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Hakim A, Feuerstein JD. In small-intestinal angiodysplasia with recurrent bleeding, thalidomide reduced bleeding episodes at 1 y. Ann Intern Med 2024; 177:JC32. [PMID: 38437700 DOI: 10.7326/j24-0005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
SOURCE CITATION Chen H, Wu S, Tang M, et al. Thalidomide for recurrent bleeding due to small-intestinal angiodysplasia. N Engl J Med. 2023;389:1649-1659. 37913505.
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Affiliation(s)
- Aaron Hakim
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA (A.H., J.D.F.)
| | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA (A.H., J.D.F.)
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2
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Anderson KL, Anand R, Feuerstein JD. Insurance Companies' Poor Adherence to Guidelines for Moderate to Severe Ulcerative Colitis/Crohn's Disease Management. Am J Gastroenterol 2024:00000434-990000000-01052. [PMID: 38417043 DOI: 10.14309/ajg.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/03/2023] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Moderate-to-severe IBD treatment transitioned from step-up therapy to induction of remission with a biologic agent, but insurance coverage varies. METHODS Top 50 insurance companies were searched for publicly available policies for 5 biologic/small molecule agents. Data regarding coverage requirements were compared to ACG/AGA guidelines. RESULTS Thirty-four insurers had public policies. Adherence to ACG/AGA guidelines ranged from 5.8-58.8%. Only 14.71% and 17.65% of policies permitted any first-line biologic therapy in CD and in UC. DISCUSSION Nearly every insurance company required failure of steroids and immunomodulators before biologic therapy. Further work is required to improve patient access to standard of care treatment.
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Affiliation(s)
- Kelsey L Anderson
- Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston MA
| | - Rajsavi Anand
- Department of Gastroenterology, Cedars Sinai Medical Center, Los Angeles CA
| | - Joseph D Feuerstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston MA
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3
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Sofia MA, Feuerstein JD, Narramore L, Chachu KA, Streett S. White Paper AGA: American Gastroenterological Association Position Statement: The Future of IBD Care in the United States-Removing Barriers and Embracing Opportunities. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00204-0. [PMID: 38428707 DOI: 10.1016/j.cgh.2024.01.050] [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: 09/19/2023] [Revised: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 03/03/2024]
Abstract
Despite incredible growth in systems of care and rapidly expanding therapeutic options for people with inflammatory bowel disease, there are significant barriers that prevent patients from benefiting from these advances. These barriers include restrictions in the form of prior authorization, step therapy, and prescription drug coverage. Furthermore, inadequate use of multidisciplinary care and inflammatory bowel disease specialists limits patient access to high-quality care, particularly for medically vulnerable populations. However, there are opportunities to improve access to high-quality, patient-centered care. This position statement outlines the policy and advocacy goals that the American Gastroenterological Association will prioritize for collaborative efforts with patients, providers, and payors.
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Affiliation(s)
- M Anthony Sofia
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland Oregon.
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Karen A Chachu
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina
| | - Sarah Streett
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California
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4
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Hakim A, Fricker ZP, Feuerstein JD, Farber HW, Schoenberg NC. Recurrent Gastrointestinal Bleeding in a Patient With Pulmonary Arterial Hypertension Treated With Sotatercept. Ann Intern Med 2024; 177:115-117. [PMID: 38163372 DOI: 10.7326/l23-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Aaron Hakim
- Department of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston; and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zachary P Fricker
- Department of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph D Feuerstein
- Department of Medicine and Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Harrison W Farber
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Noah C Schoenberg
- Department of Medicine and Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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5
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Dong J, Said H, Miller SJ, Systrom HK, Feuerstein JD. Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening. J Clin Gastroenterol 2023:00004836-990000000-00237. [PMID: 38019086 DOI: 10.1097/mcg.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/18/2023] [Accepted: 10/19/2023] [Indexed: 11/30/2023]
Abstract
GOALS The aim was to assess patient adherence to multitarget stool DNA testing as well as factors associated with adherence. BACKGROUND In the United States, disparities in colorectal cancer screening exist along racial and socioeconomic lines. While some studies suggest that stool-based screening tests may help reduce the screening gap, the data for multitarget stool DNA testing is unclear. STUDY We conducted a single-center retrospective cohort study on multitarget stool DNA testing ordered between April 2020 and July 2021. We calculated the proportion of patients who completed testing and used multivariate logistic regression to identify covariates associated with test adherence. RESULTS Among 797 patients ordered for multitarget stool DNA testing, 481 patients (60.4%) completed testing. Adherence rates by patient subgroups ranged from 35.8% to 78.1%. Higher test adherence was found in Asian patients (odds ratio 2.65, 95% CI 1.36-5.18) and those who previously completed colorectal cancer screening (OR 1.45, 95% CI 1.01-2.09), while Black patients (OR 0.58, 95% CI 0.39-0.87), patients with resident primary care physicians (OR 0.34, 95% CI 0.21-0.56), and patients contacted through an outreach program (OR 0.47, 95% CI 0.25-0.87) had lower adherence. CONCLUSIONS A significant proportion of patients ordered for multitarget stool DNA testing did not complete testing. Differences in adherence rates among patient subgroups may be reflective of underlying disparities in health care access.
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Affiliation(s)
- Jeffrey Dong
- Department of Medicine, Beth Israel Deaconess Medical Center
| | - Hyder Said
- Department of Medicine, Beth Israel Deaconess Medical Center
| | - Samuel J Miller
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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6
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Zuberi SA, Burdine L, Dong J, Feuerstein JD. Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines. J Clin Gastroenterol 2023:00004836-990000000-00232. [PMID: 38019081 DOI: 10.1097/mcg.0000000000001940] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND/AIMS Clinical guidelines should ideally be formulated from data representative of the population they are applicable to; however, historically, studies have disproportionally enrolled non-Hispanic White (NHW) patients, leading to potential inequities in care for minority groups. Our study aims to evaluate the extent to which racial minorities were represented in the United States Colorectal Cancer Surveillance Guidelines. METHODS We reviewed US guidelines between 1997 and 2020 and all identified studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps, and hyperplastic polyps. We analyzed the proportion of studies reporting race, and among these studies, we calculated the racial distribution of patients and compared the proportion of Non-NHW patients between each subtype. RESULTS For all guidelines, we reviewed 75 studies encompassing 9,309,955 patients. Race was reported in 24% of studies and 14% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for adenomas, 22% for sessile serrated polyps, and 15% for hyperplastic polyps. For the 2020 guidelines, we reviewed 33 studies encompassing 5,930,722 patients. Race was reported in 15% of studies and 21% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for tubular adenomas. Race was not cited for any other 2020 guideline. CONCLUSION Racial minorities are significantly underrepresented in US Colorectal Cancer Surveillance Guidelines, which may contribute to disparities in care. Future studies should prioritize enrolling a diverse patient population to provide data that accurately reflects their population.
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Affiliation(s)
| | | | | | - Joseph D Feuerstein
- Department of Internal Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
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El-Dallal M, Anderson KL, Saroufim A, Wang LF, Systrom HK, Hoque A, Pasam RT, Osman KT, Chaudrey K, Feuerstein JD. Patients' perspectives on marijuana use for inflammatory bowel disease: a multicenter survey. Ann Gastroenterol 2023; 36:624-629. [PMID: 38023973 PMCID: PMC10662070 DOI: 10.20524/aog.2023.0829] [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: 04/25/2023] [Accepted: 07/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background As marijuana use is rising among patients with inflammatory bowel disease (IBD), so is interest in its potential use as a therapeutic agent. We sought to survey IBD patients regarding marijuana use, self-reported impact on IBD symptoms, and perceptions of safety. Methods A multicenter anonymous survey was administered to patients with IBD between October 2020 and June 2021. The 70-question survey collected demographic variables, clinical variables, attitudes about marijuana, and perceptions of its safety and efficacy in IBD. Participants were classified by their marijuana use: "rarely/never," "current," and "former". Percentage and chi-square tests were used to compare categorical variables between the 3 groups, and means and 2-group ANOVA were used for continuous variables. Results Of 181 patients surveyed, 166 were eligible for the study. Of these, 70 (42.2%) participants were rare/never marijuana users, 44 (26.5%) were current users, and 52 (31.3%) were former users. Fifty-three percent thought marijuana would help with IBD inflammation and 80% thought it would help with IBD pain. Over 70% of patients from all groups thought marijuana had a low-to-moderate risk of harm, and 69.6% of the participants who never or rarely used marijuana thought marijuana was addictive, compared to 20.5% of the current users and 44% of the former marijuana users. Conclusions While many patients thought marijuana use helps with IBD-related pain and inflammation, many expressed concerns about addiction to marijuana and a possible risk of harm. Further studies are needed to examine the benefit and harm of marijuana in IBD.
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Affiliation(s)
- Mohammed El-Dallal
- Division of Gastroenterology, Marshall University School of Medicine, Huntington, WV (Mohammed El-Dallal)
| | - Kelsey L. Anderson
- Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA (Kelsey L. Anderson, Linda F. Wang, Hannah K. Systrom)
| | - Ariana Saroufim
- Boston University, School of Medicine, Boston, MA (Ariana Saroufim)
| | - Linda F. Wang
- Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA (Kelsey L. Anderson, Linda F. Wang, Hannah K. Systrom)
| | - Hannah K. Systrom
- Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA (Kelsey L. Anderson, Linda F. Wang, Hannah K. Systrom)
| | - Asahi Hoque
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA (Asahi Hoque, Ravi Teja Pasam, Karim Tarek Osman)
| | - Ravi Teja Pasam
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA (Asahi Hoque, Ravi Teja Pasam, Karim Tarek Osman)
| | - Karim Tarek Osman
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA (Asahi Hoque, Ravi Teja Pasam, Karim Tarek Osman)
| | - Khadija Chaudrey
- Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, MA (Khadija Chaudrey)
| | - Joseph D. Feuerstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA (Joseph D. Feuerstein), USA
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Trivedi HD, Lopes EW, Glissen Brown J, Dudani S, Lai M, Feuerstein JD, Pierce TT. Steroid Use and Risk of Nonalcoholic Fatty Liver Disease in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-analysis. J Clin Gastroenterol 2023; 57:610-616. [PMID: 35648974 DOI: 10.1097/mcg.0000000000001727] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/03/2022] [Indexed: 12/10/2022]
Abstract
GOALS We sought to evaluate the association of steroids with nonalcoholic fatty liver disease (NAFLD) among patients with inflammatory bowel disease (IBD). BACKGROUND Patients with IBD are at increased risk of NAFLD. Steroids may have a role in the pathogenesis of NAFLD. STUDY We searched MEDLINE (through PubMed) and Embase for studies from inception to July 2021. We included published interventional and observational studies of adults 18 years or older with ulcerative colitis or Crohn's disease. We reported odds ratios, 95% confidence intervals, and generated forest plots. A random effects model generated a summary effect estimate. Publication bias was assessed by funnel plot and Egger's test. Study quality was examined using modified Newcastle-Ottawa scale (NOS) and Agency for Healthcare Research and Quality (AHRQ). RESULTS A total of 12 observational studies with 3497 participants were included. NAFLD was identified in 1017 (29.1%) patients. The pooled odds ratio for the development of NAFLD in steroid users versus non-users was 0.87 (95% confidence interval: 0.72-1.04). There was no significant heterogeneity between studies ( I ²=0.00%, P =0.13). No publication bias was detected by funnel plot or Egger's test ( P =0.24). Findings were consistent among subgroup analyses stratified by study quality. CONCLUSION In this meta-analysis, steroids were not associated with NAFLD in patients with IBD. Steroids may not need to be withheld from patients with IBD for the purposes of preventing NAFLD. Additional prospective studies that systematically document steroid exposure and important confounders among patients with IBD are warranted.
