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Wetwittayakhlang P, Verdon C, Starr M, Drügg Hahn G, Golovics PA, Bessissow T, Afif W, Wild G, Bitton A, Lakatos PL. Mucosal Healing and Clinical Efficacy of Adalimumab in Small Intestinal Crohn's Disease (SIMCHA Study): Final Results From a Prospective, Open-Label, Single-Arm Study. Turk J Gastroenterol 2023; 34:603-610. [PMID: 37162506 PMCID: PMC10441132 DOI: 10.5152/tjg.2023.22527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/17/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Endoscopic healing is a key treatment target in inflammatory bowel disease; few data are available on the clinical and endoscopic efficacy of biological therapy in upper gastrointestinal Crohn's disease. This study aimed to investigate small bowel mucosal healing and clinical efficacy of adalimumab therapy by video capsule endoscopy in patients with endoscopically active upper gastrointestinal Crohn's disease. METHODS This prospective, open-label, single-arm study included Crohn's disease patients with moderate-severe endoscopic proximal small bowel involvement, defined by a Lewis score >790. Patients were treated with adalimumab monotherapy for 24 weeks. Co-primary outcomes were endoscopic healing, defined as Lewis score <350, and endoscopic response, defined as >50% decrease in Lewis score. Secondary outcomes included clinical (Harvey-Bradshaw index <4) and biomarker remission (fecal calprotectin <250 μg/g, and C-reactive protein <5 mg/L). RESULTS A total of 59 Crohn's disease patients were screened; 17 patients have met eligibility criteria and were enrolled. Endoscopic healing was observed in 8 patients (47.1%) and endoscopic response in additional 5 patients (29.4%) at 24 weeks. Median Lewis score was significantly decreased compared to baseline (1912 vs. 337, P = .0005). Eleven of 13 patients (84.6%) with clinical activity achieved clinical remission (baseline: 13/17 vs. week 24: 2/17, P < .0001). Nine of 10 patients with elevated C-reactive protein achieved normal C-reactive protein after treatment and the median C-reactive protein significantly decreased from 7.4 to 1.6 mg/L, P = .032. In contrast, no change was observed in fecal calprotectin pre- and posttreatment. CONCLUSIONS Adalimumab induced endoscopic healing and clinical remission in patients with active small bowel Crohn's disease, with approximately half of the patients achieving endoscopic healing.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Starr
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gustavo Drügg Hahn
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Porto Alegre, Brazil
| | - Petra A. Golovics
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Gastroenterology, Hungarian Defence Forces, Medical Centre, Budapest, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter L. Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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O'Neill RS, Wang WJ, Chan P, Ho V, Verdon C, Turner I, Acharya P. An obscure cause of gastrointestinal bleeding: Recurrent duodenal variceal hemorrhage treated with intramuscular octreotide in the absence of portal hypertension. JGH Open 2022; 7:78-80. [PMID: 36660056 PMCID: PMC9840189 DOI: 10.1002/jgh3.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
Duodenal varices (DVs) are ectopic gastrointestinal varices (ECVs) associated with portal hypertension (PH). We present the case of an 82-year-old woman who presented with symptomatic anemia secondary to DV hemorrhage diagnosed on oesophagogastroduodenoscopy. This lesion was treated with endoscopic adrenaline injection and clip application. The patient re-presented on multiple occasions with bleeding recurrence localized to the duodenum, which was managed with intramuscular octreotide and oral beta-blockade resulting in sustained remission of bleeding. This case highlights a rare cause of upper gastrointestinal hemorrhage and highlights the value of somatostatin analogues for conservative treatment of DVs.
