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Lim SH, Gros B, Sharma E, Lehmann A, Lindsay JO, Caulfield L, Gaya DR, Taylor J, Limdi J, Kwok J, Shuttleworth E, Dhar A, Burdge G, Selinger C, Cococcia S, Murray C, Balendran K, Raine T, George B, Walker G, Aldridge R, Irving P, Lees CW, Samaan M. Safety, Effectiveness, and Treatment Persistence of Subcutaneous Vedolizumab in IBD: A Multicenter Study From the United Kingdom. Inflamm Bowel Dis 2023:izad166. [PMID: 37603730 DOI: 10.1093/ibd/izad166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Indexed: 08/23/2023]
Abstract
BACKGROUND AND AIMS Despite intravenous (IV) vedolizumab being established for treatment of inflammatory bowel disease (IBD), the novel subcutaneous (SC) route of administration may provide numerous incentives to switch. However, large-scale real-world data regarding the long-term safety and effectiveness of this strategy are lacking. METHODS IBD patients on IV vedolizumab across 11 UK sites agreed to transition to SC injections or otherwise continued IV treatment. Data regarding clinical disease activity (Simple Clinical Colitis Activity Index, partial Mayo score, and modified Harvey-Bradshaw Index), biochemical markers (C-reactive protein and calprotectin), quality of life (IBD control), adverse events, treatment persistence, and disease-related outcomes (namely corticosteroid use, IBD-related hospitalization, and IBD-related surgery) were retrospectively collected from prospectively maintained clinical records at baseline and weeks 8, 24, and 52. RESULTS Data from 563 patients (187 [33.2%] Crohn's disease, 376 [66.8%] ulcerative colitis; 410 [72.8%] SC, 153 [27.2%] IV) demonstrated no differences in disease activity, remission rates, and quality of life between the SC and IV groups at all time points. Drug persistence at week 52 was similar (81.1% vs 81.2%; P = .98), as were rates of treatment alteration due to either active disease (12.2% vs 8.9%; P = .38) or adverse events (3.3% vs 6.3%; P = .41). At week 52, there were equivalent rates of adverse events (9.8% vs 7.8%; P = .572) and disease-related outcomes. IBD control scores were equivalent in both IV-IV and IV-SC groups. CONCLUSIONS Switching to SC vedolizumab appears as effective, safe, and well tolerated as continued IV treatment and maintains comparable disease control and quality of life as IV treatment at 52 weeks.
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Affiliation(s)
- Samuel Hsiang Lim
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Beatriz Gros
- Edinburgh IBD Unit, NHS Lothian, Edinburgh, United Kingdom
| | - Esha Sharma
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anouk Lehmann
- Department of Gastroenterology, Royal London Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - James O Lindsay
- Department of Gastroenterology, Royal London Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - Louise Caulfield
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jo Taylor
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Jimmy Limdi
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Jon Kwok
- Department of Gastroenterology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Elinor Shuttleworth
- Department of Gastroenterology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Anjan Dhar
- Department of Gastroenterology, Country Durham and Darlington NHS Foundation Trust, United Kingdom
| | - Gemma Burdge
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Christian Selinger
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sara Cococcia
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Charles Murray
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Karthiha Balendran
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Becky George
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Gareth Walker
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Robin Aldridge
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Peter Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Charlie W Lees
- Edinburgh IBD Unit, NHS Lothian, Edinburgh, United Kingdom
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Samaan
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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2
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Resál T, Bacsur P, Keresztes C, Bálint A, Bor R, Fábián A, Farkas B, Katsanos K, Michalopoylos G, Ribaldone DG, Attauabi M, Zhao M, Barak HA, Yanai H, Bezzio C, Rispo A, Castiglione F, Bar-Gil Shitrit A, Pugliese D, Armuzzi A, Savarino EV, Kolar M, Lukáš M, Chashkova E, Filip R, Rozieres A, Nancey S, Krznarić Ž, Schäfer E, Szamosi, Sarlós P, Franko M, Drobne D, Knyazev OV, Kagramanova AV, Limdi J, Wetwittayakhlang P, Lakatos PL, Maharshak N, Bannon L, Nyári T, Szepes Z, Farkas K, Molnár T. Real-Life Efficacy of Tofacitinib in Various Situations in Ulcerative Colitis: A Retrospective Worldwide Multicenter Collaborative Study. Inflamm Bowel Dis 2023:izad135. [PMID: 37542737 DOI: 10.1093/ibd/izad135] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND AIMS Tofacitinib (TFB) appears to be effective in the treatment of ulcerative colitis (UC); however, available real-world studies are limited by cohort size. TFB could be an option in the treatment of acute severe ulcerative colitis (ASUC). We aimed to investigate efficacy and safety of TFB in moderate-to-severe colitis and ASUC. METHODS This retrospective, international cohort study enrolling UC patients with ≥6-week follow-up period was conducted from February 1 to July 31, 2022. Indications were categorized as ASUC and chronic activity (CA). Baseline demographic and clinical data were obtained. Steroid-free remission (SFR), colectomy, and safety data were analyzed. RESULTS A total of 391 UC patients (median age 38 [interquartile range, 28-47] years; follow-up period 26 [interquartile range, 14-52] weeks) were included. A total of 27.1% received TFB in ASUC. SFR rates were 23.7% (ASUC: 26.0%, CA: 22.8%) at week 12 and 41.1% (ASUC: 34.2%, CA: 43.5%) at week 52. The baseline partial Mayo score (odds ratio [OR], 0.850; P = .006) was negatively associated with week 12 SFR, while biologic-naïve patients (OR, 2.078; P = .04) more likely achieved week 52 SFR. The colectomy rate at week 52 was higher in ASUC group (17.6% vs 5.7%; P < .001) and decreased with age (OR, 0.94; P = .013). A total of 67 adverse events were reported, and 17.9% resulted in cessation of TFB. One case of thromboembolic event was reported. CONCLUSIONS TFB is effective in both studied indications. TFB treatment resulted in high rates of SFR in the short and long terms. Higher baseline disease activity and previous biological therapies decreased efficacy. No new adverse event signals were found.