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Affiliation(s)
- Hirsh D Trivedi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Emily W Lopes
- Division of Gastroenterology
- Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jeremy Glissen Brown
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Shaan Dudani
- The Ottawa Hospital Cancer Center/University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Lai
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Joseph D Feuerstein
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School
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Taneja V, Anand RS, El-Dallal M, Dong J, Desai N, Taneja I, Feuerstein JD. Safety of Biologic and Small Molecule Therapy for Inflammatory Bowel Disease Among Solid Organ Transplant Recipients: Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2023:7193726. [PMID: 37300512 DOI: 10.1093/ibd/izad108] [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: 11/18/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patients undergoing organ transplantation are often on immunosuppressing medications to prevent rejection of the transplant. The data on use of concomitant immunosuppression for inflammatory bowel disease (IBD) and organ transplant management are limited. This study sought to evaluate the safety of biologic and small molecule therapy for the treatment of IBD among solid organ transplant recipients. METHODS Medline, Embase, and Web of Science databases were systematically searched for studies reporting on safety outcomes associated with the use of biologic and small molecule therapy (infliximab, adalimumab, certolizumab, golimumab, vedolizumab, ustekinumab, and tofacitinib) in patients with IBD postsolid organ transplant (eg, liver, kidney, heart, lung, pancreas). The primary outcome was infectious complications. Secondary outcomes included serious infections, colectomy, and discontinuation of biologic therapy. RESULTS Seven hundred ninety-seven articles were identified for screening, yielding 16 articles for the meta-analyses with information on 163 patients. Antitumor necrosis factor α (Anti-TNFs; infliximab and adalimumab) were used in 8 studies, vedolizumab in 6 studies, and a combination of ustekinumab or vedolizumab and anti-TNFs in 2 studies. Two studies reported outcomes after kidney and cardiac transplant respectively, whereas the rest of the studies included patients with liver transplants. The rates of all infections and serious infections were 20.09 per 100 person-years (100-PY; 95% CI, 12.23-32.99 per 100-PY, I2 = 54%) and 17.39 per 100-PY (95% CI, 11.73-25.78 per 100-PY, I2 = 21%), respectively. The rates of colectomy and biologic medication discontinuation were 12.62 per 100-PY (95% CI, 6.34-25.11 per 100-PY, I2 = 34%) and 19.68 per 100-PY (95% CI, 9.97-38.84 per 100-PY, I2 = 74%), respectively. No cases of venous thromboembolism or death attributable to biologic use were reported. CONCLUSION Biologic therapy is overall well tolerated in patients with solid organ transplant. Long-term studies are needed to better define the role of specific agents in this patient population.
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Affiliation(s)
- Vikas Taneja
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rajsavi S Anand
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammed El-Dallal
- *Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Dong
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nisa Desai
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Isha Taneja
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
SOURCE CITATION Qian HS, Li WJ, Dang YN, et al. Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy. Am J Gastroenterol. 2023;118:627-634. 36729890.
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Affiliation(s)
- Duncan J Flynn
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (D.J.F., J.D.F.)
| | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (D.J.F., J.D.F.)
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11
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Weissman S, Aziz M, Bangolo AI, Ehrlich D, Forlemu A, Willie A, Gangwani MK, Waqar D, Terefe H, Singh A, Gonzalez DMC, Sajja J, Emiroglu FL, Dinko N, Mohamed A, Fallorina MA, Kosoy D, Shenoy A, Nanavati A, Feuerstein JD, Tabibian JH. Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding: A nationwide analysis. World J Gastrointest Endosc 2023; 15:285-296. [PMID: 37138938 PMCID: PMC10150287 DOI: 10.4253/wjge.v15.i4.285] [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: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The optimal timing of esophagogastroduodenoscopy (EGD) and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding (NVUGIB) remains an area of active research.
AIM To identify independent predictors of outcomes in patients with NVUGIB, with a particular focus on EGD timing, anticoagulation (AC) status, and demographic features.
METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database. Patients were stratified by EGD timing relative to hospital admission (≤ 24 h, 24-48 h, 48-72 h, and > 72 h) and then by AC status (yes/no). The primary outcome was all-cause inpatient mortality. Secondary outcomes included healthcare usage.
RESULTS Of the 1082516 patients admitted for NVUGIB, 553186 (51.1%) underwent EGD. The mean time to EGD was 52.8 h. Early (< 24 h from admission) EGD was associated with significantly decreased mortality, less frequent intensive care unit admission, shorter length of hospital stays, lower hospital costs, and an increased likelihood of discharge to home (all with P < 0.001). AC status was not associated with mortality among patients who underwent early EGD (aOR 0.88, P = 0.193). Male sex (OR 1.30) and Hispanic (OR 1.10) or Asian (aOR 1.38) race were also independent predictors of adverse hospitalization outcomes in NVUGIB.
CONCLUSION Based on this large, nationwide study, early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage, irrespective of AC status. These findings may help guide clinical management and would benefit from prospective validation.
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Affiliation(s)
- Simcha Weissman
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Muhammad Aziz
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Ayrton I Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Dean Ehrlich
- Division of Digestive Diseases, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Arnold Forlemu
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Anthony Willie
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Manesh K Gangwani
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Danish Waqar
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hannah Terefe
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Amritpal Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Diego MC Gonzalez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jayadev Sajja
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Fatma L Emiroglu
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Nicholas Dinko
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ahmed Mohamed
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mark A Fallorina
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - David Kosoy
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ankita Shenoy
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Anvit Nanavati
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View- University of California at Los Angeles Medical Center, Sylmar, CA 91342, United States
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12
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Weissman S, Fung BM, Bangolo A, Rashid A, Khan BF, Tirumala AKG, Nagpaul S, Cornwell S, Karamthoti P, Murugan V, Taranichi IS, Kalinin M, Wishart A, Khalaf I, Kodali NA, Aluri PSC, Kejela Y, Abdul R, Jacob FM, Manoharasetty A, Sethi A, Nadimpallli PM, Ballestas NP, Venkatraman A, Chirumamilla A, Nagesh VK, Gangwani MK, Issokson K, Aziz M, Swaminath A, Feuerstein JD. The overall quality of evidence of recommendations surrounding nutrition and diet in inflammatory bowel disease. Int J Colorectal Dis 2023; 38:98. [PMID: 37061646 DOI: 10.1007/s00384-023-04404-x] [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] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND AIM Recently, there has been an increased focus on the role nutrition and diet play in maintaining health in inflammatory bowel disease (IBD). We aimed to assess the overall quality, strength, and transparency of conflicts among guidelines on nutrition/diet in IBD. METHODS A systematic search was performed on multiple databases from inception until January 1, 2021, to identify guidelines pertaining to nutrition or diet in IBD. All guidelines were reviewed for disclosure of conflicts of interest (COI) and funding, recommendation quality and strength, external document review, patient representation, and plans for update-as per Institute of Medicine (IOM) standards. In addition, recommendations and their quality were compared between guidelines/societies. RESULTS: Seventeen distinct societies and a total of 228 recommendations were included. Not all guidelines provided recommendations on key aspects of diet-such as the role of supplements or the appropriate micro/macro nutrition in IBD. Fifty-nine percent of guidelines reported on COI, 24% underwent external review, and 41% included patient representation. 18.4%, 25.9%, and 55.7% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 10.5%, 24.6%, and 64.9% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence (p = 0.12) and strong recommendations (p = 0.83) did not significantly differ across societies. CONCLUSIONS Many guidelines do not provide recommendations on key aspects of diet/nutrition in IBD. As over 50% of recommendations are based on low-quality evidence, further studies on nutrition/diet in IBD are warranted to improve the overall quality of evidence.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Brian M Fung
- Division of Gastroenterology and Hepatology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA.