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Affiliation(s)
- Robert S O'Neill
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia,St Vincent's Clinical School, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - William J Wang
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia,Western Sydney UniversityCampbelltownNew South WalesAustralia,Townsville University HospitalDouglasQueenslandAustralia
| | - Patrick Chan
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia
| | - Vincent Ho
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia,Western Sydney UniversityCampbelltownNew South WalesAustralia
| | - Christine Verdon
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia,Western Sydney UniversityCampbelltownNew South WalesAustralia
| | - Ian Turner
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia,Western Sydney UniversityCampbelltownNew South WalesAustralia
| | - Priya Acharya
- Department of GastroenterologyCampbelltown HospitalCampbelltownNew South WalesAustralia,Western Sydney UniversityCampbelltownNew South WalesAustralia
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Golovics PA, Gonczi L, Reinglas J, Verdon C, Pundir S, Afif W, Wild G, Bitton A, Bessissow T, Lakatos PL. Patient-Reported Outcome and Clinical Scores Are Equally Accurate in Predicting Mucosal Healing in Ulcerative Colitis: A Prospective Study. Dig Dis Sci 2022; 67:3089-3095. [PMID: 34286411 DOI: 10.1007/s10620-021-07178-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/12/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Optimal management of patients with ulcerative colitis (UC) requires the accurate, objective assessment of disease activity. AIMS We aimed to determine how strong patient-reported outcomes, clinical scores and symptoms correlate with endoscopy and biomarkers for assessment of disease activity in patients with UC. METHODS Consecutive patients with UC followed at the McGill University IBD Center and referred for endoscopy (surveillance or flare) were included prospectively between September 2018 and August 2020. Patient-reported outcome (PRO2), partial Mayo, Simple Clinical Colitis Activity Index (SCCAI), Mayo endoscopic subscore (MES) and Baron and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores were calculated. C-reactive protein (CRP) and fecal calprotectin (FCAL) were collected. RESULTS A total of 171 patients with UC [age: 49(IQR:38-61) years, female: 46.2%, 57.3% extensive disease, 42.7% on biologicals] were included prospectively. Rectal bleeding (RBS), stool frequency (SF) subscore of 0, or total PRO2 remission (RBS0 and SF ≤ 1), partial Mayo (≤ 2) and SCCAI (≤ 2.5) remission were similarly associated with mucosal healing defined by MES (0 or ≤ 1), Baron (0 or ≤ 1) or UCEIS (≤ 3) scores in ROC analysis (AUC:0.93-0.72). There was a moderate-to-strong agreement between MES Baron and UCEIS (K = 0.91-0.41). A UCEIS of ≤ 3 was identified as the best cutoff to clinical or endoscopic remission. Agreement between CRP and clinical remission or endoscopic healing (MES/Baron) was poor (K ~ 0.2), while agreement between FCAL and RBS-PRO2 or MES/Baron/UCEIS was moderate to strong (K = 0.44-0.70). CONCLUSIONS Agreement between RBS, SF, PRO2, partial Mayo and SCCAI in predicting endoscopic healing was moderate to strong, while no clinically meaningful difference was found in accuracy across the scores and definitions. FCAL, but not CRP, was associated to clinical and endoscopic remission.
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Affiliation(s)
- Petra Anna Golovics
- Division of Gastroenterology, Medical Centre, Hungarian Defence Forces, Podmaniczky u 109-111, Budapest, 1062, Hungary
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Koranyi S u 2/a, Budapest, 1083, Hungary
| | - Jason Reinglas
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Sheetal Pundir
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Koranyi S u 2/a, Budapest, 1083, Hungary. .,Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada.
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Cho KK, Ko Y, Nilsen K, Verdon C, Femia G. Ulcerative colitis and acute perimyocarditis. Med J Aust 2022; 216:559-561. [DOI: 10.5694/mja2.51554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Yanna Ko
- Campbelltown Hospital Sydney NSW
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Verdon C, Reinglas J, Coulombe J, Gonczi L, Bessissow T, Afif W, Vutcovici M, Wild G, Seidman EG, Bitton A, Brassard P, Lakatos PL. No Change in Surgical and Hospitalization Trends Despite Higher Exposure to Anti-Tumor Necrosis Factor in Inflammatory Bowel Disease in the Québec Provincial Database From 1996 to 2015. Inflamm Bowel Dis 2021; 27:655-661. [PMID: 32676662 DOI: 10.1093/ibd/izaa166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Crohn disease (CD) and ulcerative colitis (UC) have high health care expenditures because of medications, hospitalizations, and surgeries. We evaluated disease outcomes and treatment algorithms of patients with inflammatory bowel disease (IBD) in Québec, comparing periods before and after 2010. METHODS The province of Québec's public health administrative database was used to identify newly diagnosed patients with IBD between 1996 and 2015. The primary and secondary outcomes included time to and probability of first and second IBD-related hospitalizations, first and second major surgery, and medication exposures. Medication prescriptions were collected from the public prescription database. RESULTS We identified 34,644 newly diagnosed patients with IBD (CD = 59.5%). The probability of the first major surgery increased after 2010 in patients with CD (5 years postdiagnosis before and after 2010: 8% [SD = 0.2%] vs 15% [SD = 0.6%]; P < 0.0001) and patients with UC (6% [SD = 0.2%] vs 10% [SD = 0.6%] ;P < 0.0001). The probability of the second major surgery was unchanged in patients with CD. Hospitalization rates remained unchanged. Patients on anti-tumor necrosis factor (anti-TNF) medications had the lowest probability of hospitalizations (overall 5-year probability in patients with IBD stratified by maximal therapeutic step: 5-aminosalicylic acids 37% [SD = 0.6%]; anti-TNFs 31% [SD = 1.8%]; P < 0.0001). Anti-TNFs were more commonly prescribed for patients with CD after 2010 (4% [SD = 0.2%] vs 16% [SD = 0.6%]; P < 0.0001) in the public health insurance plan, especially younger patients. Corticosteroid exposure was unchanged before and after 2010. Immunosuppressant use was low but increased after 2010. The use of 5-ASAs was stable in patients with UC but decreased in patients with CD. CONCLUSIONS The probability of first and second hospitalizations remained unchanged in Québec and the probability of major surgery was low overall but did increase despite the higher and earlier use of anti-TNFs.