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Affiliation(s)
- Tamás Resál
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Bacsur
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csilla Keresztes
- Department for Medical Communication and Translation Studies, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Bernadett Farkas
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Kostas Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - George Michalopoylos
- Gastroenterology Department, General Hospital of Athens G. Gennimatas, Athens, Greece
| | | | - Mohamed Attauabi
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Mirabella Zhao
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Hadar Amir Barak
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Cristina Bezzio
- IBD Unit/Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Antonio Rispo
- IBD Unit Department, Clinical Medicine and Surgery, Azienda Ospedaliera Universitaria Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- IBD Unit Department, Clinical Medicine and Surgery, Azienda Ospedaliera Universitaria Federico II of Naples, Naples, Italy
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniela Pugliese
- IBD Center, Centro Malattie Apparato Digerente, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Martin Kolar
- IVth Medical Department, Charles University in Prague, Prague, Czech Republic
| | - Milan Lukáš
- IVth Medical Department, Charles University in Prague, Prague, Czech Republic
| | - Elena Chashkova
- Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - Rafał Filip
- Department of Gastroenterology with IBD, Unit of Clinical Hospital No. 2 im. Sw. Jadwigi Królowej, Rzeszow, Poland
| | - Aurore Rozieres
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche et Infectologie, INSERM U1111, Lyon, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche et Infectologie, INSERM U1111, Lyon, France
| | - Željko Krznarić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Nutrition, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eszter Schäfer
- Department of Gastroenterology, Military Hospital Medical Centre, State Health Centre, Budapest, Hungary
| | - Szamosi
- Department of Gastroenterology, Military Hospital Medical Centre, State Health Centre, Budapest, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Matej Franko
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Gastroenterology, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Oleg V Knyazev
- Moscow Clinical Scientific Center named after A. S. Loginov, Moscow, Russia
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Anna V Kagramanova
- Moscow Clinical Scientific Center named after A. S. Loginov, Moscow, Russia
- Research Institute of Health Organization and Medical Management, Moscow, Russia
| | - Jimmy Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - 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, Songkhla, Thailand
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Nitsan Maharshak
- National Medical Research Сenter of Coloproctology named after A. N. Ryzhykh, Moscow, Russia
| | - Lian Bannon
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tibor Nyári
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Darie AM, Sinopoulou V, Ajay V, Bel Kok K, Patel KV, Limdi J, Arebi N, Smith P, Din S, Din S, Shale M, Subramanian S, Pavlidis P, Cooney R, McGonagle D, A C S Wong N, Moran GW, Gordon M. BSG 2024 IBD guidelines protocol (standard operating procedures). BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001067. [PMID: 36764690 PMCID: PMC9923295 DOI: 10.1136/bmjgast-2022-001067] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION In the past 5 years, there have been several advances in the management of inflammatory bowel disease (IBD). We aim for a new guideline to update the most recent guideline published in 2019. We present the prospective operating procedure and technical summary protocol in the manuscript. METHODS 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) will be followed in the development of the guideline, approach as laid out in the GRADE handbook, supported by the WHO. The guideline development group is formed by a variety of disciplines, across both primary and secondary care that took part in an online Delphi process and split into key areas. A final consensus list of thematic questions within a 'patient, intervention, comparison, outcome' format has been produced and agreed in the final phase of the Delphi process.There will be a detailed technical evidence review with source data including systematic reviews appraised with AMSATAR 2 tool (Assessment of multiple systematic reviews), randomised controlled trial data that will be judged for risk of bias with the Cochrane tool and observational studies for safety concerns assessed through the Robins-I tool. Based on the available evidence, some of the recommendations will be based on GRADE while others will be best practice statements.A full Delphi process will be used to make recommendations using online response systems.This set of procedures has been approved by the Clinical Services and Standards Committee, the British Society of Gastroenterology executive board and aligned with IBD UK standards.
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Affiliation(s)
- Ana-Maria Darie
- Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Verma Ajay
- Digestive Disease, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jimmy Limdi
- Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Imperial College London, London, UK
| | - Philip Smith
- Gastroenterology, University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Shahida Din
- Gastroenterology, NHS Lothian Edinburgh, Western General Hospital, Clydebank, UK
| | - Said Din
- Gastroenterology, Derby Teaching Hospitals, NHS Foundation Trust, Derby, UK
| | - Matthew Shale
- Gastroenterology, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Sreedhar Subramanian
- Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Polychronis Pavlidis
- Gastroenterology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Dennis McGonagle
- Department of Rheumatology, Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Gordon W Moran
- Gastroenterology, NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals, Nottingham, UK
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
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Laube R, Liu E, Li Y, Leong RW, Limdi J, Selinger C. Gastroenterology team members' knowledge and practices with fertility therapy for women with inflammatory bowel disease. Therap Adv Gastroenterol 2022; 15:17562848221087543. [PMID: 35356361 PMCID: PMC8958717 DOI: 10.1177/17562848221087543] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/26/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Fecundity may be reduced in women with active inflammatory bowel disease (IBD) or prior IBD-related surgery, and these women may require assisted reproductive technology (ART). There are no guidelines for women with IBD to outline referral criteria for ART. METHODS We performed a prospective, multicentre, international questionnaire of gastroenterologists, gastroenterology trainees, and IBD nurses. The primary outcome was to establish clinical practices and fertility therapy referral patterns among gastroenterology team members. We hypothesised that the lack of knowledge and awareness may delay or prevent initiation of fertility consultation referrals. DISCUSSION Of 182 participants, most had never initiated a referral for fertility therapy (69.8%), and of respondents who do initiate referrals, 50% wait until the patient has been unsuccessfully attempting conception for 12 months. Participants were significantly more likely to initiate a fertility therapy referral if they believed ART was effective (p = 0.038), not impeded by IBD-related surgery (p = 0.053), and if they had access to a dedicated IBD-pregnancy clinic (p = 0.027). Superior pregnancy knowledge was predictive of a greater likelihood of fertility therapy referrals (p = 0.037). All participants thought they had inadequate knowledge about ART in IBD, and 96.2% expressed desire to improve their knowledge. CONCLUSION Gastroenterology team members infrequently initiate referrals for fertility therapy consultation in women with IBD, increasing their risk of remaining childless. Implementation of dedicated IBD pregnancy clinics and targeted education programmes to increase awareness of ART in women with IBD might increase referral rates and reduce infertility.