| | - Atif Rashid
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Badar F Khan
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | | | - Sneha Nagpaul
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Samuel Cornwell
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Praveena Karamthoti
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Vignesh Murugan
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Ihsan S Taranichi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Maksim Kalinin
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Annetta Wishart
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Ibtihal Khalaf
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Naga A Kodali
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Pruthvi S C Aluri
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Yabets Kejela
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Rub Abdul
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Feba M Jacob
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Advaith Manoharasetty
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Aparna Sethi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Preethi M Nadimpallli
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Natalia P Ballestas
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Aarushi Venkatraman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Avinash Chirumamilla
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Vignesh K Nagesh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Manesh K Gangwani
- Department of Medicine, Toledo University Medical Center, Toledo, OH, USA
| | - Kelly Issokson
- Department of Medicine, Section of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Muhammad Aziz
- Division of Gastroenterology, Toledo University Medical Center, Toledo, OH, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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13
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Weissman S, Systrom HK, Bangolo A, Elias D, Awasi M, Zahdeh T, Ogbu CE, Kim MH, Kalra M, Khota K, Kasarapu RB, Mutabi E, Makrani M, Nemalikanti S, Thomas J, Jijo JP, Thwe HM, Salib Y, Narayan KL, Ahmed K, Aziz M, Elias S, Feuerstein JD. Health Maintenance and Preventative Care in Inflammatory Bowel Disease: A Systematic Review of the Overall Quality of Societal Recommendations. J Clin Gastroenterol 2023; 57:325-334. [PMID: 36753461 DOI: 10.1097/mcg.0000000000001833] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AIMS Preventative care plays an important role in maintaining health in patients with inflammatory bowel disease (IBD). We aimed to assess the overall quality, strength, and transparency of conflicts among guidelines on preventative care in IBD. METHODS A systematic literature search was performed in multiple databases to identify all guidelines pertaining to preventative care in IBD in April 2021. All guidelines were reviewed for the transparency of conflicts of interest and funding, recommendation quality and strength, external guideline review, patient voice inclusion, and plan for update-as per Institute of Medicine standards. In addition, recommendations and their quality were compared between societies. RESULTS Fifteen distinct societies and a total of 89 recommendations were included. Not all guidelines provided recommendations on the key aspects of preventative care in IBD-such as vaccinations, cancer prevention, stress reduction, and diet/exercise. Sixty-seven percent of guidelines reported on conflicts of interest, 20% underwent external review, and 27% included patient representation. In all, 6.7%, 21.3%, and 71.9% of recommendations were based on high, moderate, and low-quality evidence, respectively. Twenty-seven percent, 23.6%, and 49.4% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence ( P =0.28) and strong recommendations ( P =0.41) did not significantly differ across societies. CONCLUSIONS Many guidelines do not provide recommendations on key aspects of preventative care in IBD. As over 70% of recommendations are based on low-quality evidence, further studies on preventative care in IBD are warranted to improve the overall quality of evidence.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Hannah K Systrom
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Daniel Elias
- Department of Medicine, NJMS School of Medicine, Newark, NJ
| | - Marcel Awasi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Tamer Zahdeh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Chukwuemeka E Ogbu
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Mishka Hoo Kim
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Meenal Kalra
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Kavya Khota
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Ritu B Kasarapu
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Erasmus Mutabi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Moinulhaq Makrani
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Sanskrita Nemalikanti
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Jim Thomas
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Joseph P Jijo
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Hla M Thwe
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Yousstina Salib
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Kiran L Narayan
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Kareem Ahmed
- Department of Medicine, University of Washington, Seattle, WA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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14
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Weissman S, Aziz M, Bangolo A, Zahdeh T, Elias D, Taneja V, El-Dallal M, Nagesh VK, Aleem H, Ghaffar U, Singla K, Thwe HM, Muthukumar A, Gurumurthy V, Prasad BA, Chugh R, Mutabi E, Kalra M, Muthineni VA, Khota K, Gade A, Thompson-Edwards A, Venkatesh HK, Jijo JP, Salib Y, Ogbu CE, Elias S, Feuerstein JD. Non-Anti-TNF Biologics as Salvage Therapy for Refractory Acute Severe Ulcerative Colitis, A Systematic Review. Curr Rev Clin Exp Pharmacol 2023; 18:CRCEP-EPUB-129677. [PMID: 36814069 DOI: 10.2174/2772432818666230221160937] [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] [Received: 09/12/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The literature regarding the efficacy and safety of non-anti-TNF biologics in hospitalized patients with refractory Acute Severe Ulcerative Colitis (ASUC) remains limited. METHODS We systematically reviewed articles reporting outcomes on non-anti-TNF biologics for patients with refractory ASUC. Pooled analysis was performed using a random-effects model. RESULTS An estimate of 41.3%, 48.5%, 81.2%, and 36.2% of patients in clinical remission showed a clinical response and were colectomy-free, and steroid free, respectively, all in 3 months. 15.7% and 8.2% of patients had adverse events or infections, respectively. CONCLUSION Non-anti-TNF biologics appear safe and effective therapeutic options for hospitalized patients with refractory ASUC.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Muhammad Aziz
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
| | - Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Tamer Zahdeh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Daniel Elias
- Department of Medicine, Rutgers NJMS, Newark, NJ, USA
| | - Vikas Taneja
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
| | - Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
| | - Vignesh K Nagesh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Haris Aleem
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Umar Ghaffar
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kushaghar Singla
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Hla M Thwe
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Ananya Muthukumar
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Vaishnavi Gurumurthy
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Bodapati A Prasad
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Rachita Chugh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Erasmus Mutabi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Meenal Kalra
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Venkata Ab Muthineni
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kavya Khota
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Amulya Gade
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Ashley Thompson-Edwards
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Harini K Venkatesh
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Joseph P Jijo
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Yousstina Salib
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Chukwuemeka E Ogbu
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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15
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Dong J, Wang LF, Ardolino E, Feuerstein JD. Real-world compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer polypectomy surveillance guidelines: an observational study. Gastrointest Endosc 2023; 97:350-356.e3. [PMID: 35998689 DOI: 10.1016/j.gie.2022.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/12/2022] [Revised: 07/16/2022] [Accepted: 08/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Overuse of screening colonoscopy increases cost and procedural adverse events, but inadequate surveillance can miss the development of colorectal cancer. We measured compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) polypectomy surveillance guidelines in clinical records and a survey. METHODS We performed a retrospective study comparing surveillance intervals for first-time average-risk colonoscopies with the 2020 USMSTF guidelines. Cases were analyzed from 3 intervals (March 2021 to May 2021, November 2021 to January 2022, and April 2022 to May 2022), collectively termed the postguideline period, and a baseline period from November 2019 to January 2020. Real-world compliance rates were compared with results of a survey conducted between November 2020 and February 2021. RESULTS Overall compliance was 48.9% among 532 colonoscopies, ranging from 8.3% for low-risk adenomas (LRAs), 88.3% for high-risk adenomas, 63.1% for sessile serrated polyps (SSPs), and 88.6% for hyperplastic polyps. Compliance for LRA increased from the baseline period (.8% vs 8.3%, P = .003), and 95.3% of nonadherent LRA cases followed the 2012 USMSTF guidelines. Compliance for LRAs was 18.6% among respondents who provided a compliant surveillance interval for LRAs in the survey. Noncompliance was associated with finishing training >10 years ago (odds ratio, 1.9; 95% confidence interval, 1.4-2.7) and performing over 800 colonoscopies annually (odds ratio, 2.0; 95% confidence interval, 1.5-2.6). CONCLUSIONS Adoption of the 2020 USMSTF surveillance guidelines remains low at 2 years. Further research into outcomes for patients with LRAs and SSPs may increase guideline adoption.
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Affiliation(s)
- Jeffrey Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda F Wang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Ardolino
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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16
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Weissman S, Mehta TI, Stein DJ, Tripathi K, Rosenwald N, Kolli S, Aziz M, Feuerstein JD. Comparative Efficacy of Endoscopic Assist Devices on Colonic Adenoma Detection: A Systematic Review With Network Meta-analysis. J Clin Gastroenterol 2022; 56:889-894. [PMID: 35324485 DOI: 10.1097/mcg.0000000000001643] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/18/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Numerous endoscopic assist devices exist, yet data surrounding their comparative efficacy is lacking. We conducted a systematic review with network meta-analysis to determine the comparative efficacy of endoscopic assist devices on colonic adenoma detection. METHODS A systematic search was performed using multiple electronic databases through July 2020, to identify all randomized controlled trials and dual-arm observational studies compared with either other endoscopic assist devices and/or standard colonoscopy. The primary outcome was adenoma detection rate (ADR). Secondary outcomes included polyp detection rate (PDR), serrated adenoma detection rate (SADR), right-sided adenoma detection rate (RADR), and proximal adenoma detection rate (PADR). RESULTS Fifty-seven studies (31,051 patients) met inclusion criteria and were analyzed. Network meta-analysis identified an enhanced ADR among (clear) cap [odds ratio (OR): 2.69, 95% confidence interval (CI): 1.45-4.99], endocuff, (OR: 4.95, 95% CI: 3.15-7.78), and endoring (OR: 3.68, 95% CI: 1.47-9.20)-with no significant difference amongst any particular device. Similar findings for PDR were also seen. Enhanced SADR was identified for endocuff (OR: 9.43) and endoring (OR: 4.06) compared with standard colonoscopy. Enhanced RADR (OR: 5.36) and PADR (OR: 3.78) were only identified for endocuff. Endocuff comparatively demonstrated the greatest ADR, PDR, and SADR, but this was not significant when compared with the other assist devices. Subgroup analysis of randomized controlled trials identified enhanced PDR and ADR for both cap and endocuff. CONCLUSIONS Endoscopic assist devices displayed increased ADR and PDR as compared with standard colonoscopy and thus should be widely adopted. A nonsignificant trend was seen toward higher efficacy for the endocuff device.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Tej I Mehta
- Department of Medicine, Medical College of Wisconsin, Madison, WI
| | | | - Kartikeya Tripathi
- Department of Gastroenterology and Hepatology, University of Massachusetts Medical School-Baystate Campus, Springfield, MA
| | | | - Sindhura Kolli
- Department of Medicine, NYU Langone Medical Center, New York, NY
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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17
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Stein DJ, Feuerstein JD. In adults using oral anticoagulants, PPI use may be associated with lower risk for upper GI bleeding. Ann Intern Med 2022; 175:JC129. [PMID: 36315943 DOI: 10.7326/j22-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/22/2022] Open
Abstract
Kurlander JE, Barnes GD, Fisher A, et al. Association of antisecretory drugs with upper gastrointestinal bleeding in patients using oral anticoagulants: a systematic review and meta-analysis. Am J Med. 2022;135:1231-43.e8. 35679879.
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Affiliation(s)
- Daniel J Stein
- Brigham and Women's Hospital, Boston, Massachusetts, USA (D.J.S.)
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18
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Taneja V, El-Dallal M, Haq Z, Tripathi K, Systrom HK, Wang LF, Said H, Bain PA, Zhou Y, Feuerstein JD. Effectiveness and Safety of Tofacitinib for Ulcerative Colitis: Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:e323-e333. [PMID: 34516458 DOI: 10.1097/mcg.0000000000001608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/11/2021] [Accepted: 07/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The objective of our systematic review and meta-analysis was to evaluate the effectiveness and safety of tofacitinib in the treatment of moderate-severe ulcerative colitis (UC). METHODS We searched Medline, Embase, Web of Science, and Cochrane Central to identify articles and abstracts reporting efficacy or safety data on tofacitinib use in UC. Primary outcome assessed was remission. Secondary outcomes included clinical response, steroid free remission, and adverse events (AEs). RESULTS A total of 26 studies were included. The rates of remission were 29.81% [95% confidence interval (CI): 22.37%-37.25%, I2 : 90%] at week 8, 32.27% (95% CI: 27.67%-36.88%, I2 : 42%) at 6 months and 38.03% (95% CI: 33.59%-42.48%, I2 : 0%) at 1-year. Clinical response rates were 59.41% (95% CI: 55.03%-63.94%, I2 : 61%) at week 8, 48.99% (95% CI: 36.92%-61.06%, I2 : 91%) at 6 months and 50.87% (95% CI: 42.16%-59.58%, I2 : 67%) at 1-year. Odds ratio of clinical response at week 8 in biologic naive versus biologic experienced patients was 1.59 (95% CI: 0.54-4.63). Pooled incidence rate for serious infections, major adverse cardiovascular events, and nonmelanotic squamous cell malignancies across all doses was 4.41 per 100-patient years (PYs) (95% CI: 2.32-8.38 per 100-PY, I2 : 78%), 0.91 per 100-PY (95% CI: 0.43-1.93 per 100-PY, I2 : 37%) and 0.91 per 100-PY (95% CI: 0.61-1.34 per 100-PY, I2 : 0%), respectively. Higher dose was associated with an increased frequency of AEs. CONCLUSIONS While the overall efficacy and safety of tofacitinib in moderate-severe UC is consistent with clinical trial data, the dose dependent increase in AEs highlights the significance of early dose de-escalation. Rate of clinical response after tofacitinb induction was similar in biologic naive and biologic experienced patients.