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Affiliation(s)
- Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Jason Reinglas
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Janie Coulombe
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Maria Vutcovici
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Ernest G Seidman
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Paul Brassard
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Reinglas J, Gonczi L, Verdon C, Bessissow T, Afif W, Wild G, Seidman E, Bitton A, Lakatos PL. Low Rate of Drug Discontinuation, Frequent Need for Dose Adjustment, and No Association with Development of New Arthralgia in Patients Treated with Vedolizumab: Results from a Tertiary Referral IBD Center. Dig Dis Sci 2020; 65:2046-2053. [PMID: 31813132 DOI: 10.1007/s10620-019-05982-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Evaluating clinical data on the safety and efficacy of vedolizumab (VDZ) in 'real-world' setting is still desirable. Recent reports have raised concerns that arthralgia may be associated with VDZ. AIMS The aim of this study is to present clinical experience with VDZ from a tertiary IBD center. METHODS Retrospective chart reviews were performed of consecutive patients exposed to VDZ between 2015 and 2018. Clinical, biomarker, and endoscopic efficacy and safety data were evaluated. RESULTS A total of 130 IBD (75CD, 55UC) patients were included. Median duration of VDZ therapy was 65 weeks. Probability of drug discontinuation was 4.9% and 9.4% at 1 and 2 years. Dose intensification was more frequent in CD compared to UC (at 1 and 2 years: 64.8/87.9% vs. 26.5/35.7%, p < 0.001). Clinical remission rates at 3-, 6- and 12 months were 44.4%, 71.4% and 77.1% in UC, and 9.1%, 26.7% and 29.2% in CD patients, respectively. Prior use of multiple biologic agents was associated with diminished efficacy of VDZ in CD. Three new cases of arthralgia were encountered during follow-up. CONCLUSION Vedolizumab (VDZ) therapy displayed good drug sustainability and clinical efficacy in a population with severe disease phenotype and high rates of previous anti-TNF failure. Frequent dose intensification was required. The safety profile was good, and no association between newly onset arthralgia and VDZ therapy was observed.
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Affiliation(s)
- Jason Reinglas
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Christine Verdon
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Ernest Seidman
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. .,1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Verdon C, Vande Casteele N, Heron V, Germain P, Afif W. Comparison of Serum Concentrations of Ustekinumab Obtained by Three Commercial Assays in Patients with Crohn's Disease. J Can Assoc Gastroenterol 2020; 4:73-77. [PMID: 33855264 PMCID: PMC8023823 DOI: 10.1093/jcag/gwaa003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Data on the association of ustekinumab (UST) drug concentrations and clinical outcomes are conflicting. We assessed serum UST drug and anti-UST antibody concentrations using three commercially available assays. Methods Sixty-one blood samples were analyzed for serum UST drug and anti-UST antibody concentrations using three assays: one homogeneous mobility shift assay (HMSA, Prometheus, Assay A), and two enzyme-linked immunosorbent assays (ELISA; Progenika, Dynacare, Assay B and Theradiag, Assay C). Results The median (IQR) serum UST concentrations for the three assays were: Assay A 7.50 (5.35 to 12.88) µg/mL, Assay B 4.02 (2.46 to 6.95) µg/mL and Assay C 4.35 (2.62 to 7.50) µg/mL. A Kruskal-Wallis test confirmed a statistically significant difference between the different assays, X2(2) = 30.606, p < 0.001. Linear regression showed near twofold increased difference in the absolute drug concentrations between the HMSA and either ELISA. Linear quantitative correlation was observed for all three assays (r = 0.836 for A versus B, r = 0.792 for A versus C, r = 0.936 for B versus C; p < 0.01). The intraclass correlation coefficient (ICC) between assay A and B was 0.649 (95% confidence interval [CI] -0.208 to 0.874); assay A and C was 0.671 (95% CI -0.165 to 0.878); and assay B and C was 0.958 (95% CI 0.928 to 0.975); p < 0.001. No anti-UST antibodies were detected. Conclusion A good correlation was observed for serum UST drug concentrations and a good agreement was observed between the ELISA tests. However, agreement was poor between the HMSA and each ELISA tests. Clinical recommendations regarding drug concentrations should be based on assay type used.
