Italy.,Proteomic Center, University of Padova, Padua, Italy
| | - Greta Lorenzon
- Department of Surgical, Oncological and Gastroenterological Sciences - DISCOG, University Hospital, Padova, Italy
| | - Claudia Mescoli
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Stefania Moz
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Dania Bozzato
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Massimo Rugge
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padova, Padova, Italy
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11
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Burns EE, Mathias HM, Heisler C, Cui Y, Kits O, Veldhuyzen van Zanten S, Jones JL. Access to inflammatory bowel disease speciality care: the primary healthcare physician perspective. Fam Pract 2021; 38:416-424. [PMID: 33615344 DOI: 10.1093/fampra/cmab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is little literature related to access to inflammatory bowel disease (IBD) care that incorporates the perspective of key system stakeholders, such as primary healthcare providers (PHCP), despite their clear and integral role in facilitating access. OBJECTIVE This study aimed to identify barriers to referring patients to speciality IBD care as perceived by referring PHCP. In particular, we sought to understand PHCP satisfaction with the current IBD specialist referral system, as well as indicators of geographic variance to access. METHODS A population-based survey was mailed out to currently practising PHCPs who have referred or who are currently referring patients to IBD speciality care in Nova Scotia (Canada). Descriptive statistics and multivariate analyses were performed. Qualitative comments were themed using framework analysis to identify key barriers. RESULTS The majority of PHCP (57%) were dissatisfied with the current referral process due to long patient wait times and perceived system inefficiency. Key areas of geographic variance in access included access to speciality care in the community and patient wait times. PHCPs suggested ideas to improve access including increased gastroenterologist supply, particularly in rural areas, and the creation of a provincial centralized referral and triage process. CONCLUSIONS PHCPs play an important role in identifying and managing patients with IBD in partnership with gastroenterologists. This study identifies key PHCP perceived barriers that may prevent patients from accessing speciality IBD care. Understanding and addressing barriers to access from multiple stakeholder perspectives, including PHCPs, has the potential to support informed system redesign and overcome access inequities.
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Affiliation(s)
- Eileen E Burns
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly M Mathias
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Courtney Heisler
- Nova Scotia Collaborative Inflammatory Bowel Disease Program, Division of Digestive Care and Endoscopy, QEII Health Science Centre, Halifax, Nova Scotia, Canada
| | - Yunsong Cui
- Atlantic Path, Dalhousie University, Halifax, Canada
| | - Olga Kits
- Research Methods Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | - Jennifer L Jones
- Nova Scotia Collaborative Inflammatory Bowel Disease Program, Division of Digestive Care and Endoscopy, QEII Health Science Centre, Halifax, Nova Scotia, Canada
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12
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Russell LA, Balart MT, Serrano P, Armstrong D, Pinto-Sanchez MI. The complexities of approaching nutrition in inflammatory bowel disease: current recommendations and future directions. Nutr Rev 2021; 80:215-229. [PMID: 34131736 DOI: 10.1093/nutrit/nuab015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis predispose patients to malnutrition due to a combination of increased basal metabolic rate, decreased oral intake, and increased nutritional losses and malabsorption. Malnutrition is common, affecting up to 75% of patients with Crohn's disease and 62% of patients with ulcerative colitis, and is associated with worse disease prognosis, higher complication rates, decreased quality of life, and increased mortality risk. It is imperative to screen patients with IBD for malnutrition to assess those at increased risk and treat accordingly to prevent progression and complications. This literature review provides an overall approach to optimizing nutrition in IBD, focusing on the assessment for the diagnosis of malnutrition, management of macro- and micronutrient deficiencies, and identification of areas for future study.
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Affiliation(s)
- Lindsey A Russell
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - Maria Teresa Balart
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - Pablo Serrano
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - David Armstrong
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - Maria Ines Pinto-Sanchez
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
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Click B, Barnes EL, Cohen BL, Sands BE, Hanson JS, Regueiro M, Rubin DT, Dubinsky MC, Gazis DR, Dalfonso L, Hildebrand JS, Crawford JM, Long MD. Methodology and Initial Results From a Real-World Observational Cohort of Patients With Inflammatory Bowel Disease: TARGET-IBD. CROHN'S & COLITIS 360 2021; 3:otab023. [PMID: 36776639 PMCID: PMC9802086 DOI: 10.1093/crocol/otab023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background Data on care patterns for inflammatory bowel disease (IBD) from large-scale, diverse clinical cohorts in real-world practice are sparse. We developed a real-world cohort of patients receiving care at academic and community sites, for comparative study of therapies and natural history of IBD. Methods We describe novel methodology of central abstraction of clinical data into a real-world IBD registry with patient reported outcomes (PROs). Baseline demographics, clinical characteristics, healthcare utilization, and disease metrics were assessed. Bivariate statistics were used to compare demographic and clinical data by Crohn disease (CD) or ulcerative colitis (UC) and site of care (academic, community). Results In 1 year, 1343 IBD patients (60.1% CD, 38.9% UC) were recruited from 27 academic (49.5%) and community (50.5%) sites, exceeding expectations (110% enrolled). Most participants also consented to provide PROs (59.5%) or biosamples (85.7%). Overall, 48.7% of the cohort provided a baseline PRO, and 62.6% provided a biosample. Compared to UC, CD subjects had higher prior (34.1% CD vs 7.7% UC; P < 0.001) and current (72.1% vs 47.9%; P < 0.001) biologic utilization. CD participants from academic sites had more complicated disease than those from community sites (62.5% vs 46.8% stricturing/penetrating; 33.5% vs 27% perianal; 36.8% vs 14.5% prior biologic, respectively). Nearly all (90.4%) participants had endoscopic data of whom 37.7% were in remission. One-year retention was 98.4%. Conclusions Centralized data abstraction and electronic PRO capture provided efficient recruitment into a large real-world observational cohort. This novel platform provides a resource for clinical outcomes and comparative effectiveness research in IBD.