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Affiliation(s)
| | - Mohammed El-Dallal
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases
- Cambridge Health Alliance, Cambridge
| | - Zadid Haq
- Johns Hopkins University School of Medicine, Bayview Medical Residency, Baltimore, MD
| | - Kartikeya Tripathi
- University of Massachusetts Medical School-Baystate Campus, Springfield, MA
| | - Hannah K Systrom
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Linda F Wang
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Hyder Said
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston
| | - Youlian Zhou
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases
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19
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Taneja V, Stein DJ, Feuerstein JD. Impact of Cirrhosis on Outcomes in Inflammatory Bowel Disease Hospitalizations. J Clin Gastroenterol 2022; 56:718-723. [PMID: 35152240 DOI: 10.1097/mcg.0000000000001640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/24/2021] [Accepted: 10/17/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Evidence regarding outcomes in inflammatory bowel disease (IBD) hospitalizations with coexisting cirrhosis is scant. We queried the National Inpatient Sample (NIS) database to evaluate the impact of cirrhosis on hospitalization characteristics and outcomes in patients with Crohn's disease and ulcerative colitis. METHODS All admissions that listed IBD as a primary diagnosis by ICD-10-CM code (K50.X for Crohn's disease and K51.X for ulcerative colitis) in the NIS for 2016 and 2017 were included. Attributes of admissions with cirrhosis (K74.XX, 70.3, 78.81, and 71.7) were compared with noncirrhosis IBD admissions. The primary outcome was inpatient mortality. Length of stay and total hospital charges comprised secondary outcomes. RESULTS A total weighted sample of 276,430 IBD admissions were identified, including 4615 with a concomitant diagnosis of cirrhosis. In a multivariate model, after adjusting for comorbidities, age, alimentary surgery during the admission and hospital type (teaching, urban nonteaching or rural), the presence of cirrhosis was associated with a higher inpatient mortality [odds ratio: 1.57; 95% confidence interval (CI): 1.16-2.15] and increased cost of admission (mean difference $11,651; 95% CI: 3830-19,472). No difference was noted in length of stay (difference: 0.44 d; 95% CI: -0.12-1.02) among these groups. Among admission diagnoses, infectious complications were the primary cause of death in 93.3% (95% CI: 87.1%-99.5%) of all inpatient mortality in the IBD with cirrhosis cohort as compared with 80.1% (95% CI: 77.6%-82.7%) of the mortality among IBD patients without cirrhosis ( P =0.01). CONCLUSIONS This study demonstrates that the presence of cirrhosis has an independent negative impact on outcomes for hospitalized patients with IBD as reflected by increased in-hospital mortality and higher cost of admission. A majority of the mortality was attributable to infections.
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Affiliation(s)
| | - Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center and Harvard Medical School
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20
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Yuan W, Marwaha JS, Rakowsky ST, Palmer NP, Kohane IS, Rubin DT, Brat GA, Feuerstein JD. Trends in Medical Management of Moderately to Severely Active Ulcerative Colitis: A Nationwide Retrospective Analysis. Inflamm Bowel Dis 2022; 29:695-704. [PMID: 35786768 PMCID: PMC10152283 DOI: 10.1093/ibd/izac134] [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: 02/12/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND With an increasing number of therapeutic options available for the management of ulcerative colitis (UC), the variability in treatment and prescribing patterns is not well known. While recent guidelines have provided updates on how these therapeutic options should be used, patterns of long-term use of these drugs over the past 2 decades remain unclear. METHODS We analyzed a retrospective, nationwide cohort of more than 1.7 million prescriptions for trends in prescribing behaviors and to evaluate practices suggested in guidelines relating to ordering biologics, step-up therapy, and combination therapy. The primary outcome was 30-day steroid-free remission and secondary outcomes included hospitalization, cost, and additional steroid usage. A pipeline was created to identify cohorts of patients under active UC medical management grouped by prescribing strategies to evaluate comparative outcomes between strategies. Cox proportional hazards and multivariate regression models were utilized to assess postexposure outcomes and adjust for confounders. RESULTS Among 6 major drug categories, we noted major baseline differences in patient characteristics at first exposure corresponding to disease activity. We noted earlier use of biologics in patient trajectories (762 days earlier relative to UC diagnosis, 2018 vs 2008; P < .001) and greater overall use of biologics over time (2.53× more in 2018 vs 2008; P < .00001) . Among biologic-naive patients, adalimumab was associated with slightly lower rates of remission compared with infliximab or vedolizumab (odds ratio, 0.92; P < .005). Comparisons of patients with early biologic initiation to patients who transitioned to biologics from 5-aminosalicylic acid suggest lower steroid consumption for early biologic initiation (-761 mg prednisone; P < .001). Combination thiopurine-biologic therapy was associated with higher odds of remission compared with biologic monotherapy (odds ratio, 1.36; P = .01). CONCLUSIONS As biologic drugs have become increasingly available for UC management, they have increasingly been used at earlier stages of disease management. Large-scale analyses of prescribing behaviors provide evidence supporting early use of biologics compared with step-up therapy and use of thiopurine and biologic combination therapy.
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Affiliation(s)
- William Yuan
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Jayson S Marwaha
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shana T Rakowsky
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nathan P Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - David T Rubin
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Gabriel A Brat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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21
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Stein DJ, Said H, Feuerstein JD. Clinical Progress Note: Diagnostic approach to lower gastrointestinal bleeding. J Hosp Med 2022; 17:547-551. [PMID: 35535943 DOI: 10.1002/jhm.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hyder Said
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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22
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Weissman S, Aziz M, Baniqued MR, Taneja V, El-Dallal M, Lee-Smith W, Elias S, Feuerstein JD. Quality measures in endoscopy: A systematic analysis of the overall scientific level of evidence and conflicts of interest. Endosc Int Open 2022; 10:E776-E786. [PMID: 35692919 PMCID: PMC9187391 DOI: 10.1055/a-1809-4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background and study aims Quality measures were established to develop standards to help assess quality of care, yet variation in endoscopy exists. We performed a systematic review to assess the overall quality of evidence cited in formulating quality measures in endoscopy. Methods A systematic search was performed on multiple databases from inception until November 15, 2020, to examine the quality measures proposed by all major societies. Quality measures were assessed for their level of quality evidence and categorized as category A (guideline-based), category B (observational studies) or category C (expert opinion). They were also examined for the type of measure (process, structure, outcome), the quality, measurability, review, existing conflicts of interest (COI), and patient participation of the quality measure. Results An aggregate total of 214 quality measures from nine societies (15 manuscripts) were included and analyzed. Of quality measures in endoscopy, 71.5 %, 23.8 %, and 4.7 % were based on low, moderate, and high quality of evidence, respectively. The proportion of high-quality evidence across societies was significantly different ( P = 0.028). Of quality measures, 76 % were quantifiable, 18 % contained patient-centric outcomes, and 7 % reported outcome measures. None of the organizations reported on patient involvement or external review, six disclosed existing COI, and 40 % were published more than 5 years ago. Conclusions Quality measures are important to standardize clinical practice. Because over 70 % of quality measures in endoscopy are based on low-quality evidence, further studies are needed to improve the overall quality to effectively set a standard, reduce variation, and improve care in endoscopic practice.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Matthew R. Baniqued
- Hackensack Meridian Health School of Medicine, Hackensack, New Jersey, United States
| | - Vikas Taneja
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Mohammed El-Dallal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Wade Lee-Smith
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
| | - Joseph D. Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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23
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Weissman S, Systrom HK, Aziz M, El-Dallal M, Lee-Smith W, Sciarra M, Feuerstein JD. Colorectal Cancer Prevention in Inflammatory Bowel Disease: A Systematic Analysis of the Overall Quality of Guideline Recommendations. Inflamm Bowel Dis 2022; 28:745-754. [PMID: 34245270 DOI: 10.1093/ibd/izab164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Owing to the increased risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD), numerous societies developed preventative guidelines. We aimed to assess the overall quality of CRC prevention guidelines in IBD. METHODS A systematic search was performed in multiple databases to identify all guidelines pertaining to CRC prevention in IBD in September 2020. All guidelines were reviewed for conflicts of interest (COIs)/funding, recommendation quality/strength, external guideline review, use of patient representation, and plans for update-as per Institute of Medicine standards. In addition, recommendations were compared amongst societies. RESULTS One hundred forty-nine recommendations from 14 different guidelines/societies were included. Not all guidelines provided recommendations on key elements surrounding (1) screening initiation and surveillance, (2) screening modality, (3) pharmacological chemoprevention, (4) dysplasia management and follow-up, and (5) molecular marker use. Only 71% of guidelines disclosed COIs, 43% reported industry funding, 14% were externally reviewed, 7% included patient representation, and 36% had plans for update. Of the total recommendations, 7.4%, 23.5%, and 69.1% were based on high,- moderate-, and low-quality evidence, respectively. Additionally, 20.1% of recommendations were strong, 14.1%, were weak/conditional, and 65.8% did not provide a strength. The proportion of high-quality evidence (P = 0.34) and strong recommendations (P = 0.57) did not significantly differ across societies. CONCLUSIONS Many guidelines do not provide recommendations on key aspects of CRC prevention in IBD. Over 90% of recommendations are based on low- to moderate-quality evidence; therefore, further studies on CRC prevention in IBD are needed to improve the overall quality of evidence.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, USA
| | - Hannah K Systrom
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Mohammed El-Dallal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Division of Hospital Medicine, Cambridge Health Alliance, Cambridge and Harvard Medical School, MA, USA
| | - Wade Lee-Smith
- Department of Library Sciences, University of Toledo Medical Center, Toledo, OH, USA
| | - Michael Sciarra
- Division of Gastroenterology and Hepatology, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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24
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El-Dallal M, Saroufim A, Systrom H, Ballou S, Farhoud A, Pasam RT, Gadupudi SS, Osman K, Chaudrey K, Cheifetz A, Feuerstein JD. Assessing the repercussions of COVID-19 pandemic on symptoms, disease management, and emotional well-being in patients with inflammatory bowel disease: a multi-site survey study. Scand J Gastroenterol 2022; 57:406-414. [PMID: 34894999 DOI: 10.1080/00365521.2021.2013527] [Citation(s) in RCA: 2] [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: 02/04/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has created numerous challenges in provision of safe and effective care for patients with Inflammatory Bowel Disease (IBD). In this study, we surveyed patients with IBD to highlight the impact of the pandemic on their IBD symptoms, management, and well-being. METHODS A multi-site survey was administered to patients with IBD. We evaluated patient's symptoms, medications changes, seeking medical attention, eating behaviors, sleep patterns, stress, self-reported anxiety and depression. The survey also measured emotional impact of the pandemic using the validated Pandemic Emotional Impact Scale (PEIS) and resilience using the Brief Resilience Scale (BRS). Logistic, ordinal, and linear regression models were utilized to perform sensitivity analyses. RESULTS The response rate to the survey was 61%. Of 391 surveyed patients, 21.1% reported worsened gastrointestinal symptoms, 17.5% reported changing biologic medication infusion schedule, 18.7% reported changing medication regimen, 43.6% attended at least one telemedicine visit with their gastroenterologist, 16.5% reported a less healthy diet, 40.5% reported worsening sleep, 63.7% reported more stress, and 65.3% reported feeling more vulnerable than before the pandemic. Women and participants with self-reported anxiety and depression were more likely to have worse symptoms, psychological well-being and daily functioning. Increased PEIS scores and decreased BRS scores were associated with worse outcomes. CONCLUSIONS COVID-19 pandemic has impacted symptoms, disease management and well-being for patient with IBD, more prominently in patients who suffer from anxiety and depression. Utilizing PEIS and BRS scores as screening tools could help better tailor outreach and follow-up to support these patients.