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Affiliation(s)
- Christine Verdon
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Niels Vande Casteele
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Valérie Heron
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Pascale Germain
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Waqqas Afif
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Nene S, Gonczi L, Kurti Z, Morin I, Chavez K, Verdon C, Reinglas J, Kohen R, Bessissow T, Afif W, Wild G, Seidman E, Bitton A, Lakatos PL. Benefits of implementing a rapid access clinic in a high-volume inflammatory bowel disease center: Access, resource utilization and outcomes. World J Gastroenterol 2020; 26:759-769. [PMID: 32116423 PMCID: PMC7039829 DOI: 10.3748/wjg.v26.i7.759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/29/2019] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emergency situations in inflammatory bowel diseases (IBD) put significant burden on both the patient and the healthcare system.
AIM To prospectively measure Quality-of-Care indicators and resource utilization after the implementation of the new rapid access clinic service (RAC) at a tertiary IBD center.
METHODS Patient access, resource utilization and outcome parameters were collected from consecutive patients contacting the RAC between July 2017 and March 2019 in this observational study. For comparing resource utilization and healthcare costs, emergency department (ED) visits of IBD patients with no access to RAC services were evaluated between January 2018 and January 2019. Time to appointment, diagnostic methods, change in medical therapy, unplanned ED visits, hospitalizations and surgical admissions were calculated and compared.
RESULTS 488 patients (Crohn’s disease: 68.4%/ulcerative colitis: 31.6%) contacted the RAC with a valid medical reason. Median time to visit with an IBD specialist following the index contact was 2 d. Patients had objective clinical and laboratory assessment (C-reactive protein and fecal calprotectin in 91% and 73%). Fast-track colonoscopy/sigmoidoscopy was performed in 24.6% of the patients, while computed tomography/magnetic resonance imaging in only 8.1%. Medical therapy was changed in 54.4%. ED visits within 30 d following the RAC visit occurred in 8.8% (unplanned ED visit rate: 5.9%). Diagnostic procedures and resource utilization at the ED (n = 135 patients) were substantially different compared to RAC users: Abdominal computed tomography was more frequent (65.7%, P < 0.001), coupled with multiple specialist consults, more frequent hospital admission (P < 0.001), higher steroid initiation (P < 0.001). Average medical cost estimates of diagnostic procedures and services per patient was $403 CAD vs $1885 CAD comparing all RAC and ED visits.
CONCLUSION Implementation of a RAC improved patient care by facilitating easier access to IBD specific medical care, optimized resource utilization and helped avoiding ED visits and subsequent hospitalizations.
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Affiliation(s)
- Sofia Nene
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Isabelle Morin
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Kelly Chavez
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Jason Reinglas
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Rita Kohen
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Ernest Seidman
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Peter Laszlo Lakatos
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
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Verdon C, Bessissow T, Lakatos PL. Management of Acute Severe Colitis in the Era of Biologicals and Small Molecules. J Clin Med 2019; 8:jcm8122169. [PMID: 31817972 PMCID: PMC6947608 DOI: 10.3390/jcm8122169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022] Open
Abstract
Acute severe ulcerative colitis (ASUC) is a medical emergency which occurs in about 20%–30% of patients with ulcerative colitis during their lifetime, and does carry a mortality risk of 1%. The management of inflammatory bowel diseases has evolved with changes in objective patient monitoring, as well as the availability of new treatment options with the development of new biological and small molecules; however, data is limited regarding their use in the context of ASUC. This review aims to discuss the emerging data regarding biologicals and small molecules therapies in the context of ASUC.
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Affiliation(s)
- Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (C.V.); (T.B.)
