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McMillan C, Li DK, Mohamed G, Alsadoun DA, Almohsen LA, Gaidos JKJ, Proctor DD, Al-Bawardy B. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohns Colitis 360 2024; 6:otae020. [PMID: 38585555 PMCID: PMC10998460 DOI: 10.1093/crocol/otae020] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Colonoscopy withdrawal time (CWT) of at least 6-9 minutes is the minimum time needed for adequate adenoma detection in the general population. The ideal CWT in patients with inflammatory bowel disease (IBD) has not been determined. We aimed to identify the optimal CWT associated with the detection of visible dysplasia in patients with IBD. Methods This is a retrospective study from 1/1/2017 to 9/1/2022 of adult patients with IBD in endoscopic healing undergoing surveillance via high-definition white light colonoscopy. The primary outcome was the association of CWT with visible dysplasia detection. Results A total of 259 patients (mean age 56 ± 14.8 years; 51.3% female, 68% with ulcerative colitis; 8.9% with primary sclerosing cholangitis) underwent 330 colonoscopies. Patients with visible dysplasia were more likely to be older (P < .001) and have a personal history of visible dysplasia (P < .001) and invisible dysplasia (P = .023). The mean CWT was significantly longer in the visible dysplasia group at 26 minutes (interquartile range [IQR] 20-38.5) vs. 21 minutes (IQR 15-28) in procedures without visible dysplasia (P < .001). On multivariable analysis, increased age (P < .001), increased CWT (P = .001), and personal history of visible dysplasia (P = .013) were independently associated with the detection of visible dysplasia. A CWT of ≥15 minutes (odds ratio [OR] 2.71; 95% confidence interval [CI], 1.11-6.6; P = .02] and not ≥9 minutes (OR 2.57; 95% CI, 0.33-20.2; P = .35) is significantly associated with detection of visible dysplasia. Conclusions For patients with IBD undergoing surveillance via high-definition white light colonoscopy, the mean CWT was independently associated with the detection of visible dysplasia.
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Affiliation(s)
| | - Darrick K Li
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Gamal Mohamed
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Danah A Alsadoun
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Leena A Almohsen
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Jill K J Gaidos
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Deborah D Proctor
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Badr Al-Bawardy
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Sahyoun LC, Fetene J, McMillan C, Protiva P, Al Bawardy B, Gaidos JKJ, Proctor D. Impact of COVID-19 Treatment on Real-World Outcomes in Inflammatory Bowel Disease. Dig Dis Sci 2024:10.1007/s10620-024-08355-3. [PMID: 38466459 DOI: 10.1007/s10620-024-08355-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND While there are multiple safe and effective agents for COVID-19 treatment, their impact in inflammatory bowel disease (IBD) remains uncertain. AIMS Our objective was to assess the effects of these therapies on both IBD and COVID outcomes. METHODS A single-center retrospective study of adult patients with IBD who contracted COVID-19 between 12/2020 and 11/2022 was performed. Patients were stratified by COVID-19 treatment (antivirals and/or intravenous antibodies) vs no therapy. The primary outcome was the development of severe COVID-19 infection, defined by need for supplemental oxygen, corticosteroids and/or antibiotics, or hospitalization. Secondary outcomes included rates of withholding advanced IBD therapy (defined as biologic agents or small molecules) and of post-COVID-19 IBD flare. RESULTS Of 127 patients with COVID-19 infection, 70% were on advanced therapies, 35% received COVID-19 treatment, and 15% developed severe COVID-19. Those treated for COVID-19 were more likely to be on corticosteroids [odds ratio (OR) 4.61, 95% confidence interval (CI) 1.72-12.39, p = 0.002] or advanced IBD therapies (OR 2.78, 95% CI 1.04-7.43, p = 0.041). After adjusting for age, race, sex, corticosteroid use, obesity, COVID-19 vaccination status, and severe COVID-19 infection, those treated for COVID-19 were more likely to have IBD therapy held (OR 6.95, 95% CI 1.72-28.15, p = 0.007). There was no significant difference in rates of post-COVID-19 IBD flares or severe COVID-19 infection. There were no COVID-related deaths. CONCLUSIONS Patients with IBD on advanced therapies were frequently treated for acute COVID-19. Although COVID-19 treatment was associated with temporary withholding of IBD therapy, it did not result in increased IBD flares.