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Affiliation(s)
- Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ariana Saroufim
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hannah Systrom
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston and Harvard Medical School, MA, USA
| | - Sarah Ballou
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adel Farhoud
- Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Ravi Teja Pasam
- Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Karim Osman
- Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Khadija Chaudrey
- Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Adam Cheifetz
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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25
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El-Dallal M, Walradt TJ, Stein DJ, Khrucharoen U, Feuerstein JD. Pros and Cons of Performing Early Endoscopy in Geriatric Patients Admitted with Non-variceal Upper Gastrointestinal Bleeding: Analysis of the US National Inpatient Database. Dig Dis Sci 2022; 67:826-833. [PMID: 33710436 DOI: 10.1007/s10620-021-06924-4] [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: 09/06/2020] [Accepted: 02/23/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Age greater than 65 years is a well-defined risk factor for increased mortality in patients with non-variceal upper gastrointestinal bleeding (NVGIB). Endoscopy is indicated in most patients at any age but presents unique risks in the elderly cohort, and ideal timing is unclear. This study examined the association between outcomes and early (within 24 h) esophagogastroduodenoscopy (EGD) among elderly patients with NVGIB. METHODS All patients over age 65 admitted primarily for NVGIB who underwent EGD were included from the National Inpatient Sample 2016-2017. Clinical outcomes stratified by early EGD versus late EGD were compared after adjustment for comorbidities and bleeding severity using inverse probability of treatment weighting with survey-adjusted linear and logistic regression. RESULTS Out of estimated 625,530 admissions with a primary diagnosis of NVGIB, 120,835 met eligibility criteria; 24,830 underwent early EGD. Mean length of stay and total charges decreased by 1.17 days (95%CI 1.04-1.30, P < 0.001) and $5717.24 (95%CI 4034.57-7399.91, P < 0.001), respectively, in the early EGD group. Early EGD increased the odds ratio of death 1.32 (95%CI 1.06-1.64, P 0.01) and transfer to other hospitals 1.48 (95%CI 1.22-1.81, P < 0.001). No change was seen in the requirement for surgery or angiography. Rates of discharge to a nursing facility or home health were similar. CONCLUSION In a comprehensive cohort of geriatric patients with NVGIB, early EGD is associated with decreased hospital stay and charges, but also with increased mortality and inter-hospital transfer. Further research is needed to determine the optimal management of this vulnerable population.
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Affiliation(s)
- Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA. .,Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis St 8e Gastroenterology, Boston, MA, 02215, USA.
| | - Trent J Walradt
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Usah Khrucharoen
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis St 8e Gastroenterology, Boston, MA, 02215, USA
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26
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Burke CA, Lieberman D, Feuerstein JD. AGA Clinical Practice Update on Approach to the Use of Noninvasive Colorectal Cancer Screening Options: Commentary. Gastroenterology 2022; 162:952-956. [PMID: 35094786 DOI: 10.1053/j.gastro.2021.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/09/2022]
Abstract
The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update Commentary is to review the available evidence and provide expert advice regarding the approach to using noninvasive colorectal cancer (CRC) screening options, including evidence for their effectiveness, selection of individuals for whom these tests are appropriate, implications of a positive non-colonoscopy screening test, and opportunities to enhance the quality of noninvasive CRC screening programs. This Clinical Practice Update was commissioned and approved by the AGA Institute Clinical Practice Updates 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 Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. This expert commentary reflects recently published studies in this field, as well as the experiences of the authors who are gastroenterologists with high-level expertise in CRC screening and prevention.
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Affiliation(s)
| | | | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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27
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Schwartz J, Stein DJ, Feuerstein JD. Comprehensive National Inpatient Sample data reveals low but rising Pneumocystis jiroveci pneumonia risk in inflammatory bowel disease patients. Ann Gastroenterol 2022; 35:260-266. [PMID: 35599933 PMCID: PMC9062846 DOI: 10.20524/aog.2022.0713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/08/2022] [Indexed: 11/14/2022] Open
Abstract
Background There are only limited data to guide the management of infectious risk for Pneumocystis jiroveci pneumonia (PCP) in patients with inflammatory bowel disease (IBD). We evaluated the frequency of admissions for PCP among patients with IBD, as well as the temporal trend in PCP admission rates and the contribution of non-IBD risk factors to the development of infection. Methods The National Inpatient Sample from 2016-2017 was queried for all admissions involving both PCP and either Crohn’s disease or ulcerative colitis. Inpatient outcomes associated with PCP and additive risk factors for development of PCP within the IBD patient population were assessed using multivariate regression. Linear regression was performed on data from 2002-2017 to measure infectious trends over time. Results There were an estimated 225 admissions involving PCP among patients with IBD from 2016-2017 nationwide, representing 0.035% of total admissions. IBD patients with PCP faced a 4.67-fold higher adjusted odds of inpatient mortality (95% confidence interval 1.72-12.66), while 49% of patients with IBD who developed PCP had an unrelated risk factor. The most common factors were HIV and congenital immunodeficiency, both of which were associated with PCP in adjusted regression. The infectious incidence of PCP increased by 141% from 2002 to 2017 (P=0.003). Conclusions National admissions data indicate that significant PCP is rare in IBD patients. Routine PCP prophylaxis is probably not necessary, although further study of high-risk subgroups of patients is required. The rising incidence of PCP indicates a need for continued surveillance.
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Affiliation(s)
- Jeffrey Schwartz
- Department of Hospital Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA (Jeffrey Schwartz)
- Correspondence to: Jeffrey Schwartz, 55 Fruit Street Blake 15, Boston, MA 02114, USA, e-mail:
| | - Daniel J. Stein
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital and Harvard Medical School, Boston MA, USA (Daniel J. Stein)
| | - Joseph D. Feuerstein
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA, USA (Joseph D. Feuerstein)
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28
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Weissman S, Goldowsky A, Aziz M, Mehta TI, Sharma S, Lipcsey M, Walradt T, Iqbal U, Elias S, Feuerstein JD. Colorectal Cancer Screening Guidelines Are Primarily Based on Low-Moderate-Quality Evidence. Dig Dis Sci 2021; 66:4208-4219. [PMID: 33433802 DOI: 10.1007/s10620-020-06755-9] [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: 10/01/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Owning to colorectal cancer's (CRC) high mortality, multiple societies developed screening guidelines. AIMS We aimed to assess the overall quality of CRC screening guidelines. METHODS A systematic search was performed to review CRC screening guidelines for conflicts of interest (COI), recommendation quality and strength, external document review, use of patient representative, and recommendation age-as per Institute of Medicine (IOM) standards. In addition, recommendations were compared between guidelines/societies. Statistical analysis was conducted using R. RESULTS Twelve manuscripts were included in final analysis. Not all guidelines reported on COI, provided a grading method, underwent external review, or included patient representation. 14.5%, 34.2%, and 51.3% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 27.8%, 54.6%, and 17.5% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence and strong recommendations did not significantly differ across societies, nor were significant associations between publication year and evidence quality seen (P = 0.4). CONCLUSIONS While the majority of the CRC guidelines contain aspects of the standards set forth by the IOM, there is an overall lack of adherence. As over 85% of recommendations are based on low-moderate quality evidence, further studies on CRC screening are warranted to improve the overall quality of evidence.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health, Palisades Medical Center, North Bergen, NJ, USA
| | - Alexander Goldowsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Tej I Mehta
- Department of Medicine, Medical College of Wisconsin, Madison, WI, USA
| | - Sachit Sharma
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Megan Lipcsey
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Trent Walradt
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Umair Iqbal
- Department of Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health, Palisades Medical Center, North Bergen, NJ, USA
| | - Joseph D Feuerstein
- Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
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29
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Del Valle JP, Lee GC, Serrato JC, Feuerstein JD, Bordeianou LG, Hodin R, Kunitake H, Poylin V. Recurrence of Clostridium Difficile and Cytomegalovirus Infections in Patients with Ulcerative Colitis Who Undergo Ileal Pouch-Anal Anastomosis. Dig Dis Sci 2021; 66:4441-4447. [PMID: 33433814 DOI: 10.1007/s10620-020-06772-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patients with ulcerative colitis (UC) are at increased risk for infections such as Clostridium difficile and cytomegalovirus (CMV) colitis due to chronic immunosuppression. These patients often undergo multiple surgeries putting them at risk for recurrence of the infection. However, rates of recurrence in this setting and outcomes are not well understood. AIM The aim of this study is to determine rates of recurrence of C difficile and CMV infection in patients undergoing multistage UC surgeries and effects of antibiotic prophylaxis on outcomes. METHODS All patients with UC who underwent IPAA between 2001 and 2017 (at two tertiary referral centers were identified. History of C. difficile or CMV colitis prior to any surgery and recurrence after IPAA was noted RESULTS: A total of 633 patients with UC who underwent IPAA were identified, of whom 8.1% patients had C. difficile and 2.7% had CMV infections. 9.8% of C. difficile and 5.9% of CMV patients recurred after IPAA. Rates of abdominal sepsis (14.7% vs. 12.7%), 90-day mortality (0% vs. 0.4%), pouchitis (36.8% vs. 45.0%), or return to stoma (7.4% vs. 5.4%) were similar between patients who did or did not have infections. In patients with C. difficile infection prior to first surgery, none of the patients who received prophylaxis had recurrent infection. CONCLUSIONS Rates of C. difficile and CMV infections remain high in patients undergoing surgery for UC, with substantial minority developing recurrent infection during subsequent surgical procedures. Antibiotic prophylaxis in patients with a history of C difficile may reduce the rate of recurrent infection.
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Affiliation(s)
- Jonathan Pastrana Del Valle
- Department of Surgery, Beth Israel Deaconess Medical Center, Beth Israel Deaconess Medical Center Suite 9B, 110 Francis Street, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Grace C Lee
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jose Cataneo Serrato
- Department of Surgery, Beth Israel Deaconess Medical Center, Beth Israel Deaconess Medical Center Suite 9B, 110 Francis Street, Boston, MA, 02215, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center Medicine, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Liliana Grigorievna Bordeianou
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Richard Hodin
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Harvard Medical School, Boston, MA, USA
- Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL, 60657, USA
| | - Vitaliy Poylin
- Division of Gastrointestinal and Oncologic Surgery, Northwestern Medicine, Arkes Family Pavilion, 676 North Saint Clair Street, Suite 650, Chicago, IL, 60611, USA.