- Department of Gastroenterology, Campbelltown Hospital, Sydney, NSW 2560, Australia
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (C.V.); (T.B.)
| | - Peter L. Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (C.V.); (T.B.)
- 1st Department of Medicine, Semmelweis University, Budapest H1083, Hungary
- Correspondence: ; Tel.: +514-934-1934 (ext. 45567)
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman E, Bitton A, Lakatos PL. High Adherence to Surveillance Guidelines in Inflammatory Bowel Disease Patients Results in Low Colorectal Cancer and Dysplasia Rates, While Rates of Dysplasia are Low Before the Suggested Onset of Surveillance. J Crohns Colitis 2019; 13:1343-1350. [PMID: 30918959 DOI: 10.1093/ecco-jcc/jjz066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with Crohn's disease [CD] and ulcerative colitis [UC] are at increased risk for colorectal dysplasia [CRD] and colorectal cancer [CRC]. Adherence to CRC surveillance guidelines is reportedly low internationally. AIM To evaluate surveillance practices at the tertiary IBD Center of the McGill University Health Center [MUHC] and to determine CRD/CRC incidence. METHODS A representative inflammatory bowel disease cohort with at least 8 years of disease duration [or with primary sclerosing cholangitis] who visited the MUHC between July 1 and December 31, 2016 were included. Adherence to surveillance guidelines was compared to modified 2010 British Society of Gastroenterology guidelines. Incidence rates of CRC, high-grade dysplasia [HGD], low-grade dysplasia [LGD] and colorectal adenomas [CRA] were calculated based on pathology. RESULTS In total, 1356 CD and UC patients (disease duration: 12 [interquartile range: 6-22) and 10 [interquartile range: 5-19] years) were identified. The surveillance cohort consisted of 680 patients [296 UC and 384 CD]. Adherence to surveillance guidelines was 76/82% in UC/colonic CD. An adequate number of biopsies were taken in 54/54% of UC/colonic CD patients. The incidence of CRC/HGD in UC and CD with colonic involvement was 19.5/58.5 and 25.1/37.6 per 100,000 patient-years, respectively. The incidence of dysplasia before 8 years of disease duration was low in both UC/CD [19.5 and 12.5/100,000 patient-years] with no CRC detected. The CRA rate was 30/38% in UC/colonic CD. CONCLUSION High adherence to surveillance guidelines and low CRC and dysplasia, but not CRA rates were found, suggesting that adhering to updated, stratified, surveillance recommendations may result in low advanced neoplasia rates. The incidence of dysplasia before the start of surveillance was low.
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Affiliation(s)
- Kelita Singh
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alex Al Khoury
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Jason Reinglas
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Christine Verdon
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Rita Kohen
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Talat Bessissow
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Waqqas Afif
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Gary Wild
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Ernest Seidman
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Alain Bitton
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal QC, Canada.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Gonczi L, Kurti Z, Verdon C, Reinglas J, Kohen R, Morin I, Chavez K, Bessissow T, Afif W, Wild G, Seidman E, Bitton A, Lakatos PL. Perceived Quality of Care is Associated with Disease Activity, Quality of Life, Work Productivity, and Gender, but not Disease Phenotype: A Prospective Study in a High-volume IBD Centre. J Crohns Colitis 2019; 13:1138-1147. [PMID: 30793162 DOI: 10.1093/ecco-jcc/jjz035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Measuring quality of care [QoC] in inflammatory bowel diseases [IBD] has become increasingly important, yet complex assessment of QoC from the patients' perspective is rare. We evaluated perceived QoC using the Quality of Care Through the Patient's Eyes-IBD [QUOTE-IBD] questionnaire, and investigated associations between QoC, disease phenotype, work productivity, and health-related quality of life [HRQoL] in a high-volume IBD centre. METHODS Consecutive patients attending McGill University Health Centre [MUHC]-IBD Centre completed the QUOTE-IBD, Short Inflammatory Bowel Disease Questionnaire [SIBDQ], IBD-Control, and Work Productivity and Activity Impairment [WPAI] questionnaires. The QUOTE-IBD comprises 23 questions, each rated by a quality impact [QI] score. QI scores were calculated for the evaluation of IBD specialists, general practitioners [GPs], and hospital care. RESULTS In all, 525 patients completed the questionnaire. Total QI scores for IBD specialists, GPs, and hospital care were 8.57, 8.70, and 8.33, respectively. The lowest QI scores were related to 'accessibility' for both IBD specialists and GPs. Female gender, current disease activity, poor HRQoL [SIBDQ score ≤50], and poor disease control [IBD-Control score <13] were associated with lower mean QI scores [p <0.001 for all]. Disease phenotype was not associated with QI scores in either Crohn's disease [CD] or ulcerative colitis [UC] [p = 0.69, p = 0.791, respectively]. An inverse correlation was found between total QI scores and work productivity loss [IBD specialist: p <0.001; GP: p = 0.004]. CONCLUSIONS Overall patient satisfaction with QoC was good; however, improving patient accessibility to care is warranted. Disease phenotype was not associated with patient satisfaction, whereas female gender, current disease activity, HRQoL, and work productivity loss were associated with patients' quality assessment, underlining that perceived QoC could be partly subjective regarding disease control and quality of life.