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Affiliation(s)
- Robyn Laube
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia,Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Eleanor Liu
- Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Ying Li
- Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rupert W. Leong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia,Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Jimmy Limdi
- Northern Care Alliance NHS Foundation Trust, Manchester, UK
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Ruiz-Casas L, Evans J, Rose A, Pedra GG, Lobo A, Finnegan A, Hayee B, Peyrin-Biroulet L, Sturm A, Burisch J, Terry H, Avedano L, Tucknott S, Fiorino G, Limdi J. Correction to: The LUCID study: living with ulcerative colitis; identifying the socioeconomic burden in Europe. BMC Gastroenterol 2021; 21:475. [PMID: 34911455 PMCID: PMC8675528 DOI: 10.1186/s12876-021-02062-3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Leonardo Ruiz-Casas
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Jonathan Evans
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK.
| | - Alison Rose
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Gabriel Ghizzi Pedra
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Alan Lobo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,The University of Sheffield, Sheffield, UK
| | | | - Bu Hayee
- King's College Hospital NHS Foundation Trust London, London, UK
| | | | | | | | - Helen Terry
- Crohn's and Colitis UK, Hatfield, Hertfordshire, UK
| | - Luisa Avedano
- European Federation of Crohn's and Ulcerative Colitis Associations, Brussels, Belgium
| | | | | | - Jimmy Limdi
- Pennine Acute Hospitals NHS Trust, Manchester, UK
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Ruiz-Casas L, Evans J, Rose A, Pedra GG, Lobo A, Finnegan A, Hayee B, Peyrin-Biroulet L, Sturm A, Burisch J, Terry H, Avendano L, Tucknott S, Fiorino G, Limdi J. The LUCID study: living with ulcerative colitis; identifying the socioeconomic burden in Europe. BMC Gastroenterol 2021; 21:456. [PMID: 34863112 PMCID: PMC8645093 DOI: 10.1186/s12876-021-02028-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ulcerative colitis (UC) is an inflammatory bowel disease with increasing prevalence worldwide. Current treatment strategies place considerable economic and humanistic burdens on patients. The aim of this study was to determine the socioeconomic burden of UC in adult patients in European countries in a real-world setting. METHODS In this retrospective, cross-sectional and observational pan-European study, patients with moderate or severe UC were assigned to ARM 1 and patients who had moderate or severe UC but achieved mild or remission status 12 months before index date (or clinical consultation date), were assigned to ARM 2. Clinical and medical resource use data were collected via electronic case report forms, and data on non-medical and indirect costs, and health-related quality of life (HRQoL) were collected via patient and public involvement and engagement (PPIE) questionnaires. Per-patient annual total costs per ARM and per country were calculated using the collated resource use in the last 12 months (between the start of the documentation period and patient consultation or index date) and country specific unit costs. Quality of life was described by arm and by country. RESULTS In the physician-reported eCRF population (n = 2966), the mean annual direct medical cost was €4065 in ARM 1 (n = 1835) and €2935 in ARM 2 (n = 1131). In the PPIE population (ARM 1, n = 1001; ARM 2, n = 647), mean annual direct cost was €4526 in ARM 1 and €3057 in ARM 2, mean annual direct non-medical cost was €1162 in ARM 1 and €1002 in ARM 2, mean annual indirect cost was €3098 in ARM 1 and €2309 ARM 2, and mean annual total cost was in €8787 in ARM 1 and €6368 in ARM 2. HRQoL scores showed moderate to high burden of UC in both groups. CONCLUSIONS The cost and HRQoL burden were high in patients in both ARM 1 and ARM 2 indicating unmet needs in the UC active population.