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30
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Weissman S, Ghoneim S, Sanayei A, Said H, Rosenblatt S, Mohammed A, Jafri S, Atoot A, Feuerstein JD. New-onset depression after colorectal cancer diagnosis: a population-based longitudinal study. Int J Colorectal Dis 2021; 36:2599-2602. [PMID: 34272995 DOI: 10.1007/s00384-021-03994-8] [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] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION To date, no large studies examining the temporal relationship between colorectal cancer (CRC) and the subsequent development of depressive disorders exist. We aimed to assess the incidence of depression post-colorectal cancer (CRC) diagnosis. METHODS To conduct this longitudinal study, we searched the large US population-based database, Explorys (IBM), from January 1, 1999, to January 1, 2021. We investigated new-onset depression and its associated mortality as well as the role of the mental health provider post-CRC diagnosis. Confidence intervals were calculated for all outcomes and multivariate regression analysis was performed. RESULTS Incident depression post-CRC diagnosis was 20.8 vs 8.9 per 100 person-years [OR 3.46, p < 0.0001] in the general population and conferred a 123% increased risk of all-cause mortality [P < 0.0001]. Male patients (OR: 1.89) were more likely to become depressed post-CRC diagnosis as compared to females. Moreover, the absolute number of male patients with post-CRC depression was significantly higher than that of females (68% vs 32%; P < 0.0001). In addition, depression after CRC was more common among Whites (OR: 1.68) and patients aged > 65 years (OR: 5.17). Referral to a mental health provider resulted in significantly lower all-cause mortality (3.6% vs 26.9%; p < 0.0001). DISCUSSION Our findings advocate for initiating depression screening for high-risk patients post-CRC diagnosis and prompt mental health provider referral.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA.
| | - Sara Ghoneim
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ava Sanayei
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hyder Said
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel Rosenblatt
- Department of Psychiatry, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Abdul Mohammed
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Syed Jafri
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Adam Atoot
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Weissman S, Patel K, Kolli S, Lipcsey M, Qureshi N, Elias S, Walfish A, Swaminath A, Feuerstein JD. Obesity in Inflammatory Bowel Disease Is Associated with Early Readmissions Characterised by an Increased Systems and Patient-level Burden. J Crohns Colitis 2021; 15:1807-1815. [PMID: 33999137 DOI: 10.1093/ecco-jcc/jjab088] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Rates of obesity are rising in patients with inflammatory bowel disease [IBD]. We conducted a US population-based study to determine the effects of obesity on outcomes in hospitalised patients with IBD. METHODS We searched the Nationwide Readmissions Database 2016-2017 to identify all adult patients hospitalised for IBD, using ICD-10 codes. We compared obese (body mass index [BMI] ≥ 30) vs non-obese [BMI < 30] patients with IBD to evaluate the independent effects of obesity on readmission, mortality, and other hospital outcomes. Multivariate regression and propensity matching were performed. RESULTS We identified 143 190 patients with IBD, of whom 9.1% were obese. Obesity was independently associated with higher all-cause readmission at 30 days {18% vs 13% (adjusted odds ratio [aOR] 1.16, p = 0.005)} and 90 days (29% vs 21% [aOR 1.27, p < 0.0001]), as compared with non-obese patients, with similar findings upon a propensity-matched sensitivity analysis. Obese and non-obese patients had similar risks of mortality on index admission [0.24% vs 0.31%, p = 0.18] and readmission [1.5% vs 1.8% p = 0.3]. Obese patients had longer [5.3 vs 4.9 days] and more expensive [USD12,195 vs USD11,154] hospitalisations on index admission. Obesity did not affect the risk of intestinal surgery or bowel obstruction. Compared with index admissions, readmissions were characterised by increased mortality [6-fold], health care use, and bowel obstruction [3-fold] [all p < 0.0001]. CONCLUSIONS Obesity in IBD appears to be associated with increased early readmission, characterised by a higher burden, despite the introduction of weight-based therapeutics. Prevention of obesity should be a focus in the treatment of IBD to decrease readmission and health care burden.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kirtenkumar Patel
- Department of Medicine, North Shore University Hospital, Conway, SC, USA
| | - Sindhura Kolli
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan Lipcsey
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nabeel Qureshi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Aaron Walfish
- Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Goldowsky A, Sen R, Hoffman G, Feuerstein JD. Is there a standardized practice for the development of international ulcerative colitis and Crohn's disease treatment guidelines? Gastroenterol Rep (Oxf) 2021; 9:408-417. [PMID: 34733526 PMCID: PMC8560035 DOI: 10.1093/gastro/goab009] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/17/2020] [Accepted: 10/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Guidelines are published by international gastroenterology societies regarding the management of ulcerative colitis (UC) and Crohn's disease (CD) to help clinicians to provide high-quality patient care. We examined the guidelines for the quality and strength of evidence used to develop the recommendations, methods for grading evidence, differences in disease-specific recommendations, conflicts of interest, and plans for guideline updates. METHODS A systematic search was performed on PubMed using "ulcerative colitis," "Crohn's disease," and "guidelines" in April 2019. International gastroenterology society websites were searched for UC- and CD-specific guidelines. Guidelines from 12 societies were examined by two authors. Chi-squared tests were used for comparing evidence-level grades, strength of recommendations, and reported conflicts of interest. Linear-regression modeling was used to evaluate the relationship between the number of authors and the number of recommendations in a given guideline. RESULTS Of 28 guidelines reviewed, 25 (89%) used a total of three different systems to grade the level of evidence and 2 (7%) used an unknown system. Three (11%) reviewed guidelines did not provide a conflict-of-interest statement, while three (11%) provided a timeline for guideline updates. Of 1,265 total statements examined, 246 (19%) reported no grade of evidence quality or explicitly stated that the recommendation was based on "expert opinion." One hundred and thirty-five (22%) UC recommendations were noted to be "weak/conditional" and 95 (16%) did not have a recommendation strength. Two hundred and forty-two (37%) CD recommendations were noted to be "weak/conditional" and 151 (23%) did not have a recommendation strength. CONCLUSION The majority of UC and CD guidelines are based on a low/very low quality of evidence and are further weakened due to the lack of homogeneity in specific aspects of management recommendations as well as conflicts of interest.
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Affiliation(s)
- Alexander Goldowsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rohan Sen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gila Hoffman
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joseph D Feuerstein
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Tripathi K, Dong J, Mishkin BF, Feuerstein JD. Patient Preference and Adherence to Aminosalicylates for the Treatment of Ulcerative Colitis. Clin Exp Gastroenterol 2021; 14:343-351. [PMID: 34511961 PMCID: PMC8412827 DOI: 10.2147/ceg.s237653] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disorder that requires sustained treatment for optimal outcomes. The 5-aminosalicylate (5-ASA) class of medications are first-line for the treatment of mild-to-moderate UC but suffer from suboptimal adherence rates in real-world settings. This review summarizes the literature on adherence and patient preference to 5-ASA in patients with UC. We begin by highlighting key studies that measure real-world adherence rates, as well as some of the pitfalls associated with certain techniques. We examine the data on the consequences of non-adherence, which range from decreased quality of life and higher risk of colorectal cancer at the individual level to increased costs to the overall healthcare system. We then turn to the reasons and risk factors for non-adherence and summarize the current understanding of the barriers towards adherence. Afterwards, we describe the research on patient preferences between 5-ASA formulations and dosing regimen. Finally, we summarize the evidence regarding interventions to improve 5-ASA adherence. While adherence remains a challenge in practice, understanding the current state of the field can better inform future efforts towards increasing adherence, and thus clinical outcomes, in UC.
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Affiliation(s)
- Kartikeya Tripathi
- Department of Gastroenterology, University of Massachusetts Medical School - Baystate Campus, Springfield, MA, USA
| | - Jeffrey Dong
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brooke F Mishkin
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Murthy SK, Feuerstein JD, Nguyen GC, Velayos FS. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161:1043-1051.e4. [PMID: 34416977 DOI: 10.1053/j.gastro.2021.05.063] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [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: 09/17/2020] [Revised: 04/19/2021] [Accepted: 05/21/2021] [Indexed: 02/08/2023]
Abstract
Improvements in disease management, as well as endoscopic technology and quality, have dramatically changed the way in which we conceptualize and manage inflammatory bowel disease-related dysplasia over the past 20 years. Based on evolving literature, we propose a conceptual model and best practice advice statements for the prevention, detection, and management of colorectal dysplasia in people with inflammatory bowel disease. This expert review was commissioned and approved by the American Gastroenterological Association Institute Clinical Practice Updates Committee and the American Gastroenterological Association Governing Board to provide timely guidance on a topic of high clinical importance to the American Gastroenterological Association membership. It underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.
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Affiliation(s)
- Sanjay K Murthy
- The Ottawa Hospital Inflammatory Bowel Disease Centre, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph D Feuerstein
- Center for Inflammatory Bowel Disease Beth Israel Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
| | - Fernando S Velayos
- Division of Gastroenterology and Hepatology, The Permanente Medical Group, San Francisco, California.
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Sultan S, Siddique SM, Singh S, Altayar O, Caliendo AM, Davitkov P, Feuerstein JD, Kaul V, Lim JK, Mustafa RA, Falck-Ytter Y, Inadomi JM. AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update. Gastroenterology 2021; 161:1011-1029.e11. [PMID: 34029569 PMCID: PMC8139430 DOI: 10.1053/j.gastro.2021.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Indexed: 01/22/2023]
Abstract
This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota.
| | - Shazia M. Siddique
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Angela M. Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Perica Davitkov
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph D. Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Vivek Kaul
- Division of Gastroenterology and Hepatology at the University of Rochester Medical Center, Rochester, New York
| | - Joseph K. Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Reem A. Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John M. Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Weissman S, Aziz M, Baniqued MR, Ahmed M, Elias S, Feuerstein JD, Tabibian JH. Extra-Colonic Malignancy in Inflammatory Bowel Disease: a Paucity of Recommendations with Weak Evidence. J Gastrointest Cancer 2021; 53:669-673. [PMID: 34467516 DOI: 10.1007/s12029-021-00700-3] [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] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Little data is available surrounding societal recommendations regarding extra-colonic malignancy in patients with inflammatory bowel disease (IBD). As a result, we systematically analyzed these international guidelines to assess their overall quality as well as their adherence to standards for high-quality practice guidelines. METHODS A systematic search was performed in multiple databases to identify all guidelines pertaining to extra-colonic malignancy in IBD in April 2020. All guidelines were reviewed for conflicts of interest (COI)/funding, recommendation quality and strength, external document review, use of patient representation, and plans for update-as per Institute of Medicine standards. In addition, recommendations were compared between guidelines/societies. Statistical analysis was conducted using R. RESULTS A total of 11 recommendations on extra-colonic malignancy in IBD were put forth by 5 guidelines/societies. Zero percent of recommendations were found to be based on high-quality evidence, 36.4% of recommendations on moderate-quality evidence, and 63.6% of recommendations on low-quality evidence. 9.1% were strong recommendations, 0% were weak/conditional recommendations, and 90.9% of recommendations did not provide a strength. No guideline included patient representation or had plans for future update of their recommendations. CONCLUSION There is a consistent lack of high-quality recommendations for extra-colonic malignancy in IBD across different societal guidelines. The need for high-quality studies to improve the strength of recommendations is eminent, as this will ultimately lead to high-quality patient care.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA.