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Affiliation(s)
- Laura C Sahyoun
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Fetene
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Chandler McMillan
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Petr Protiva
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
- VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Badr Al Bawardy
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jill K J Gaidos
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Deborah Proctor
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
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Al-Bawardy B, Malter L, Ehrlich AC, Rieder F, Gaidos JKJ, Proctor D, Windish DM. Assessment of Inflammatory Bowel Disease Training Among Gastroenterology Fellows. Inflamm Bowel Dis 2023; 29:1990-1992. [PMID: 36810663 DOI: 10.1093/ibd/izad030] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Indexed: 02/24/2023]
Abstract
Lay Summary
In this multicenter survey study, we found that many gastroenterology fellows lacked confidence and desired a “moderate to a lot more” training in important inflammatory bowel disease management domains.
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Affiliation(s)
- Badr Al-Bawardy
- Section of Digestive Disease, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Lisa Malter
- Department of Medicine, Division of Gastroenterology, New York University Langone Medical Center, NY, USA
| | - Adam C Ehrlich
- Section of Gastroenterology, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jill K J Gaidos
- Section of Digestive Disease, Yale School of Medicine, New Haven, CT, USA
| | - Deborah Proctor
- Section of Digestive Disease, Yale School of Medicine, New Haven, CT, USA
| | - Donna M Windish
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Hedrick TL, Sherman A, Cohen-Mekelburg S, Gaidos JKJ. AGA Clinical Practice Update on Management of Ostomies: Commentary. Clin Gastroenterol Hepatol 2023; 21:2473-2477. [PMID: 37498275 DOI: 10.1016/j.cgh.2023.04.035] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 07/28/2023]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to review the available evidence and provide expert advice regarding the management of patients with an enteral stoma. METHODS This CPU was commissioned and approved by the AGA Institute Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of a multidisciplinary group of authors composed of gastroenterologists, a colorectal surgeon, a wound ostomy and continence nurse, and ostomate.
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Affiliation(s)
- Traci L Hedrick
- Department of Surgery, University of Virginia Health, Charlottesville, Virginia.
| | - Alexis Sherman
- Department of Nursing, Mount Sinai Hospital, New York, New York
| | - Shirley Cohen-Mekelburg
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; VA Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Jill K J Gaidos
- Department of Medicine, Section of Digestive Diseases, Yale University, New Haven, Connecticut
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Gaidos JKJ, Al Bawardy B, Farraye FA, Regueiro M. Use of Standardized Inflammatory Bowel Disease Endoscopy Scores in Clinical Practice. Crohns Colitis 360 2023; 5:otad037. [PMID: 37559746 PMCID: PMC10407976 DOI: 10.1093/crocol/otad037] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Indexed: 08/11/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) treatment targets include mucosal healing based on standardized endoscopic scoring systems. The rates and ease of use of these scoring systems in practice have not been well described. We aimed to assess the rates and factors associated with the use of IBD endoscopic scoring systems in practice from IBD LIVE attendees. Methods IBD Live is an international case-based conference focusing on the management of patients with IBD. We created a web-based survey consisting of 38 questions on the frequency and ease of use of various IBD endoscopic scores. This survey was emailed to the IBD Live listserv in March 2022 with a second email sent 14 days later. We included only respondents who are currently performing endoscopy. Continuous variables were analyzed using an unpaired student's t-test. Categorical variables were analyzed using Pearson's chi-square test. Results There were 65 responses out of 170 (38.2% response rate) regular attendees. Eleven responses were excluded (4 with no response on the use of endoscopy scores, and 7 were not performing endoscopy). Of the respondents, 72.2% are from the United States, 70.4% are adult gastroenterologists, 53.9% in academic practice, and 40.7% in practice for ≥15 years. Of the endoscopy scores used ≥50% of the time, 74.1% were using the Mayo Endoscopic Subscore (MES), 72.3% using the Rutgeerts Score, 61.2% using the Simple Endoscopic Score for Crohn's Disease, and 28.6% using the Pouchitis Disease Activity Index. Attending IBD LIVE ≥ monthly (P = .028), attending an IBD conference at least every 2 years (P = .020), and having the scoring system incorporated into the endoscopy documentation software (P = .002) were associated with more consistent use of the MES. Attending IBD Live at least monthly (P = .026), having an IBD volume of ≥50% (P = .011), and attending an IBD conference at least every 2 years (P = .004) was associated with more frequent use of the Rutgeerts score. There were no factors that increased the use of other endoscopic scores. Conclusions The MES and the Rutgeerts score are more commonly used with much lower rates of use of endoscopic scores for Crohn's disease and pouchitis. The use of these endoscopy scores is more common among those who regularly attend IBD conferences, have higher volume IBD practices, and have these scoring systems incorporated into endoscopy software. Further evaluation of barriers to use and ways to improve utilization of endoscopic scoring for Crohn's disease and pouchitis is needed.