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Affiliation(s)
- Leonardo Ruiz-Casas
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Jonathan Evans
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Alison Rose
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Gabriel Ghizzi Pedra
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Alan Lobo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The University of Sheffield, Sheffield, UK
| | | | - Bu Hayee
- King’s College Hospital NHS Foundation Trust London, London, UK
| | | | | | | | - Helen Terry
- Crohn’s and Colitis UK, Hatfield, Hertfordshire, UK
| | - Luisa Avendano
- European Federation of Crohn’s and Ulcerative Colitis Associations, Brussels, Belgium
| | | | | | - Jimmy Limdi
- Pennine Acute Hospitals NHS Trust, Manchester, UK
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7
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O'Hagan P, Limdi J, Akbar A, Tucknott S, Kahol DN. Ulcerative colitis: understanding the impact of ulcerative colitis on everyday life and exploring the unmet needs of patients. Curr Med Res Opin 2021; 37:1901-1911. [PMID: 34420463 DOI: 10.1080/03007995.2021.1971180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is a life-long disease characterised by flare ups and periods of remission. This market research sponsored by Janssen-Cilag Ltd was designed to gain an understanding of the impact of UC from the patient's perspective and to establish the main unmet needs associated with it. METHODS The market research was conducted by telephone among 30 patients in the UK with a diagnosis of moderate to severe UC. RESULTS Delayed referral from primary care to secondary care was identified as the key unmet need. Hospital appointments were often unavailable for months and in some cases, it was 6 months before a procedure was performed. Specialists rarely involved the patient in discussions regarding diagnosis and initial treatment. Communications improved when treatment changes became necessary but gaps still existed particularly regarding the continued emotional impact of UC. All patients required treatment changes to regain or maintain control and the response to medications varied between patients. Patients who had transitioned through multiple treatments feared they would run out of options and therefore require surgery. The UC "journey" was highly individualized and patients experienced many emotional "ups and downs". CONCLUSIONS Healthcare bodies should aim to improve earlier referral to secondary care and waiting times for investigation need to be reduced significantly. Patients felt that specialists could support them in understanding their condition by discussing it with them immediately following diagnosis and by involving them in the development of their individual treatment plans. There is a need for more effective and better tolerated medications to expand the armamentarium and thus reduce the need for surgery.
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Affiliation(s)
| | - Jimmy Limdi
- Head - Section of Inflammatory Bowel Disease, Pennine Acute Hospitals NHS Trust, Manchester, UK
- Manchester Academic Health Sciences, Faculty of Biology, Medicine &Health, University of Manchester, Manchester, UK
| | - Ayesha Akbar
- St. Mark's Hospital and Academic Institute, Harrow, UK
| | | | - Durgesh Nandini Kahol
- Health Economics, Market Access & Reimbursement UK, Janssen-Cilag Ltd, High Wycombe, UK
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8
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Selinger CP, Fraser A, Collins P, Gunn M, Chew TS, Kerry G, Patel KV, Roysam M, Bel Kok K, Bancil A, Hall V, Cooney R, Smith L, Steed H, Segal J, Kent A, Limdi J, Sebastian S. Impact of the coronavirus infectious disease (COVID-19) pandemic on the provision of inflammatory bowel disease (IBD) antenatal care and outcomes of pregnancies in women with IBD. BMJ Open Gastroenterol 2021; 8:e000603. [PMID: 33753426 PMCID: PMC7985978 DOI: 10.1136/bmjgast-2021-000603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/08/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes. METHODS Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters. RESULTS We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded. CONCLUSION IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.
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Affiliation(s)
| | - Aileen Fraser
- Department of Gastroenterology, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Paul Collins
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Melanie Gunn
- Department of Gastroenterology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Thean Soon Chew
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Kerry
- Department of Gastroenterology, St Georges Hospital, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St Georges Hospital, London, UK
| | - Maya Roysam
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Aaron Bancil
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Veronica Hall
- Department of Gastroenterology, Bolton NHS Foundation Trust, Bolton, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Lyn Smith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Helen Steed
- Gastroenterology, University of Wolverhampton, Wolverhampton, UK
| | - Jonathan Segal
- Department of Gastroenterology, The Hillingdon Hospital, Uxbridge, UK
| | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jimmy Limdi
- Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
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9
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Crooks B, McLaughlin J, Limdi J. Dietary beliefs and recommendations in inflammatory bowel disease: a national survey of healthcare professionals in the UK. Frontline Gastroenterol 2020; 13:25-31. [PMID: 34966530 PMCID: PMC8666871 DOI: 10.1136/flgastro-2020-101723] [Citation(s) in RCA: 7] [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: 11/02/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The role of diet in inflammatory bowel disease (IBD) remains incompletely understood. Knowledge around the actual dietary advice healthcare professionals provide to individuals with IBD is scarce. Our objective was to describe the dietary beliefs of healthcare professionals and dietary recommendations made to people with IBD. METHODOLOGY An online survey regarding IBD-related dietary beliefs and advice provided to patients was distributed to gastroenterologists, dietitians and IBD nurses in the UK. RESULTS Two-hundred and twenty-three eligible healthcare professionals participated: 107 (48%) believed that diet was involved in IBD development. The most frequently implicated dietary components were processed foods (78%), additives/preservatives (71%), sweet/sugary foods (36%), red meat (36%) and fatty foods (31%). Views were broadly consistent across professions, however, gastroenterologists were significantly more likely to believe red meat and additives/preservatives initiated IBD. One hundred and thirteen participants (53%) believed that diet could trigger disease relapse and 128 (61%) recommended limiting specific foodstuffs to reduce this risk, most commonly high fibre foods. Forty-six (23%) considered recommending a low Fermentable Oligo-, Di- and Monosaccharides and Polyols diet to reduce relapse risk. IBD nurses and healthcare professionals with <5 years experience were most likely to recommend this. Dietitians felt most comfortable providing dietary advice for functional gastrointestinal symptoms in quiescent IBD. CONCLUSION Dietary advice in IBD is inconsistent reflecting uncertainty among healthcare professionals. While some consensus exists regarding dietary components implicated in IBD development and relapse, dietary recommendations varied. Future research is required to disentangle these complex relationships, alongside better training and education.