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Affiliation(s)
- Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Christine Verdon
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Jason Reinglas
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Rita Kohen
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Isabelle Morin
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Kelly Chavez
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Talat Bessissow
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Waqqas Afif
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Gary Wild
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Ernest Seidman
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Alain Bitton
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary.,Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
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Verdon C, Aruljothy A, Lakatos PL, Bessissow T. Endoscopic surveillance strategies for dysplasia in ulcerative colitis. Frontline Gastroenterol 2019; 11:124-132. [PMID: 32133111 PMCID: PMC7043085 DOI: 10.1136/flgastro-2018-101056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/11/2019] [Accepted: 03/17/2019] [Indexed: 02/04/2023] Open
Abstract
Ulcerative colitis (UC) is a chronic inflammatory bowel disorder with an increased risk of colorectal cancer (CRC). This has led to the implementation of surveillance programmes to minimise this risk. Overall, these proactive programmes in association with better medical therapies have reduced the incidence of CRC in this population. Specific populations remain at increased risk, such as younger age at diagnosis, primary sclerosing cholangitis, colonic strictures and pseudopolyps. The majority of gastrointestinal international societies favour chromoendoscopy with targeted biopsies or random biopsies. The aim of this review is to present the current literature on dysplasia surveillance, the methodology and endoscopic technology available to assess dysplasia in UC.
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Affiliation(s)
- Christine Verdon
- Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Achuthan Aruljothy
- Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Peter L Lakatos
- Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A134 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Singh
- McGill University Health Center, Montreal, QC, Canada
| | - A Al Khoury
- McGill University Health Center, Montreal, QC, Canada
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - J Reinglas
- McGill University Health Center, Montreal, QC, Canada
| | - C Verdon
- McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - P Lakatos
- McGill University Health Center, Montreal, QC, Canada
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14
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A76 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Singh
- McGill University, Montreal, QC, Canada
| | | | - Z Kurti
- Semmelweis University , Budapest, Hungary
| | - L Gonczi
- Semmelweis University , Budapest, Hungary
| | | | - C Verdon
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - R Kohen
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - E G Seidman
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - P Lakatos
- Gastroenterology, McGill University, Montreal, QC, Canada
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15
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Al Khoury A, Singh K, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A105 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - K Singh
- McGill University, Montreal, QC, Canada
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | | | - C Verdon
- McGill University, Montreal, QC, Canada
| | - R Kohen
- McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- McGill University, Montreal, QC, Canada
| | - E G Seidman
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - P Lakatos
- Gastroenterology, McGill University, Montreal, QC, Canada
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16
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Reinglas J, Restellini S, Gonczi L, Kurti Z, Verdon C, Nene S, Kohen R, Afif W, Bessissow T, Wild G, Seidman E, Bitton A, Lakatos PL. Harmonization of quality of care in an IBD center impacts disease outcomes: Importance of structure, process indicators and rapid access clinic. Dig Liver Dis 2019; 51:340-345. [PMID: 30591367 DOI: 10.1016/j.dld.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the quality of care at a tertiary inflammatory bowel disease (IBD) center using quality of care indicators (QIs) including patient assessment strategy, monitoring, treatment decisions and outcomes. METHODS We retrospectively reviewed the quality of care pre- and post-referral and during follow-up at the at the McGill University Health Center (MUHC) IBD center. Consecutive patients were included presenting with an outpatient visit ('index visit') between July and December 2016. Disease characteristics, biochemistry, imaging and endoscopy data, changes in medications, and vaccination profiles were captured. RESULTS 1357 patients were included. At referral, a large proportion of patients were objectively re-evaluated (ileocolonoscopy: 79%, cross-sectional imaging: 39.3%, biomarkers: 89.9%, 81.9%). Therapeutic strategy was changed in 53.6% with 22.5% of patients starting biologics. Tight objective patient monitoring was applied during follow-up (colonoscopy: 79%, cross-sectional imaging: 61.8% were available at index visit; C-reactive protein: 78%, Faecal calprotectin: 37.6%, therapeutic drug monitoring: 16.3% were performed additionally). Maximum therapeutic step was biologicals in 48.8% of the patients, while only 6.6% of all patients were steroid dependent. Implementation of a rapid access clinic improved healthcare delivery. CONCLUSIONS Our data support that tight monitoring was applied at the MUHC IBD center with a high emphasis on objective patient (re)evaluation, timely access and accelerated treatment strategy at referral and during follow-up.