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Affiliation(s)
- Jill K J Gaidos
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Badr Al Bawardy
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology & Nutrition Cleveland Clinic, Cleveland, OH, USA
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6
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Sharma S, Li DK, Levine LJ, Chaar A, McMillan C, Gaidos JKJ, Proctor DD, Al-Bawardy B. Early Flexible Sigmoidoscopy Improves Clinical Outcomes in Acute Severe Ulcerative Colitis. Crohns Colitis 360 2023; 5:otad032. [PMID: 37323477 PMCID: PMC10263117 DOI: 10.1093/crocol/otad032] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives Guidelines recommend performing a flexible sigmoidoscopy in patients hospitalized with acute severe ulcerative colitis (ASUC). However, it is unclear if time to sigmoidoscopy affects relevant clinical outcomes. We aimed to assess the impact of early sigmoidoscopy on clinical outcomes using a well-characterized cohort of patients with ASUC. Methods This is a single-center, retrospective study of all patients hospitalized with ASUC from January 1, 2012 to November 1, 2021. Early sigmoidoscopy was defined as occurring within 72 hours of admission while delayed sigmoidoscopy was defined as occurring >72 hours after admission. Primary outcomes were cumulative days of intravenous (IV) corticosteroid (CS) use, length of hospital stay, and colectomy rates. Secondary outcomes were time to infliximab (IFX) rescue and inpatient opioid medication use. Results A total of 112 patients hospitalized with ASUC who underwent sigmoidoscopy were included in the analysis. Eighty-seven patients (78%) had early sigmoidoscopy and 25 (22%) had delayed sigmoidoscopy. Patients in the early sigmoidoscopy group were exposed to significantly fewer days of IV CS (4.5 vs 9.2 days; P < .001), had shorter hospital stays (6.4 vs 19.3 days; P < .001), and shorter time to IFX rescue (3.5 vs 6.4 days; P = .004). Rates of colectomy in the early and delayed sigmoidoscopy groups were 17% versus 28%, respectively (P = .23). Longer time to sigmoidoscopy was associated with a 16% increased risk of colectomy (HR = 1.16, P = .002). Conclusions In this well-characterized cohort, early sigmoidoscopy in ASUC was associated with favorable clinical outcomes. These findings highlight the benefits of early sigmoidoscopy in patients with ASUC. Larger prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Shreyak Sharma
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Darrick K Li
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louis J Levine
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Abdelkader Chaar
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Jill K J Gaidos
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Deborah D Proctor
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Badr Al-Bawardy
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Chugh R, Gaidos JKJ. Fertility and Pregnancy in Crohn's Disease. Gastroenterol Clin North Am 2022; 51:381-399. [PMID: 35595421 DOI: 10.1016/j.gtc.2021.12.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The prevalence of inflammatory bowel disease is continuing to increase worldwide and is more commonly diagnosed in women of reproductive age. Individuals with Crohn's disease may have inaccurate perceptions regarding the rate of infertility, heritability, and the safety of taking therapies for Crohn's disease during pregnancy, all of which greatly affect their decisions surrounding family planning. Given this area of need for both patients and providers, in this article, we have included the latest evidence on the impact of Crohn's disease on fertility, heritability, pregnancy outcomes, and the safety of medications for Crohn's disease during pregnancy and lactation.