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Affiliation(s)
- Benjamin Crooks
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
- Section of IBD - Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust Gastroenterology, Manchester, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jimmy Limdi
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Section of IBD - Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust Gastroenterology, Manchester, UK
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10
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Wolloff S, Moore E, Glanville T, Limdi J, Kok KB, Fraser A, Kent A, Mulgabal K, Nelson-Piercy C, Selinger C. Provision of care for pregnant women with IBD in the UK: the current landscape. Frontline Gastroenterol 2020; 12:487-492. [PMID: 34712466 PMCID: PMC8515275 DOI: 10.1136/flgastro-2020-101546] [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: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Suboptimal control of inflammatory bowel disease (IBD) can result in increased rates of adverse pregnancy-related outcomes. We aimed to describe the current landscape of provision of antenatal care for women with IBD in the UK. METHODS This cross-sectional survey collected data on service setup; principles of care pre-conception, during pregnancy and post partum; and on perceived roles and responsibilities of relevant clinicians. RESULTS Data were provided for 97 IBD units. Prepregnancy counselling was offered mostly on request only (54%) and in an ad hoc manner. In 86% of units, IBD antenatal care was provided by the patient's usual gastroenterologist, rather than a gastroenterologist with expertise in pregnancy (14%). Combined clinics with obstetricians and gastroenterologists were offered in 14% of units (24% academic vs 7% district hospitals; p=0.043). Communication with obstetrics was 'as and when required' in 51% and 30% of IBD units reviewed pregnant women with IBD 'only when required'. The majority of respondents thought gastroenterologists should be involved in decisions regarding routine vaccinations (70%), breast feeding (80%), folic acid dosage (61%) and venous thromboembolism (VTE) prophylaxis (53%). Sixty-five per cent of respondents thought that gastroenterologists should be involved in decisions around mode of delivery and 30% recommended caesarean sections for previous but healed perianal disease. CONCLUSIONS This nationwide survey found considerable variation in IBD antenatal services. We identified deficiencies in service setup, care provided by IBD units and clinician knowledge. A basic framework to inform service setup, and better education on the available clinical guidance, is required to ensure consistent high-quality multidisciplinary care.
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Affiliation(s)
- Sarah Wolloff
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Moore
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tracey Glanville
- Department of Obstetrics, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Jimmy Limdi
- Section of IBD—Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Gastroenteterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Klaartje B Kok
- Department of Gastroenterology, Barts and The London NHS Trust, London, UK
| | - Aileen Fraser
- Department of Gastroenterology, United Hospitals Bristol, Bristol, UK
| | - Alexandra Kent
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Khasia Mulgabal
- Department of Obstetrics, Royal Bolton Foundation NHS Trust, Bolton, UK
| | | | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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11
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Snell A, Segal J, Limdi J, Banerjee R. Inflammatory bowel disease in India: challenges and opportunities. Frontline Gastroenterol 2020; 12:390-396. [PMID: 35401961 PMCID: PMC8988999 DOI: 10.1136/flgastro-2020-101500] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Evidence is emerging that inflammatory bowel diseases (IBDs) are becoming increasingly prevalent in developing countries, altering the previously held view that these were diseases of the West. Within this is a substantial increase in the burden of this disease in India, a matter of great importance to the country itself as well as in furthering our understanding of the disease. There is comparatively less data on this, both from the epidemiological standpoint as well as on disease pathogenesis in this particular cohort and is very much a subject matter of evolving understanding and research. This article aims to look at the changing global distribution of the disease and its implications. The Indian disease phenotype, and the aetiology of disease development will also be addressed with particular focus on differing pathogenetic processes in the Indian subpopulation, with consideration of what clues may be offered by the increasing incidence of the disease in this developing nation. Available evidence will be evaluated with the objective of providing a comprehensive overview of the development of IBD in India.
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Affiliation(s)
- Alice Snell
- Department of Gastroenterology, Northwick Park Hospital, London, UK
| | - Jonathan Segal
- Department of Gastroenterology, Saint Mary's Hospital Medical School, London, UK
| | - Jimmy Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK,Manchester Academic Health Science Centre, Manchester, UK
| | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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12
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Kennedy NA, Hansen R, Younge L, Mawdsley J, Beattie RM, Din S, Lamb CA, Smith PJ, Selinger C, Limdi J, Iqbal TH, Lobo A, Cooney R, Brain O, Gaya DR, Murray C, Pollok R, Kent A, Raine T, Bhala N, Lindsay JO, Irving PM, Lees CW, Sebastian S. Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic. Frontline Gastroenterol 2020; 11:343-350. [PMID: 32874484 PMCID: PMC7335699 DOI: 10.1136/flgastro-2020-101520] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 04/30/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services. METHODS Internet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020. RESULTS Respondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4-7.5 and median 3, IQR 2-4) to the point of survey (median 2, IQR 1-4.8 and median 2, IQR 1-3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery. CONCLUSIONS IBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.