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Affiliation(s)
- Jason Reinglas
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Sophie Restellini
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada; Division of Gastroenterology and Hepatology, Geneva's University Hospitals and University of Geneva, Switzerland
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Christine Verdon
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Sofia Nene
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Rita Kohen
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Waqqas Afif
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Talat Bessissow
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Gary Wild
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Ernest Seidman
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Alain Bitton
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Peter L Lakatos
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada; 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Ould-Chikh S, Pavan S, Fecant A, Trela E, Verdon C, Gallard A, Crozet N, Loubet JL, Hemati M, Rouleau L. Hierarchical porous catalyst support: shaping, mechanical strength and catalytic performances. Scientific Bases for the Preparation of Heterogeneous Catalysts - Proceedings of the 10th International Symposium, Louvain-la-Neuve, Belgium, July 11-15, 2010 2010. [DOI: 10.1016/s0167-2991(10)75024-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ninomiya T, Perkovic V, Verdon C, Barzi F, Cass A, Gallagher M, Jardine M, Anderson C, Chalmers J, Craig JC, Huxley R. Proteinuria and stroke: a meta-analysis of cohort studies. Am J Kidney Dis 2008; 53:417-25. [PMID: 19070947 DOI: 10.1053/j.ajkd.2008.08.032] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 08/29/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND The associations between decreased kidney function and cardiovascular disease recently have been established. However, there is uncertainty about the consistency between the independent associations of proteinuria as a risk factor across all cardiovascular end points. We undertook a meta-analysis of published cohort studies to provide a reliable estimate of the strength of association between proteinuria and risk of stroke. STUDY DESIGN Meta-analysis of observational cohort studies. SETTING & POPULATION General population of participants with diabetes. Studies were excluded if participants had known glomerular disease or had undergone dialysis or transplantation. SELECTION CRITERIA FOR STUDIES MEDLINE, EMBASE, and CINAHL databases were searched for studies that reported age- or multivariate-adjusted risk ratio with some estimate of the variance of the association between proteinuria and risk of stroke, without language restriction. FACTOR Proteinuria or albuminuria. OUTCOMES Fatal or nonfatal stroke. RESULTS Data from 10 published studies involving 140,231 participants and 3,266 strokes were eligible for inclusion. Participants with proteinuria had a 71% greater risk of stroke compared with those without proteinuria (95% confidence interval, 1.39 to 2.10). There was evidence of significant quantitative heterogeneity in the magnitude of the association across studies (I(2) = 60%; P for heterogeneity = 0.008), which was partially explained by differences in methods for measuring proteinuria. The risk of stroke remained significant after adjustment for other vascular risk factors. LIMITATIONS Because individual patient data were unavailable, we were unable to fully examine the impact of adjustment for known cardiovascular risk factors on the strength of the association between proteinuria and stroke risk. It is possible that the pooled estimate was affected by regression dilution bias. CONCLUSIONS These findings support the independent relationship between proteinuria and stroke. Additional studies are warranted to determine whether interventions to reduce proteinuria are effective at reducing rates of stroke.