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Affiliation(s)
- Rishika Chugh
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Gastroenterology, Department of Medicine, University of California San Francisco, 1701 Divisadero, San Francisco, CA 94115, USA
| | - Jill K J Gaidos
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Section of Digestive Diseases, Yale Inflammatory Bowel Disease Program, 40 Temple Street, Suite 1C, New Haven, CT 06510, USA.
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Levine LJ, Gaidos JKJ, Proctor DD, Viana AV, Al-Bawardy B. Effect of obesity on vedolizumab response in inflammatory bowel disease. Ann Gastroenterol 2022; 35:275-280. [PMID: 35599926 PMCID: PMC9062841 DOI: 10.20524/aog.2022.0699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/07/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Jill K. J. Gaidos
- Section of Digestive Diseases (Jill K. J. Gaidos, Deborah D. Proctor, Artur V. Viana, Badr Al-Bawardy), Yale School of Medicine, New Haven, CT, USA
| | - Deborah D. Proctor
- Section of Digestive Diseases (Jill K. J. Gaidos, Deborah D. Proctor, Artur V. Viana, Badr Al-Bawardy), Yale School of Medicine, New Haven, CT, USA
| | - Artur V. Viana
- Section of Digestive Diseases (Jill K. J. Gaidos, Deborah D. Proctor, Artur V. Viana, Badr Al-Bawardy), Yale School of Medicine, New Haven, CT, USA
| | - Badr Al-Bawardy
- Section of Digestive Diseases (Jill K. J. Gaidos, Deborah D. Proctor, Artur V. Viana, Badr Al-Bawardy), Yale School of Medicine, New Haven, CT, USA
- Correspondence to: Badr Al-Bawardy, MD, Assistant Professor of Medicine, Section of Digestive Diseases, 40 Temple Street, Suite 1A, New Haven, CT, 06510, USA, e-mail:
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Love BL, Finney CJ, Gaidos JKJ. Effectiveness of Conjugate and Polysaccharide Pneumococcal Vaccines for Prevention of Severe Pneumococcal Disease Among Inflammatory Bowel Disease Patients. J Crohns Colitis 2021; 15:1279-1283. [PMID: 33491047 DOI: 10.1093/ecco-jcc/jjab017] [Citation(s) in RCA: 3] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Streptococcus pneumoniae is an important pathogen responsible for severe pneumococcal diseases, including pneumonia, bacteraemia/sepsis, and meningitis. Inflammatory bowel disease [IBD] patients have an increased risk for infections due to an altered immune system and treatment with immunosuppressive medications. The aim of this study was to assess the prevalence of severe pneumococcal disease [SPD] and evaluate the impact of pneumococcal vaccination on the risk of SPD in Veterans with IBD. METHODS Subjects with IBD and SPD were identified from the VA Health Administration database using ICD9/10 codes. Pneumococcal vaccination and use of immunosuppressant medications were collected. Risk of SPD was evaluated using an adjusted Cox proportional hazards model controlling for demographics, medications, vaccination, and comorbidities. RESULTS A total of 1798 cases of SPD were identified [283 pneumonia, 1513 bacteraemia, and two meningitis]. SPD patients were older [60.9 years vs 59.4 years; p <0.001], had more comorbidities [Charlson Comorbidity Index of 2.11 vs 0.96; p <0.001], and had increased mortality [4.6% vs 1.5%, p <0.001]. The risk of SPD was increased in Crohn's disease (hazard ratio [HR] 1.15; 95% confidence interval [CI] 1.05-1.27) and with more comorbidities [HR 1.45; 95% CI 1.42-1.48]. Use of immunosuppressive medications increased the risk of SPD. Receipt of PCV13 either alone or in combination with PPSV23 predicted a 5-fold decreased risk of SPD compared with no vaccination. CONCLUSIONS Risk factors for severe pneumococcal disease include having Crohn's disease, more comorbidities, and exposure to combination immunosuppression. Vaccination with PCV13 alone or in combination with PPSV23 and revaccination with PPSV23, was protective against SPD. All IBD patients should be evaluated for pneumococcal vaccination, particularly those receiving or expected to receive immunosuppressive therapies.