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Affiliation(s)
- Benjamin Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA,Address correspondence to: Benjamin Click, MD, MS, Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA ()
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce E Sands
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John S Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte, NC, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Marla C Dubinsky
- Division of Pediatric Gastroenterology, The Susan & Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Choe MY, Wright R, Parian A. Follow-up Care in Inflammatory Bowel Disease: An Integrative Review. Gastroenterol Nurs 2021; 44:E48-R58. [PMID: 34037572 DOI: 10.1097/sga.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract and is associated with high risks for complications, surgeries, and frequent hospitalizations. Approximately one in four inflammatory bowel disease patients are readmitted to the hospital within 90 days of discharge in the United States. Although existing literature showed a timely clinic appointment with gastroenterologists is a protective factor for disease flare-ups and hospitalizations, the follow-up appointments were found to be either lacking or significantly delayed. Further, evidence-based guidelines in timely inflammatory bowel disease care are lacking. Thus, this integrative review examined current literature to identify effective strategies for achieving timely clinic appointments with gastroenterologists in inflammatory bowel disease. A comprehensive search of three electronic databases (PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature [CINAHL] Plus) was conducted from January 2009 to September 2019 using the key terms: inflammatory bowel disease, ulcerative colitis, Crohn's disease, appointments, and time to appointment. Nine articles met the inclusion criteria. The main interventions for timely inflammatory bowel disease care included (i) clinic-wide scheduling protocols, (ii) a dedicated healthcare team, (iii) efficient referral process, (iv) appointment management based on disease acuity and severity, and (v) addressing shortage of inflammatory bowel disease clinicians. Further research is needed to quantify the magnitude of timely inflammatory bowel disease care interventions with controls and evaluate the efficacy with a head-to-head trial. Through timely referrals, evaluations, and treatments, these quality improvement endeavors will ultimately improve quality of care and contribute to reduction in preventable hospitalizations and associated healthcare costs from delayed outpatient inflammatory bowel disease care.
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Affiliation(s)
- Monica Y Choe
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rebecca Wright
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Hwang C, Issokson K, Giguere-Rich C, Reddy S, Tinsley A, Van Deen WK, Bray H, Lum D, Aguilar H, Zisman TL, Younes Z, Crate D, Oberai R, Weaver A, Melmed G, Siegel C, Hou JK. Development and Pilot Testing of the Inflammatory Bowel Disease Nutrition Care Pathway. Clin Gastroenterol Hepatol 2020; 18:2645-2649.e4. [PMID: 32599016 DOI: 10.1016/j.cgh.2020.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Caroline Hwang
- Section of Gastroenterology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kelly Issokson
- Section of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Giguere-Rich
- Section of Gastroenterology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Andrew Tinsley
- Section of Gastroenterology, Department of Medicine, Penn State Health, Hershey, Pennsylvania
| | - Welmoed K Van Deen
- Section of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Timothy L Zisman
- Section of Gastroenterology, Department of Medicine, Virginia Mason Medical Center, Seattle, Washington
| | | | - Damara Crate
- Section of Gastroenterology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | - Gil Melmed
- Section of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Corey Siegel
- Section of Gastroenterology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jason K Hou
- Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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16
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Barnes EL. Standardizing Healthcare Delivery to Reduce Utilization, the Potential of Evidence-Based Care Pathways. CROHN'S & COLITIS 360 2020; 2:otaa081. [PMID: 36777746 PMCID: PMC9802397 DOI: 10.1093/crocol/otaa081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Address correspondence to: Edward L. Barnes, MD, MPH, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Campus Box #7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7080 ()
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Abstract
PURPOSE OF REVIEW Multiple new medications with novel mechanisms of action are now available to treat inflammatory bowel disease (IBD). Identifying the appropriate patients in whom to use these therapies is critical in maximizing benefit and reducing unnecessary risks. Once the appropriate therapy is selected, using a treat-to-target algorithm including symptomatic, biochemical, and endoscopic monitoring can improve clinical outcomes. If symptoms recur, these same principles, coupled with therapeutic drug monitoring, should be considered to confirm inflammation and determine next therapeutic steps. RECENT FINDINGS Multiple network meta-analyses can assist clinicians in determining the ideal biologic or small molecule therapy for patients with moderate-to-severe IBD. Once selected, several clinical trials have demonstrated that follow-up in 3 to 4 months, coupled with fecal calprotectin or C-reactive protein monitoring, can improve clinical remission and mucosal healing rates. Structural assessment should be performed via colonoscopy, enterography, or capsule endoscopy, dependent on disease location, at 9--12 months to confirm healing. SUMMARY Appropriate disease stratification, coupled with biologic or small molecule medication selection and treat-to-target follow-up, can greatly assist clinicians who are managing patients with IBD in achieving the greatest potential benefits of medical therapy.
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