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Matthew R Baniqued
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Mohamed Ahmed
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
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Ghoneim S, Weissman S, Wang L, Aziz M, Atoot A, Sandhu D, Swaminath A, Feuerstein JD. Impact of inflammatory bowel disease on hospital outcomes in acute ischemic stroke: a nationwide cohort study. Int J Colorectal Dis 2021; 36:1759-1764. [PMID: 33733312 DOI: 10.1007/s00384-021-03912-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with inflammatory bowel disease (IBD) have an increased risk of venous thrombotic events. The impact IBD has on arterial thrombosis is not well characterized. We aimed to identify the impact of IBD on hospital outcomes in patients admitted for acute ischemic stroke (AIS). METHODS This is a retrospective cohort study utilizing the 2017 National Inpatient Sample. We identified all adult patients with a principal diagnosis of AIS and compared those with a concurrent diagnosis of IBD to those without-subgrouped by ulcerative colitis (UC) and Crohn's disease (CD). Outcomes were mortality and healthcare usage among IBD patients with AIS. Multivariate analysis was used to control for confounders. Analyses were performed using STATA. RESULTS Five hundred twenty-four thousand and forty-five patients were admitted for AIS in 2017; of them 2200 (0.41%) had a concurrent diagnosis of IBD. The presence of IBD did not significantly affect in-hospital mortality (4.09% vs. 4.01%) among patients admitted for AIS [OR 1.07 95% CI: 0.65-1.76], with similar findings upon subgroup analysis of UC [OR 0.91, 95% CI: 0.39-2.09] and CD [OR 1.17, 95% CI: 0.62-2.19]. Mean hospital length of stay and charges/costs in AIS were similar irrespective of IBD. CONCLUSIONS UC and CD do not appear to be associated with a higher risk of mortality or increased healthcare usage in AIS. AIS risk assessment in patients with IBD is important but should be done in a similar fashion to the general population.
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Affiliation(s)
- Sara Ghoneim
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA.
| | - Linda Wang
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA
| | - Adam Atoot
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Dalbir Sandhu
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Lipcsey M, Stein DJ, Yu RL, Anand R, Bilal M, Leibowitz A, Sawhney M, Feuerstein JD. High rate of percutaneous gastrostomy placement in COVID-19 patients with low overall complications. ACTA ACUST UNITED AC 2021; 23:385-387. [PMID: 34250514 PMCID: PMC8262403 DOI: 10.1016/j.tige.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Megan Lipcsey
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh PA
| | - Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA
| | - Rosa L Yu
- Department of Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston MA
| | - Rajsavi Anand
- Department of Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston MA
| | - Mohammad Bilal
- Department of Gastroenterology, University of Minnesota Minneapolis VA Medical Center, Minneapolis, MN
| | - Akiva Leibowitz
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Mandeep Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston MA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston MA
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Weissman S, Sharma, S, Fung BM, Aziz M, Sciarra M, Swaminath A, Feuerstein JD. Increased Mortality and Healthcare Costs Upon Hospital Readmissions of Ulcerative Colitis Flares: A Large Population-Based Cohort Study. Crohns Colitis 360 2021; 3:otab029. [PMID: 36776672 PMCID: PMC9802231 DOI: 10.1093/crocol/otab029] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Ulcerative colitis (UC) flares often result in prolonged hospitalization and considerable mortality. Nevertheless, large-scale analyses evaluating the frequency and characteristics of hospital readmissions for UC remain limited. We aimed to examine these clinical outcomes in a nationwide cohort of patients hospitalized with UC. Methods We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted for UC. Outcomes including mortality, readmission rates, predictors of readmission and mortality, and healthcare usage were assessed. Multivariate analysis was used to adjust for potential confounders. Results From the 31,063 patients hospitalized for UC, 17.38% were readmitted within 30 days and 28.51% in 90 days. UC accounted for 28.17% and 29.82% of readmissions at 30 and 90 days, respectively. Compared to index admission, 30- and 90-day readmissions were characterized by significantly higher mortality (0.42% vs 1.99% and 1.65%, respectively), longer hospital stays (5.05 vs 6.62 and 6.04 days, respectively), and increased hospital cost ($49,999 vs $62,288 and $59,698, respectively) (all P < 0.01). Numerous factors, including chronic steroid use [hazard ratio (HR) 1.35] and opioid use (HR 1.6, were independently associated with increased 30-day readmission (P < 0.01). Numerous factors, including anxiety (HR 1.21) and venous thromboembolism (HR 5.39), were independently associated with increased 30-day mortality (P < 0.01). Conclusions In a large cohort of patients hospitalized for UC, we found that readmission is associated with higher mortality and more lengthy/costly admissions. Additionally, we found independent associations for readmission and mortality that may help identify patients who can benefit from close postdischarge follow-up.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, USA,Address correspondence to: Simcha Weissman, DO, Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, USA ()
| | - Sachit Sharma,
- Department of Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Brian M Fung
- Division of Gastroenterology and Hepatology, University of Arizona College of Medicine—Phoenix, Phoenix, Arizona, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Michael Sciarra
- Department of Gastroenterology and Hepatology, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, New York, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Horton LC, Feuerstein JD. In recurrent C difficile infection, oral FMT capsules have a pooled cure rate of 82% (low-quality evidence). Ann Intern Med 2021; 174:JC65. [PMID: 34058102 DOI: 10.7326/acpj202106150-065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/22/2022] Open
Abstract
Du C, Luo Y, Walsh S, Grinspan A. Oral fecal microbiota transplant capsules are safe and effective for recurrent Clostridioides difficile infection: a systematic review and meta-analysis. J Clin Gastroenterol. 2021;55:300-8. 33471490.
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Affiliation(s)
- Laura C Horton
- Brigham and Women's Hospital, Boston, Massachusetts, USA (L.C.H.)
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Shmidt E, Ho EY, Feuerstein JD, Singh S, Terdiman JP. Spotlight: Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn's Disease. Gastroenterology 2021; 160:2511. [PMID: 34057068 DOI: 10.1053/j.gastro.2021.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/02/2022]
Affiliation(s)
- Eugenia Shmidt
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN
| | - Edith Y Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, MA
| | - Siddharth Singh
- Division of Gastroenterology and Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, CA
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Cohen RD, Feuerstein JD, Rubin DT. Reply. Gastroenterology 2021; 160:2627. [PMID: 33561439 PMCID: PMC7867470 DOI: 10.1053/j.gastro.2021.02.012] [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] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/02/2022]
Affiliation(s)
| | | | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
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Singh S, Proctor D, Scott FI, Falck-Ytter Y, Feuerstein JD. AGA Technical Review on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn's Disease. Gastroenterology 2021; 160:2512-2556.e9. [PMID: 34051985 PMCID: PMC8986997 DOI: 10.1053/j.gastro.2021.04.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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] [Indexed: 02/06/2023]
Abstract
The incidence and prevalence of Crohn's disease (CD) is rising globally. Patients with moderate to severe CD are at high risk for needing surgery and hospitalization and for developing disease-related complications, corticosteroid dependence, and serious infections. Optimal management of outpatients with moderate to severe luminal and/or fistulizing (including perianal) CD often requires the use of immunomodulator (thiopurines, methotrexate) and/or biologic therapies, including tumor necrosis factor-α antagonists, vedolizumab, or ustekinumab, either as monotherapy or in combination (with immunomodulators) to mitigate these risks. Decisions about optimal drug therapy in moderate to severe CD are complex, with limited guidance on comparative efficacy and safety of different treatments, leading to considerable practice variability. Since the last iteration of these guidelines published in 2013, significant advances have been made in the field, including the regulatory approval of 2 new biologic agents, vedolizumab and ustekinumab. Therefore, the American Gastroenterological Association prioritized updating clinical guidelines on this topic. To inform the clinical guidelines, this technical review was completed in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The review addressed the following focused questions (in adult outpatients with moderate to severe luminal CD): overall and comparative efficacy of different medications for induction and maintenance of remission in patients with or without prior exposure to tumor necrosis factor-α antagonists, comparative efficacy and safety of biologic monotherapy vs combination therapy with immunomodulators, comparative efficacy of a top-down (upfront use of biologics and/or immunomodulator therapy) vs step-up treatment strategy (acceleration to biologic and/or immunomodulator therapy only after failure of mesalamine), and the role of corticosteroids and mesalamine for induction and/or maintenance of remission. Finally, in adult outpatients with moderate to severe fistulizing CD, this review addressed the efficacy of pharmacologic interventions for achieving fistula and the role of adjunctive antibiotics without clear evidence of active infection.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Deborah Proctor
- Division of Gastroenterology, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Frank I. Scott
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Yngve Falck-Ytter
- Division of Gastroenterology and Liver Disease, Case Western Reserve University, Cleveland, Ohio CA
| | - Joseph D. Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, MA
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Feuerstein JD, Ho E, Shmidt E, Singh H, Falck-Ytter Y, Sultan S, Terdiman JP. AGA Clinical Practice Guidelines on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn's Disease. Gastroenterology 2021; 160:2496-2508. [PMID: 34051983 PMCID: PMC8988893 DOI: 10.1053/j.gastro.2021.04.022] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [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: 02/07/2023]
Affiliation(s)
- Joseph D. Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, MA
| | - Edith Ho
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA
| | - Eugenia Shmidt
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN
| | - Harminder Singh
- Section of Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Case Western Reserve University, and VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Shanaz Sultan
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN
| | - Jonathan P. Terdiman
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
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Taneja V, El-Dallal M, Bilal M, Flier SN, Sheth SG, Ballou SK, Berzin TM, Pleskow DK, Feuerstein JD, Sawhney MS. Patient Perspective on Safety of Elective Gastrointestinal Endoscopy During the COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 23:234-243. [PMID: 34007972 PMCID: PMC8118706 DOI: 10.1016/j.tige.2021.05.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients' perception regarding the risks of COVID-19 infection with gastrointestinal (GI) and the preventive measures taken in GI endoscopy units to mitigate infection risk remains unclear. We aimed to assess patients' perception regarding risks of COVID-19 with GI endoscopy and the changes in the endoscopy unit as a result of the ongoing pandemic. Methods Outpatients undergoing GI endoscopy at our institution were categorized into those scheduled to undergo GI endoscopy (preprocedure) and those who had recently undergone GI endoscopy during the pandemic (postprocedure). Two separate but similar survey instruments were designed. Patients were asked to respond on a 5-point Likert scale. Responses were stratified as "low," "neutral," and "high" for analysis. Results A total of 150 and 355 respondents completed the preprocedure and postprocedure surveys, with a combined response rate of 82.5%. Non-white ethnicity was associated with reporting a "high" level of concern for endoscopy related COVID-19 exposure in both the preprocedure (OR 4.09, 95% CI 1.54-10.82) and postprocedure cohorts (OR 2.11, 95% CI 1.04-4.29). 42% of patients in the preprocedure cohort and 11.8% in the postprocedure cohort reported their level of concern for COVID exposure as "high." Among the postprocedure cohort, 88% of the patients were likely to undergo repeat endoscopy during the pandemic if recommended. Conclusion Patients are willing to undergo GI endoscopy during the COVID-19 pandemic. Non-white and older patients, and those undergoing screening examinations were more concerned with the GI endoscopy related COVID-19 transmission risk.