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Affiliation(s)
- Bryan L Love
- Office of Research, William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Christopher J Finney
- Office of Research, William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
| | - Jill K J Gaidos
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
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Syal G, Serrano M, Jain A, Cohen BL, Rieder F, Stone C, Abraham B, Hudesman D, Malter L, McCabe R, Holubar S, Afzali A, Cheifetz AS, Gaidos JKJ, Moss AC. Health Maintenance Consensus for Adults With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1552-1563. [PMID: 34279600 PMCID: PMC8861367 DOI: 10.1093/ibd/izab155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the management of inflammatory bowel disease (IBD) becoming increasingly complex, incorporating preventive care health maintenance measures can be challenging. The aim of developing these updated recommendations is to provide more specific details to facilitate their use into a busy clinical practice setting. METHOD Fifteen statements were formulated with recommendations regarding the target, timing, and frequency of the health maintenance interventions in patients with IBD. We used a modified Delphi method and a literature review to establish a consensus among the panel of experts. The appropriateness of each health maintenance statement was rated on a scale of 1 to 5 (1-2 as inappropriate, and 4-5 as appropriate) by each panelist. Interventions were considered appropriate, and statements were accepted if ≥80% of the panelists agreed with a score ≥4. RESULTS The panel approved 15 health maintenance recommendations for adults with IBD based on the current literature and expert opinion. These recommendations include explicit details regarding specific screening tools, timing of screening, and vaccinations for adults with IBD. CONCLUSIONS Patients with IBD are at an increased risk for infections, malignancies, and other comorbidities. Given the complexity of caring for patients with IBD, this focused list of recommendations can be easily incorporated in to clinical care to help eliminate the gap in preventative care for patients with IBD.
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Affiliation(s)
- Gaurav Syal
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Animesh Jain
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Christian Stone
- Comprehensive Digestive Institute of Nevada, Las Vegas, Nevada, USA
| | | | - David Hudesman
- New York University Langone Medical Center, New York, New York, USA
| | - Lisa Malter
- NYU Grossman School of Medicine, Bellevue Hospital Center, New York, New York, USA
| | | | | | - Anita Afzali
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam S Cheifetz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Alan C Moss
- Boston University School of Medicine, Boston, Massachusetts, USA,Address correspondence to: Alan C. Moss, MD, MBBCh, BAO, Professor, Boston University School of Medicine, 830 Harrison Avenue, 2nd floor, Boston, MA, 02118, USA. E-mail:
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Affiliation(s)
- Jill K J Gaidos
- Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - David J Hass
- Department of Medicine, Yale University School of Medicine, Gastroenterology Center of Connecticut, A Division of PACT, LLC, Hamden, Connecticut
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Gaidos JKJ, Kane SV. Medication Adherence During Pregnancy in IBD: Compliance Avoids Complications. Dig Dis Sci 2021; 66:336-337. [PMID: 32323073 DOI: 10.1007/s10620-020-06271-w] [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: 12/09/2022]
Affiliation(s)
- Jill K J Gaidos
- Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - Sunanda V Kane
- Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Malter L, Jain A, Cohen BL, Gaidos JKJ, Axisa L, Butterfield L, Rescola BJ, Sarode S, Ehrlich O, Cheifetz AS. Identifying IBD Providers' Knowledge Gaps Using a Prospective Web-based Survey. Inflamm Bowel Dis 2020; 26:1445-1450. [PMID: 32100018 DOI: 10.1093/ibd/izaa032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND As treatments, management strategies, and the role of advanced practice providers (APPs) have evolved in recent years, the Crohn's & Colitis Foundation sought to understand the educational and resource needs of clinicians caring for patients with inflammatory bowel diseases (IBDs). The aim of this study was to describe the self-identified IBD knowledge and resource gaps of clinicians to inform the development of future programming. METHODS A survey containing 19 questions created by the foundation's Professional Education Committee, a subset of its National Scientific Advisory Committee, was conducted from September 7, 2018 to October 15, 2018. Responses were included from providers if they were currently seeing any IBD patients in a clinical setting. The foundation distributed the survey by email and various social media channels to encourage a diverse response. The