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Affiliation(s)
- Nicholas A Kennedy
- Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Richard Hansen
- Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
| | - Lisa Younge
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - R Mark Beattie
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shahida Din
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - Christopher A Lamb
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Jimmy Limdi
- Section of IBD, Division of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Tariq H Iqbal
- Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alan Lobo
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Cooney
- Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel R Gaya
- Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Charles Murray
- Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Pollok
- Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Gastroenterology, St George's University of London, London, UK
| | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tim Raine
- Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - James O Lindsay
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
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13
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Selinger CP, Nelson-Piercy C, Fraser A, Hall V, Limdi J, Smith L, Smith M, Nasur R, Gunn M, King A, Mohan A, Mulgabal K, Kent A, Kok KB, Glanville T. IBD in pregnancy: recent advances, practical management. Frontline Gastroenterol 2020; 12:214-224. [PMID: 33912333 PMCID: PMC8040511 DOI: 10.1136/flgastro-2019-101371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 11/21/2019] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) poses complex issues in pregnancy, but with high-quality care excellent pregnancy outcomes are achievable. In this article, we review the current evidence and recommendations for pregnant women with IBD and aim to provide guidance for clinicians involved in their care. Many women with IBD have poor knowledge about pregnancy-related issues and a substantial minority remains voluntarily childless. Active IBD is associated with an increased risk of preterm birth, low for gestation weight and fetal loss. With the exception of methotrexate and tofacitinib the risk of a flare outweighs the risk of IBD medication and maintenance of remission from IBD should be the main of care. Most women with IBD will experience a normal pregnancy and can have a vaginal delivery. Active perianal Crohn's disease is an absolute and ileal pouch surgery a relative indication for a caesarean section. Breast feeding is beneficial to the infant and the risk from most IBD medications is negligible.
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Affiliation(s)
| | | | - Aileen Fraser
- Gastroenterology, United Hospitals Bristol, Bristol, Avon, UK
| | - Veronica Hall
- Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
| | - Jimmy Limdi
- Section of iBD- Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Lyn Smith
- Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
| | - Marie Smith
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Reem Nasur
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Melanie Gunn
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Andrew King
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Aarthi Mohan
- Obstetrics, United Hospitals Bristol, Bristol, Avon, UK
| | | | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
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14
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Selinger C, Carey N, Cassere S, Nelson-Piercy C, Fraser A, Hall V, Harding K, Limdi J, Smith L, Smith M, Gunn MC, Mohan A, Mulgabal K, Kent A, Kok KB, Glanville T. Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society. Frontline Gastroenterol 2020; 12:182-187. [PMID: 33912332 PMCID: PMC8040496 DOI: 10.1136/flgastro-2020-101459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/01/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD. AIM To develop a position statement on service set-up and minimum standards of care in the UK. METHODS A working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters' feedback after each round. Statements with ≥80% agreement were accepted. RESULTS All 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended. CONCLUSION Position statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.
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Affiliation(s)
- Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicola Carey
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Aileen Fraser
- Gastroenterology, United Hospitals Bristol, Bristol, UK
| | - Veronica Hall
- Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
| | - Kate Harding
- Obstetrics, Guy’s and Saint Thomas’ Hospitals NHS Trust, London, UK
| | - Jimmy Limdi
- Section of IBD—Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Lyn Smith
- Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
| | - Marie Smith
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Melanie Catherine Gunn
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aarthi Mohan
- Obstetrics, United Hospitals Bristol, Bristol, UK
| | | | - Alexandra Kent
- Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
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15
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Abstract
As the incidence of inflammatory bowel disease (IBD) rises and the global population ages, the number of older people living with these conditions will inevitably increase. The challenges posed by comorbid conditions, polypharmacy, the unintended consequences of long-term treatment and the real but often underestimated mismatch between chronological and biological ages underpin management. Significantly, there may be differences in disease characteristics, presentation and management of an older patient with IBD, together with other unique challenges. Importantly, clinical trials often exclude older patients, so treatment decisions are frequently pragmatic, extrapolated from a number of sources of evidence and perhaps primarily dictated by concerns around adverse effects. This review aimed to discuss the epidemiology, clinical features and considerations with management in older patients with IBD.
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Affiliation(s)
| | | | - Jimmy Limdi
- Section of IBD, Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Department of Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
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16
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Misra R, Limdi J, Cooney R, Sakuma S, Brookes M, Fogden E, Pattni S, Sharma N, Iqbal T, Munkholm P, Burisch J, Arebi N. Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study. World J Gastroenterol 2019; 25:6145-6157. [PMID: 31686769 PMCID: PMC6824277 DOI: 10.3748/wjg.v25.i40.6145] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/02/2019] [Revised: 08/01/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The current epidemiology of inflammatory bowel disease (IBD) in the multi-ethnic United Kingdom is unknown. The last incidence study in the United Kingdom was carried out over 20 years ago.
AIM To describe the incidence and phenotype of IBD and distribution within ethnic groups.
METHODS Adult patients (> 16 years) with newly diagnosed IBD (fulfilling Copenhagen diagnostic criteria) were prospectively recruited over one year in 5 urban catchment areas with high South Asian population. Patient demographics, ethnic codes, disease phenotype (Montreal classification), disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom database.
RESULTS Across a population of 2271406 adults, 339 adult patients were diagnosed with IBD over one year: 218 with ulcerative colitis (UC, 64.3%), 115 with Crohn's disease (CD, 33.9%) and 6 with IBD unclassified (1.8%). The crude incidence of IBD, UC and CD was 17.0/100000, 11.3/100000 and 5.3/100000 respectively. The age adjusted incidence of IBD and UC were significantly higher in the Indian group (25.2/100000 and 20.5/100000) compared to White European (14.9/100000, P = 0.009 and 8.2/100000, P < 0.001) and Pakistani groups (14.9/100000, P = 0.001 and 11.2/100000, P = 0.007). The Indian group were significantly more likely to have extensive disease than White Europeans (52.7% vs 41.7%, P = 0.031). There was no significant difference in time to diagnosis, disease activity and treatment.
CONCLUSION This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom population. The Indian ethnic group showed the highest age-adjusted incidence of UC (20.5/100000). Further studies on dietary, microbial and metabolic factors that might explain these findings in UC are underway.