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Affiliation(s)
- Toshiharu Ninomiya
- The George Institute for International Health, The University of Sydney, Sydney, Australia
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Perkovic V, Verdon C, Ninomiya T, Barzi F, Cass A, Patel A, Jardine M, Gallagher M, Turnbull F, Chalmers J, Craig J, Huxley R. The relationship between proteinuria and coronary risk: a systematic review and meta-analysis. PLoS Med 2008; 5:e207. [PMID: 18942886 PMCID: PMC2570419 DOI: 10.1371/journal.pmed.0050207] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 09/09/2008] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Markers of kidney dysfunction such as proteinuria or albuminuria have been reported to be associated with coronary heart disease, but the consistency and strength of any such relationship has not been clearly defined. This lack of clarity has led to great uncertainty as to how proteinuria should be treated in the assessment and management of cardiovascular risk. We therefore undertook a systematic review of published cohort studies aiming to provide a reliable estimate of the strength of association between proteinuria and coronary heart disease. METHODS AND FINDINGS A meta-analysis of cohort studies was conducted to obtain a summary estimate of the association between measures of proteinuria and coronary risk. MEDLINE and EMBASE were searched for studies reporting an age- or multivariate-adjusted estimate and standard error of the association between proteinuria and coronary heart disease. Studies were excluded if the majority of the study population had known glomerular disease or were the recipients of renal transplants. Two independent researchers extracted the estimates of association between proteinuria (total urinary protein >300 mg/d), microalbuminuria (urinary albumin 30-300 mg/d), macroalbuminuria (urinary albumin >300 mg/d), and risk of coronary disease from individual studies. These estimates were combined using a random-effects model. Sensitivity analyses were conducted to examine possible sources of heterogeneity in effect size. A total of 26 cohort studies were identified involving 169,949 individuals and 7,117 coronary events (27% fatal). The presence of proteinuria was associated with an approximate 50% increase in coronary risk (risk ratio 1.47, 95% confidence interval [CI] 1.23-1.74) after adjustment for known risk factors. For albuminuria, there was evidence of a dose-response relationship: individuals with microalbuminuria were at 50% greater risk of coronary heart disease (risk ratio 1.47, 95% CI 1.30-1.66) than those without; in those with macroalbuminuria the risk was more than doubled (risk ratio 2.17, 1.87-2.52). Sensitivity analysis indicated no important differences in prespecified subgroups. CONCLUSION These data confirm a strong and continuous association between proteinuria and subsequent risk of coronary heart disease, and suggest that proteinuria should be incorporated into the assessment of an individual's cardiovascular risk.
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Affiliation(s)
- Vlado Perkovic
- The George Institute for International Health, Sydney, New South Wales, Australia.
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Feusier G, Cutard T, Verdon C, Viatte T, Benoit W. High Temperature Properties of TiCN-Mo2C-Co Cermets Studied by Mechanical Spectroscopy. ACTA ACUST UNITED AC 1996. [DOI: 10.1051/jp4:19968163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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22
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Chaumette P, Verdon C, Boucot P. Influence of the hydrocarbons distribution on the heat produced during Fischer-Tropsch synthesis. Top Catal 1995. [DOI: 10.1007/bf01491974] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hayes KC, Stephan ZF, Pronczuk A, Lindsey S, Verdon C. Lactose protects against estrogen-induced pigment gallstones in hamsters fed nutritionally adequate purified diets. J Nutr 1989; 119:1726-36. [PMID: 2557406 DOI: 10.1093/jn/119.11.1726] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To evaluate the impact of dietary factors on gallstone induction in hamsters, male Syrian hamsters were fed for 2-8 wk purified diets that varied in type and amount of simple sugar (glucose vs. lactose, 17.5-72%), fat (2-5%), fiber (0-15%) and estrogen (0 or 300 micrograms/kg diet). Plasma and liver cholesterol and plasma triglycerides were measured, daily weight gain was determined, cecal weights were obtained, and gallbladder bile was scored by light microscopy and analyzed chemically for its lithogenicity and gallstone incidence. Lactose reduced plasma lipids, especially triglycerides, and hepatic cholesterol accumulation, and maintained a lower biliary cholesterol concentration. When fed at 30% or more, lactose reduced weight gain, increased cecal volume 2- to 4-fold and prevented gallstone formation. Diarrhea and death from 'wet tail' was associated with gallstones and was frequent in hamsters fed glucose without fiber, but its incidence was essentially eliminated by rice flour plus fiber or lactose. Under these experimental conditions of time and diet, estrogen supplementation was required for the formation of gallstones. These appeared to be pigment stones containing a minimal amount of cholesterol. In summary, pigment gallstones were induced in less than 8 wk in hamsters fed estrogen-supplemented purified diets. Lactose feeding improved lipid metabolism and reduced gallstone formation, apparently through its impact on large bowel metabolism.
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Affiliation(s)
- K C Hayes
- Foster Biomedical Research Laboratory, Brandeis University, Waltham, MA 02254
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