survey included questions on comfort levels around diagnosis, treatment, and management of patients with IBD, in addition to preferences and utilization of educational resources. The × 2 test was used to evaluate significant differences among respondents in the various domains surveyed. RESULTS There were 197 eligible responses, of which 75% were from MD/Dos, followed by 25% APN/PA/RN/MSN/PhD/other; and 70% of respondents provide care for adult patients. The amount of time in practice was divided evenly among respondents. Fifty-seven percent of respondents practice in an academic/university setting, and approximately 75% indicated that ≥21% of their practice consisted of patients with IBD. Forty-four percent and 46% of respondents reported access to IBD based mental health providers and social workers in their practice, respectively. Seventy-two percent reported access to radiologists, 69% had access to dietitians, and 62% had access to advance practice providers. The areas of greatest educational need were prescribing medical cannabis (if approved locally) for pain management (62%); caring for patients with prior malignancy (35%); caring for pregnant patients and family planning (33%); caring for elderly patients (30%); and therapy decisions, including use of JAK inhibitors (29%), drug holidays (25%), and use of biosimilars (24%). More than 50% of respondents stated they do not participate in shared decision-making, citing time as the most common limiting factor. The majority of providers cited live education as their preferred learning format, and they wish to earn continuing medical education (CME) hours. CONCLUSION This survey helped identify current IBD educational needs in our professional community. With a rapidly changing treatment landscape and an increase in the diversity of providers delivering care, additional opportunities to keep abreast of practice changes are critical to providing comprehensive, quality care in IBD. Our survey demonstrated that shared decision-making is underutilized in practice due to a need for resources that aid in its efficient integration into practice. Based on our results, a focus on creating live learning opportunities that offer CME are needed in the areas of therapeutic decision-making and treating IBD in special subsets (eg, prior malignancy, pregnancy, elderly).
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Affiliation(s)
| | - Animesh Jain
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Jill K J Gaidos
- Virginia Commonwealth University, McGuire VA Medical Center, Richmond, VA
| | - Lisa Axisa
- Crohn's & Colitis Foundation, New York, NY
| | | | | | | | | | - Adam S Cheifetz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Feagins LA, Kim J, Chandrakumaran A, Gandle C, Naik KH, Cipher DJ, Hou JK, Yao MD, Gaidos JKJ. Rates of Adverse IBD-Related Outcomes for Patients With IBD and Concomitant Prostate Cancer Treated With Radiation Therapy. Inflamm Bowel Dis 2020; 26:728-733. [PMID: 31412114 DOI: 10.1093/ibd/izz175] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/15/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) may be at higher risk for complications from radiation treatment for prostate cancer. However, available data are limited, and controversy remains regarding the best treatment approach for IBD patients who develop prostate cancer. METHODS A retrospective cohort study across 4 Department of Veterans Affairs hospital systems. Patients with established IBD who were diagnosed and treated for prostate cancer between 1996-2015 were included. We assessed for flares of IBD, IBD-related hospitalizations, and IBD-related surgeries within 6, 12, and 24 months of cancer diagnosis and survival at 1, 2, and 5 years. Flares of IBD were those documented as such by the treating physician, and treatment changed accordingly. RESULTS One hundred patients with IBD and prostate cancer were identified. Forty-seven were treated with either treatment with external beam radiation or brachytherapy, and 53 were treated with nonradiation modalities. Comparing cohorts with or without radiation treatment, there were no differences in baseline IBD characteristics, Charlson comorbidity index, or prostate cancer stage. Inflammatory bowel disease flares were 2-fold higher for radiation-treated patients within 6 months (10.6% vs 5.7%) and 6-12 months (4.3% vs 1.9%) after cancer diagnosis. On multiple logistic regression analysis, radiation treatment (adjusted odds ratio, 4.82; 95% confidence interval, 1.15-20.26) was a significant predictor of flares. However, rates of IBD-related hospitalizations or surgeries were not significantly different. CONCLUSIONS In this retrospective, multicenter study, 2-fold higher rates of flare were found within the first year after prostate cancer diagnosis for patients treated with radiation, but there were no differences in IBD-related hospitalizations or surgeries. Although patients should be counseled of these risks, avoidance of radiation therapy in IBD patients with prostate cancer is likely not necessary.