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Affiliation(s)
- Ravi Misra
- Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
| | - Jimmy Limdi
- The Pennine Acute Hospitals NHS Trust, Institute of Inflammation and Repair, University of Manchester, Manchester BL9 7TD, United Kingdom
| | - Rachel Cooney
- Gastroenterology, University Hospitals Birmingham, Birmingham B12 2TH, United Kingdom
| | - Samia Sakuma
- Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
| | - Matthew Brookes
- Gastroenterology, Royal Wolverhampton NHS Trust, London WV10 0QP, United Kingdom
| | - Edward Fogden
- Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham B71 4HJ, United Kingdom
| | - Sanjeev Pattni
- Gastroenterology, University Leicester Hospitals, Leicester LE1 5WW, United Kingdom
| | - Naveen Sharma
- Gastroenterology, Heartlands Hospital, Birmingham B9 5SS, United Kingdom
| | - Tariq Iqbal
- Gastroenterology, University Hospitals Birmingham, Birmingham B12 2TH, United Kingdom
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund 3600, Denmark
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund 3600, Denmark
| | - Naila Arebi
- Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
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Sebastian S, Lisle J, Subramanian S, Dhar A, Shenoy A, Limdi J, Butterworth J, Allen PB, Samuel S, Moran G, Shenderey R, Parkes G, Raine T, Lobo AJ, Kennedy NA. Practice pattern variability in the management of acute severe colitis: a UK provider survey. Frontline Gastroenterol 2019; 11:272-279. [PMID: 32587670 PMCID: PMC7307042 DOI: 10.1136/flgastro-2019-101277] [Citation(s) in RCA: 5] [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: 06/09/2019] [Revised: 07/22/2019] [Accepted: 07/31/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Lack of comparative trial data on dosing regimens of infliximab in patients with acute severe ulcerative colitis (ASUC) failing intravenous corticosteroids has resulted in variability of rescue regimes in ASUC with potential impact on clinical outcomes. We aimed to evaluate practice variability and physician perspectives in decision-making with rescue therapy. METHODOLOGY An internet-based survey of members of the inflammatory bowel disease (IBD) section of the British Society of Gastroenterology was conducted. The survey evaluated provider characteristics and general practice in the setting of ASUC, followed by a vignette with linked questions. RESULTS The response rate of the survey was 31% (209/682 IBD section members). 134 (78%) reported they would use standard infliximab dose (5 mg/kg) while 37 (22%) favoured a higher front-loading dose of 10 mg/kg citing low albumin, high C-reactive protein as their reason for their preference. IBD specialists chose the higher front-loading dose more often compared with other gastroenterologists (p=0.01) In the specific case vignette, accelerated induction (AI) was favoured by 51% of the respondents while 25% used the standard induction regime and 19% favoured colectomy. IBD specialists more often favoured AI compared with other gastroenterologists (p=0.03) with the main reason being presence of predictors of low infliximab levels (74%). The reasons cited for favouring standard induction (n=57) included lack of evidence for AI (18), their usual practice (11), unlicensed regime (7), and safety concerns (4). CONCLUSIONS There are significant variations in practice in the use of infliximab rescue therapies with an urgent need for development of care pathways to standardise practice.
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Affiliation(s)
- Shaji Sebastian
- IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, Hull, UK
| | - Jessica Lisle
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Anjan Dhar
- Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Bishop Auckland, UK
| | - Achut Shenoy
- Department of Gastroenterology, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Jimmy Limdi
- Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Jeffrey Butterworth
- Department of Gastroenterology, Royal Shrewsbury Hospitals NHS Trust, Shrewsbury, UK
| | - Patrick B Allen
- department of Gastroenterology, Ulster Hospital, Dundonald, UK
| | - Sunil Samuel
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gordon Moran
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Richard Shenderey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | - Gareth Parkes
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Tim Raine
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge, UK
| | - Alan J Lobo
- Gastroenterology Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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18
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Kapasi R, Glatter J, Lamb CA, Acheson AG, Andrews C, Arnott ID, Barrett KJ, Bell G, Bhatnagar G, Bloom S, Brookes MJ, Brown SR, Burch N, Burman A, Crook K, Cummings JRF, Davies J, Demick A, Epstein J, Faiz O, Feakins R, Fletcher M, Garrick V, Jaffray B, Johnson M, Keetarut K, Limdi J, Meade U, Muhammed R, Murdock A, Posford N, Rowse G, Shaw I, St Clair Jones A, Taylor S, Weaver S, Younge L, Hawthorne AB. Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK. Frontline Gastroenterol 2019; 11:178-187. [PMID: 32419908 PMCID: PMC7223296 DOI: 10.1136/flgastro-2019-101260] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 05/10/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Symptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models. DESIGN Led by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi. RESULTS Consensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework. CONCLUSIONS The Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.
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Affiliation(s)
| | | | - Christopher A Lamb
- Newcastle University, Newcastle upon Tyne, UK,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | - Stuart Bloom
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew James Brookes
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK,University of Wolverhampton, Wolverhampton, UK
| | - Steven R Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicola Burch
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Andy Burman
- British Dietetic Association, Birmingham, UK
| | | | | | - Justin Davies
- Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Anne Demick
- Ileostomy & Internal Pouch Association, Essex, UK
| | - Jenny Epstein
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Omar Faiz
- St Mark's Hospital, Harrow, UK,Imperial College London, London, UK
| | - Roger Feakins
- Barts Health NHS Trust, London, UK,Queen Mary University of London, London, UK
| | | | | | - Bruce Jaffray
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK,Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Matthew Johnson
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Katie Keetarut
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jimmy Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Uchu Meade
- St Mark's Hospital, Harrow, UK,University of Hertfordshire, Hatfield, UK
| | - Rafeeq Muhammed
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Ian Shaw
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | | | - Stuart Taylor
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sean Weaver
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
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19
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Sturm A, Maaser C, Mendall M, Karagiannis D, Karatzas P, Ipenburg N, Sebastian S, Rizzello F, Limdi J, Katsanos K, Schmidt C, Jeuring S, Colombo F, Gionchetti P. European Crohn's and Colitis Organisation Topical Review on IBD in the Elderly. J Crohns Colitis 2017; 11:263-273. [PMID: 27797918 DOI: 10.1093/ecco-jcc/jjw188] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 09/01/2016] [Revised: 09/17/2016] [Accepted: 10/18/2016] [Indexed: 12/12/2022]
Abstract
This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focuses on the epidemiology, pathophysiology, diagnosis, management and outcome of the two most common forms of inflammatory bowel disease, Crohn's disease and ulcerative colitis, in elderly patients. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.