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Affiliation(s)
- Vikas Taneja
- Section of Hospital Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohammed El-Dallal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Division of Hospital Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Mohammad Bilal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sarah N Flier
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sarah K Ballou
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Tyler M Berzin
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Douglas K Pleskow
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Stein DJ, Moore MB, Hoffman G, Feuerstein JD. Improving All-Cause Inpatient Mortality After Percutaneous Endoscopic Gastrostomy. Dig Dis Sci 2021; 66:1593-1599. [PMID: 32556970 DOI: 10.1007/s10620-020-06396-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 03/04/2020] [Accepted: 06/03/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Percutaneous gastrostomy (PEG) is a common inpatient procedure. Prior data from National Inpatient Sample (NIS) in 2006 reported a mortality rate of 10.8% and recommended more careful selection of PEG candidates. This study assessed for improvement in the last 10 years in mortality rate and complications for hospitalized patients. METHODS A retrospective cohort analysis of all adult inpatients in the NIS from 2006 to 2016 undergoing PEG placement compared demographics and indication for PEG placement per ICD coding. Survey-based means and proportions were compared to 2006, and rates of change in mortality and complication rates were trended from 2006 through 2016 and compared with linear regression. Multivariable survey-adjusted logistic regression was used to determine predictors of mortality and complications in the 2016 sample. RESULTS A total of 155,550 patients underwent PEG placement in 2016, compared with 174,228 in 2006. Mortality decreased from 10.8 to 6.6% without decreased comorbidities (p < 0.001). This trend was gradual and persistent over 10 years in contrast to a stable overall inpatient mortality rate (p = 0.113). Stroke remained the most common indication (29.7%). The majority of patients (64.6%) had Medicare. Indications for placement were stable. Complication rates were stable from 2006 (4.4%) to 2016 (5.1%) (p = 0.201). CONCLUSIONS Inpatient PEG placement remains common. Despite similar patient characteristics, mortality has decreased by approximately 40% over the last 10 years without a decrease in complications likely reflecting improved patient selection.
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Affiliation(s)
- Daniel J Stein
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis St 8e Gastroenterology, Boston, MA, 02215, USA.
| | - Matthew B Moore
- Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis St 8e Gastroenterology, Boston, MA, 02215, USA
| | - Gila Hoffman
- Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis St 8e Gastroenterology, Boston, MA, 02215, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis St 8e Gastroenterology, Boston, MA, 02215, USA
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Papamichael K, Clarke WT, Casteele NV, Germansky KA, Feuerstein JD, Melmed GY, Siegel CA, Irving PM, Cheifetz AS. Comparison of Assays for Therapeutic Monitoring of Infliximab and Adalimumab in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2021; 19:839-841.e2. [PMID: 32147594 PMCID: PMC7483237 DOI: 10.1016/j.cgh.2020.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/04/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
Comparison data regarding anti-tumor necrosis factor drug concentrations in inflammatory bowel disease (IBD) between the enzyme-linked immunosorbent assay (ELISA) and the homogenous mobility shift assay (HMSA) are scarce.1-3 As decisions in clinical practice depend on the thresholds that define a therapeutic drug concentration, it is important to determine if this varies based on the type of assay used for therapeutic drug monitoring.4 We recently showed a discrepancy between a commercially available ELISA and the HMSA for both infliximab and adalimumab concentrations in patients with IBD.5 Based on the results of the study, Prometheus Laboratories (San Diego, CA) initiated a comprehensive review of their HMSA assays and found that there was an upward drift for both infliximab (from December 2017 to May 2019) and adalimumab (from August 2017 to May 2019), including when our study was performed. Prometheus Laboratories corrected the errant values and reported the revised drug concentrations to physicians (Supplementary Methods). We aimed to compare the corrected infliximab and adalimumab concentrations with the original ELISA values.
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Affiliation(s)
| | | | - Niels Vande Casteele
- Department of Medicine, University of California San Diego, La Jolla, California
| | | | | | - Gil Y. Melmed
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Peter M. Irving
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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El-Dallal M, Stein DJ, Raita Y, Feuerstein JD. The impact of obesity on hospitalized patients with ulcerative colitis. Ann Gastroenterol 2021; 34:196-201. [PMID: 33654359 PMCID: PMC7903582 DOI: 10.20524/aog.2021.0592] [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: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022] Open
Abstract
Background Obesity is the fifth leading risk factor for mortality in the world and it has increased among patients with ulcerative colitis in recent years. We examined the impact of obesity on the hospitalized patients admitted primarily with a diagnosis of ulcerative colitis. Methods We used the National Inpatient Sample data for the year 2016 to identify patients with ulcerative colitis and compared obese and non-obese patients in terms of length of hospital stay, total charges, and mortality. We used multiple imputations to estimate missing values and survey analysis to estimate the outcomes, and we adjusted for confounders by implementing the inverse probability of treatment weighting using propensity score. Results A total of 61,075 admissions with ulcerative colitis were identified. Among these, 6020 were diagnosed with obesity. Baseline hospital and patient characteristics between the 2 groups were notable for differences in age and sex. Patients with obesity were found to have a mean hospital stay longer by 0.57 days (95% confidence interval [CI] 0.22-0.93; P=0.002) and charges $6341.71 higher (95%CI 2499.72-10,183.71; P=0.001) compared to non-obese patients. There was no difference in hospital mortality, with an odds ratio of 0.28 (95%CI 0.04-2.05; P=0.212). Conclusion In a comprehensive review of inpatient admissions in 2016, primarily for ulcerative colitis, obesity was associated with a longer hospital stay and higher total charges per admission after balancing of confounders.
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Affiliation(s)
- Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA (Mohammed El-Dallal).,Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Mohammed El-Dallal, Joseph D. Feuerstein)
| | - Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Daniel J. Stein)
| | - Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Yoshihiko Raita), USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Mohammed El-Dallal, Joseph D. Feuerstein)
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Sharma S, Weissman S, Aburayyan K, Acharya A, Aziz M, Systrom HK, Lew D, Vohra I, Feuerstein JD, Pandol SJ. Sex differences in outcomes of acute pancreatitis: Findings from a nationwide analysis. J Hepatobiliary Pancreat Sci 2021; 28:280-286. [PMID: 33417740 DOI: 10.1002/jhbp.890] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sex is thought to play a significant role in predicting outcomes in numerous diseases. The role sex plays in acute pancreatitis (AP) remains limited. We sought to determine if sex is associated with hospitalization outcomes in this population, using a large national database. METHODS This was a retrospective study of adult patients with AP utilizing the 2016 and 2017 National Inpatient Sample via ICD-10 codes. The clinical courses of females were compared to that of males. The primary outcome was all-cause inpatient mortality. Secondary outcomes, including healthcare utilization, were assessed. Statistical analyses were performed using STATA, version 16.1. RESULTS Of the 553 480 adult patients hospitalized with AP; 25.3% had AP secondary to alcohol (61.4% male, 38.6% female) and 17.44% secondary to gallstones (48.6% male, 51.4% female). Females were significantly older than males (52.81 years vs 50.97 years, P < .01). Females had a significantly lower likelihood of mortality (aOR: 0.69), shock (aOR: 0.64), sepsis (aOR: 0.70), acute kidney injury (aOR 0.66), intensive care unit admission (aOR 0.53), and pancreatic drainage (aOR 0.61) as compared to males (all with P < .01). There was no significant difference between females and males with regards to mean length of stay and hospitalization charges and costs. CONCLUSIONS In this large cohort of patients admitted for AP, despite being significantly older, we found that females had significantly improved clinical outcomes, including lower mortality, compared to males. Further prospective studies are needed to accurately understand these differences to guide clinical practice.
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Affiliation(s)
- Sachit Sharma
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kanana Aburayyan
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Ashu Acharya
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Muhammad Aziz
- Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Hannah K Systrom
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Lew
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ishaan Vohra
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Poylin VY, Serrato JC, Pastrana Del Valle J, Feuerstein JD. Vedolizumab does not increase perioperative surgical complications in patients with inflammatory bowel disease, cohort study. Intest Res 2021; 20:72-77. [PMID: 33525861 PMCID: PMC8831769 DOI: 10.5217/ir.2020.00117] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background/Aims Biologics are increasingly used to manage ulcerative colitis (UC) and Crohn’s disease (CD). However, even with earlier usage of biologic therapy, a significant proportion of patients will require surgery. Vedolizumab is an anti-integrin antibody that is increasingly used given that it is more gut selective and associated with fewer side effects. The aim of this study is to assess the effect of vedolizumab compared to anti-tumor necrosis factor (anti-TNF) therapy on the perioperative complications in patients undergoing surgery for inflammatory bowel disease (IBD). Methods Retrospective review of patients treated for IBD at a tertiary care center between 2013 and 2017. Rates of 30- and 90-day complications for patients on vedolizumab were compared to patients on anti-TNF regimens. Results One hundred and ninety-nine patients met inclusion criteria with 87 (43%) patients undergoing surgery for CD, 111 (55.8%) for UC and 1 (0.5%) for indeterminate colitis. Thirty-eight patients received preoperative vedolizumab and 94 received anti-TNF. There were more males and lower body mass index in the anti-TNF group. There was no significant difference in overall rate of complications at 30 or 90 days. There was a trend for lower leak rate vedolizumab group (0% for vedolizumab vs. 2.1% for anti-TNF at 30 days, P = 1.00; 0% for vedolizumab vs. 1.1% for anti-TNF at 90 days, P = 1.00). Multivariate analysis showed low albumin (< 3.6 g/dL) at the time of surgery to be a significant risk factor for overall and infectious complications at 90 days (odds ratio, 3.24; 95% confidence interval, 1.12–8.79; P = 0.021). Conclusions Perioperative vedolizumab does not increase rates of perioperative complications in IBD surgery when compared to anti-TNF medications.
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Affiliation(s)
- Vitaliy Y Poylin
- Division of Gastrointestinal Surgery, Northwestern Medicine, Chicago, IL, USA
| | - Jose Cataneo Serrato
- Department of Surgery Advocate Illinois Masonic Medical Center, University of Illinois/Metropolitan Group Hospitals, Chicago, IL, USA
| | | | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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