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Affiliation(s)
- Linda A Feagins
- VA North Texas Health Care System, Dallas, Texas, USA.,The University of Texas at Austin, Dell Medical School, Austin, Texas, USA
| | - Jaehyun Kim
- VA North Texas Health Care System, Dallas, Texas, USA
| | | | - Cassandra Gandle
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | | | - Daisha J Cipher
- The College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Jason K Hou
- McGuire VA Medical Center and Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael D Yao
- Washington DC VA Medical Center, Washington, DC, USA
| | - Jill K J Gaidos
- McGuire VA Medical Center and Virginia Commonwealth University, Richmond, Virginia, USA
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Gaidos JKJ, Naik K, Dave J, Yao M, Hou JK, Cipher DJ, Smith AD, Feagins LA. High Prevalence of Male Sexual Dysfunction in a Prospective Multicenter VA Inflammatory Bowel Disease Population. Crohns Colitis 360 2020; 2:otaa004. [PMID: 36777954 PMCID: PMC9801960 DOI: 10.1093/crocol/otaa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
Background Aims of this study were to assess the prevalence of and risk factors for sexual dysfunction (SD) in male veterans with inflammatory bowel disease (IBD). Methods We collected IBD history, quality of life (QOL), and sexual function surveys. Results One hundred seventy-one men enrolled, mean age 50 years, 85% had SD, 92% had erectile dysfunction (ED). More severe ED (P = 0.0001), decreased sexual desire (P = 0.004), and decreased satisfaction (P = 0.001) were associated with poorer QOL. Biologic use was associated with increased SD; hypertension with a decrease in sexual desire. Conclusions SD and ED are highly prevalent and associated with poorer QOL.
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Affiliation(s)
- Jill K J Gaidos
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center and Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA,Address correspondence to: Jill K. J. Gaidos, MD, 1201 Broad Rock Boulevard, Richmond, VA 23249 ()
| | - Katrina Naik
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jenny Dave
- School of Medicine, George Washington University, Washington, District of Columbia, USA
| | - Michael Yao
- Division of Gastroenterology, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Jason K Hou
- Division of Gastroenterology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Daisha J Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Andrew D Smith
- Division of Gastroenterology, VA North Texas Health Care System, Dallas, Texas, USA
| | - Linda A Feagins
- Division of Gastroenterology and Hepatology, VA North Texas Health Care System and Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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Abstract
Many factors influence the sexual health of people with Crohn's disease, but active disease and depression play key roles. The fertility rate in nonoperated patients with inflammatory bowel disease with quiescent disease is similar to that in the general population. Crohn's disease can increase the risk for adverse pregnancy outcomes, but being in remission on a stable, steroid-free medication regimen for at least 3 months before conception and adhering to the treatment throughout pregnancy can improve outcomes. Infants with intrauterine exposure to anti-tumor necrosis factor medications should avoid live vaccines for the first 9 months or until drug concentrations are undetectable.
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Affiliation(s)
- Jill K J Gaidos
- GI/Hepatology Service, McGuire VA Medical Center, Virginia Commonwealth University, 111-N, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
| | - Sunanda V Kane
- Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Affiliation(s)
- Jill K J Gaidos
- McGuire VA Medical Center, GI/Hepatology Service (111-N), Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Michael Fuchs
- McGuire VA Medical Center, GI/Hepatology Service (111-N), Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA.
