Lebensbedrohliche Komplikationen von Morbus Crohn und Colitis ulcerosa

Clinical Presentation and Outcome of Critically Ill Patients with Inflammatory Bowel Disease

Introduction

Admission to the intensive care unit severely affects inflammatory bowel disease (IBD) patients. This study aimed to determine factors associated with mortality in IBD patients admitted to the intensive care unit.

Methods

A retrospective cohort study was performed, analyzing data of all IBD patients admitted to the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf between 2013 and 2022. Bivariate comparisons and multivariate regression analyses were performed to identify factors associated with mortality.

Results

Overall, 439 IBD patients were admitted to the intensive care unit, representing 0.56% of total admissions. In 98 of these patients, IBD-associated complications were accountable for admission (22.3%). In detail, 39 (40.8%) patients were admitted after IBD-related surgery, 36 (35.7%) due to infections, and 23 (23.5%) due to medical conditions such as bleeding or electrolyte derangement. A total of 16 (16.3%) of these patients died within 90 days after admission. Parameters associated with increased mortality were age (p < 0.001), later age at diagnosis (p 0.026), catecholamine therapy (p 0.003), mechanical ventilation (p < 0.001), renal replacement therapy (p < 0.001), and parenteral nutrition (p 0.002). Prior treatment with anti-TNF therapy was associated with a higher chance of survival (p 0.018). There was no association between prior immunosuppressant therapy and admission because of infections (p 0.294).

Conclusions

16.3% of IBD patients admitted to the intensive care unit died within 90 days after admission. Prior treatment with anti-TNF therapy was associated with a higher chance of survival.

Engaging natural antibody responses for the treatment of inflammatory bowel disease via phosphorylcholine-presenting nanofibres

Inflammatory bowel disease lacks a long-lasting and broadly effective therapy. Here, by taking advantage of the anti-infection and anti-inflammatory properties of natural antibodies against the small-molecule epitope phosphorylcholine (PC), we show in multiple mouse models of colitis that immunization of the animals with self-assembling supramolecular peptide nanofibres bearing PC epitopes induced sustained levels of anti-PC antibodies that were both protective and therapeutic. The strength and type of immune responses elicited by the nanofibres could be controlled through the relative valency of PC epitopes and exogenous T-cell epitopes on the nanofibres and via the addition of the adjuvant CpG. The nanomaterial-assisted induction of the production of therapeutic antibodies may represent a durable therapy for inflammatory bowel disease.

Development and Pilot Testing of an Online Calculation Tool for Relapse Risk Prediction in Ulcerative Colitis

Background: Ulcerative colitis (UC) is a relapsing gastrointestinal disease. Identifying patients at a high risk of UC relapse and initiating preventive treatment can reduce the risk of UC recurrence and its dangerous side effects. The present study was performed to design and pilot test an online calculation tool for relapse risk prediction in UC. Methods: This study is based on our previous prospective study on 157 patients with UC in-remission UC. We designed an online website rooted in our pre-developed equation to calculate relapse risk scores. Then, 280 patients with UC who were not in relapse were randomly selected from our database, and the required information was filled in on the website accordingly. Finally, the indicators were manually calculated using the formula and compared with online-calculated data. Results: The developed bilingual website is available at http://www.ucrelapserisk.com. Of the 280 patients with UC, 151 (53.9%) were male. 88 patients were at high risk of relapse in the following year. There were no differences between the manually and online calculated Seo index, UC risk score, and probability of relapse in one year. Conclusion: This online tool is now available for patients and clinicians and provides an accurate relapse risk prediction for UC patients.

Bilateral Pulmonary Embolism in a Hospitalized Ulcerative Colitis Patient

Patients with inflammatory bowel disease (IBD) are at higher risk of venous thromboembolism (VTE), though physicians may be unaware of this risk or hesitant to start pharmacologic VTE prophylaxis in the presence of active gastrointestinal bleeding. We report a case of a 38-year-old patient hospitalized with acute severe ulcerative colitis (UC) who was not placed on pharmacologic VTE prophylaxis and developed bilateral pulmonary embolism (PE). The patient's UC did not respond to medical therapy. Due to his PE, the patient’s total proctocolectomy was delayed six months. He also developed a large pelvic hematoma after colectomy requiring further surgical intervention. Hospitalized inflammatory bowel disease (IBD) patients require pharmacologic VTE prophylaxis unless they have life-threatening bleeding.

Increased incidence of critical illness among patients with inflammatory bowel disease: a population-based study

BACKGROUND & AIMS

Little is known about how often, and for what reasons, patients with inflammatory bowel diseases (IBD) are admitted to the intensive care unit (ICU). We compared incidences of ICU admission, characteristics of critical illness, and mortality after ICU admission between patients with IBD and the general population.

METHODS

We identified all persons with IBD in the province of Manitoba using a validated administrative definition of IBD for the period from 1984 to 2010. Cases were considered incident for IBD if their first health system contact for IBD was in 1989 or later. We identified a population-based control group, matched by age, sex, and geography (based on postal code). Case and control cohorts were linked to the Manitoba ICU database. We compared outcomes between groups using age- and sex-standardized rates, Cox proportional hazards models, and logistic regression models, adjusting for age, sex, comorbidity, and socioeconomic status.

RESULTS

There were 8224 prevalent and 4580 incident cases of IBD. After adjustment, the risk for ICU admission was higher for patients with IBD than controls (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.58-2.02). The risk of ICU admission was higher for patients with Crohn's disease (HR, 2.31; 95% CI, 1.95-2.75) than ulcerative colitis (HR, 1.37; 95% CI, 1.13-1.65). From 2000 through 2010, age- and sex-standardized annual incidence rates for ICU admission in the prevalent IBD cohort ranged from 0.55% to 1.12%. Compared with controls admitted to ICUs, 1 year after ICU admission, mortality was 32% among patients with IBD.

CONCLUSIONS

Patients with IBD have a higher risk for admission to the ICU than the general population, and increased mortality 1 year after admission. These findings underscore the potential severity of IBD.

[Intensive care and inflammatory bowel diseases (IBD). The severe and fulminant flare]

Inflammatory bowel disease (IBD) is a non-curable disease. Although we seem to have a definitive surgical solution for ulcerative colitis, patients are at risk of suffering from acute and chronic pouchitis as well as peri- and postoperative complications. In Crohn's disease medical treatment is able to prolong surgery-free survival, but no definitive healing strategy is as yet at hand. Moreover, effective medication exposes patients to potentially life-threatening complications. The severely compromised patient in particular needs careful surveillance and requires a balanced treatment strategy endorsed by gastroenterologists and surgeons. Treatment is still aimed at suppressing immune mechanisms and is far from being causal. Nevertheless, this approach has resulted in a reduction in surgical procedures and hospitalizations. The following overview covers special issues related to strategies for severe and fulminant flares of inflammatory bowel disease.