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Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend. Akademisches Lehrkrankenhaus der Charite, Spandauer Damm 130, 14050 Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology and Department of Geriatrics, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany
| | - Michael Mendall
- Croydon University Hospital, Mayday Road, CR4 7YE Thornton Heath; & St George's Medical School, Cranmer Terrace SW17 ORE, UK
| | - Dimitrios Karagiannis
- Department of Gastroenterology, Iatriko Kentro Athinon, Dervenakion St. 3, 14572 Athens, Greece
| | - Pantelis Karatzas
- Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilantou Street, 10676 Athens, Greece
| | - Nienke Ipenburg
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Shaji Sebastian
- IBD Unit, Hull & East Yorkshire NHS Trust, Anlaby Road, Hull HU3 2JZ, UK
| | - Fernando Rizzello
- IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, BO, Italy
| | - Jimmy Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester M8 5RB, Institute of Inflammation and Repair, Manchester Academic Health Sciences, University of Manchester, UK
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, PO Box 1186, 45110 Ioannina, Greece
| | - Carsten Schmidt
- Department of Internal Medicine IV, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Steven Jeuring
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Francesco Colombo
- Dipartimento di Area Chirurgica, Ospedale "Luigi Sacco"- Polo Universitario, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Paolo Gionchetti
- IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, BO, Italy
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Patkar D, Shah J, Prasad S, Patankar T, Gokhale S, Krishnan A, Limdi J. Giant rheumatoid synovial cyst of the hip joint: diagnosed by MRI. J Postgrad Med 1999; 45:118-9. [PMID: 10734350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Synovial cysts are commonly found in the knee joint. Hip Joint is an infrequent site for formation of synovial cysts. The features of a large, synovial cyst on magnetic resonance imaging, occurring in the hip joint, are described.
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Affiliation(s)
- D Patkar
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, India
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21
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Shah J, Patkar D, Patankar T, Krishnan A, Prasad S, Limdi J. Hallervorden Spatz disease: MR imaging. J Postgrad Med 1999; 45:114-7. [PMID: 10734349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Three patients were diagnosed as suffering from Hallervorden Spatz disease, a rare disorder, on the basis of their clinical and MRI findings.
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Affiliation(s)
- J Shah
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, India
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22
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Patkar D, Patankar T, Krishnan A, Prasad S, Shah J, Limdi J. MR imaging in children with ectopic pituitary gland and anterior hypopituitarism. J Postgrad Med 1999; 45:81-3. [PMID: 10734341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Posterior pituitary ectopia refers to an absent normal posterior pituitary bright spot within the sella with ectopic bright signal at another site (such as the median eminence) on a weighted magnetic resonance. We describe two children with idiopathic anterior hypopituitarism who showed an ectopic posterior pituitary and absent pituitary stalk on imaging. We emphasize the association of the absent pituitary stalk in ectopic pituitary gland and low growth hormone levels.
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Affiliation(s)
- D Patkar
- Department of Radiology, Dr Balabhai Nanavati Hospital, Mumbai, India
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Patkar D, Krishnan A, Patankar T, Prasad S, Shah J, Limdi J. Ruptured intracranial dermoids: magnetic resonance imaging. J Postgrad Med 1999; 45:49-52. [PMID: 10734333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Rupture of intracranial dermoids tumour is rare and carries with it the risk of significant morbidity as well as fatality. Three cases that presented with varying symptoms ranging from headache to chiasmatic compression and suspected to have rupture of dermoid tumour are described. The importance of MR imaging in their diagnosis is discussed.
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Affiliation(s)
- D Patkar
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, India
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Prasad S, Krishnan A, Limdi J, Patankar T. Imaging features of gossypiboma: report of two cases. J Postgrad Med 1999; 45:18-9. [PMID: 10734327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Recognition of postoperatively retained foreign body referred euphemistically as gossypiboma is essential but is very often considerably delayed. Legal implications as well as confusing configuration patterns cause considerable dilemma in the accurate diagnosis. We present computed tomographic features of gossypiboma in two patients who presented with symptoms of fever and pain in the immediate post-operative period. A prospective radiological diagnosis is essential for further management in these patients.
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Affiliation(s)
- S Prasad
- Department of Radiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
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25
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Shah J, Patkar D, Patankar T, Krishnan A, Prasad S, Limdi J. Pedunculated nasal glioma: MRI features and review of the literature. J Postgrad Med 1999; 45:15-7. [PMID: 10734326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Nasal gliomas are uncommon lesions, with approximately 100 cases reported in the literature. We present a case of intranasal glioma with a pedicle of glial tissue and defect in the cribriform plate of the ethmoid bone. Presence of such a pedicle is almost always present in the encephaloceles and is known to be distinctively uncommon in nasal gliomas.
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Affiliation(s)
- J Shah
- Department of Radiology, Dr Balabhai Nanavati Hospital, Vile Parle, Mumbai, India
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