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Abstract
Inflammatory bowel disease (IBD) is frequently diagnosed before or during the peak reproductive years. Overall management of inflammatory bowel disease is becoming more complex given the nuances involved with multiple mechanisms of action of the current treatment and need for therapeutic monitoring for safety and efficacy; another layer of complexity is added in the setting of a pregnancy. In this review, we have identified several key challenges that health care providers face when caring for patients with IBD during pregnancy. The goal of this review is to provide the most up-to-date evidence and provide our expert recommendations so that providers can more comfortably address patients' questions about pregnancy in IBD and the associated risks as well as optimize their care to ensure the best outcomes possible.
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Affiliation(s)
- Jill K J Gaidos
- a McGuire VA Medical Center , Virginia Commonwealth University , Richmond , VA , USA
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19
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Williamson JB, Judah JR, Gaidos JKJ, Collins DP, Wagh MS, Chauhan SS, Zoeb S, Buscaglia JM, Yan H, Hou W, Draganov PV. Prospective evaluation of the long-term outcomes after deep small-bowel spiral enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc 2012; 76:771-8. [PMID: 22771101 DOI: 10.1016/j.gie.2012.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/16/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Spiral enteroscopy can be safe and effective in the short term for evaluation of obscure GI bleeding, but long-term data are lacking. OBJECTIVE To assess the long-term clinical outcomes after deep small-bowel spiral enteroscopy performed for obscure GI bleeding. DESIGN Prospective cohort study. SETTING Academic referral center. PATIENTS This study included 78 patients who underwent antegrade spiral enteroscopy for evaluation of obscure GI bleeding. INTERVENTION Diagnostic spiral enteroscopy with hemostatic therapeutic maneuvers applied as indicated. MAIN OUTCOME MEASUREMENTS Postprocedure evidence of recurrent overt GI bleeding, blood transfusion requirements, need for iron supplementation, serum hemoglobin values, and the need for additional therapeutic procedures. RESULTS Long-term follow-up data (mean [± standard deviation] 25.3 ± 7.5 months; range 12.9-38.8 months) were obtained in 61 patients (78%). Among those with long-term follow-up data, overt bleeding before spiral enteroscopy was present in 62%, compared with 26% in the follow-up period (P < .0001). The mean (± SD) hemoglobin value increased from 10.6 ± 1.8 to 12.6 ± 1.9 g/dL (P < .0001). Blood transfusion requirements decreased by a mean of 4.19 units per patient (P = .0002), and the need for iron supplementation (P = .0487) and additional procedures (P < .0001) decreased in the follow-up period. There were 8 adverse events (9%) (7 mild, 1 moderate). LIMITATIONS Single-center study, intervention bias. CONCLUSION In patients with obscure GI bleeding, deep small-bowel spiral enteroscopy is safe and effective in reducing the incidence of overt bleeding. An increase in hemoglobin values along with a decrease in blood transfusion requirement, need for iron supplementation, and need for additional therapeutic procedures were found over long-term follow-up. ( CLINICAL TRIAL REGISTRATION NUMBER NCT00861263.).
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Affiliation(s)
- J Blair Williamson
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is an increasingly prevalent clinical syndrome reflecting a mixture of pathological liver histology with the potential to progress to cryptogenic cirrhosis. Liver biopsy (LB) is the only way to determine the severity of disease. However, LB is invasive, has complications and financial costs. The aim of this study is to determine the benefits of early LB for diagnosis and early treatment. METHODS A decision tree model tracked the potential outcomes of NAFLD between an LB-directed approach vs. no initial LB. Each specific biopsy category determined subsequent care actions. The baseline probabilities were determined by literature review and expert opinion. RESULTS An initial LB strategy was projected to have a lower mortality compared with the no initial LB group and fewer transplant eligible patients after 5 years. If the prevalence of NAFLD is increased, the mortality increases in both the study groups. With improved efficacy of medical and/or surgical intervention, the mortality rate was decreased. CONCLUSION This decision tree model provides a context for balancing the risk and benefit of LB in NAFLD. With early biopsy, and early intervention, the relative return of preventing advanced liver disease per LB was high.
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Affiliation(s)
- Jill K J Gaidos
- Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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