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Darie AM, Sinopoulou V, Ajay V, Bel Kok K, Patel KV, Limdi J, Arebi N, Smith P, Din S, Din S, Shale M, Subramanian S, Pavlidis P, Cooney R, McGonagle D, A C S Wong N, Moran GW, Gordon M. BSG 2024 IBD guidelines protocol (standard operating procedures). BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001067. [PMID: 36764690 PMCID: PMC9923295 DOI: 10.1136/bmjgast-2022-001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION In the past 5 years, there have been several advances in the management of inflammatory bowel disease (IBD). We aim for a new guideline to update the most recent guideline published in 2019. We present the prospective operating procedure and technical summary protocol in the manuscript. METHODS 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) will be followed in the development of the guideline, approach as laid out in the GRADE handbook, supported by the WHO. The guideline development group is formed by a variety of disciplines, across both primary and secondary care that took part in an online Delphi process and split into key areas. A final consensus list of thematic questions within a 'patient, intervention, comparison, outcome' format has been produced and agreed in the final phase of the Delphi process.There will be a detailed technical evidence review with source data including systematic reviews appraised with AMSATAR 2 tool (Assessment of multiple systematic reviews), randomised controlled trial data that will be judged for risk of bias with the Cochrane tool and observational studies for safety concerns assessed through the Robins-I tool. Based on the available evidence, some of the recommendations will be based on GRADE while others will be best practice statements.A full Delphi process will be used to make recommendations using online response systems.This set of procedures has been approved by the Clinical Services and Standards Committee, the British Society of Gastroenterology executive board and aligned with IBD UK standards.
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Affiliation(s)
- Ana-Maria Darie
- Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Verma Ajay
- Digestive Disease, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jimmy Limdi
- Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Imperial College London, London, UK
| | - Philip Smith
- Gastroenterology, University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Shahida Din
- Gastroenterology, NHS Lothian Edinburgh, Western General Hospital, Clydebank, UK
| | - Said Din
- Gastroenterology, Derby Teaching Hospitals, NHS Foundation Trust, Derby, UK
| | - Matthew Shale
- Gastroenterology, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Sreedhar Subramanian
- Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Polychronis Pavlidis
- Gastroenterology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Dennis McGonagle
- Department of Rheumatology, Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Gordon W Moran
- Gastroenterology, NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals, Nottingham, UK
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
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Selinger CP, Bel Kok K, Limdi JK, Kent A, Cooney R, Nelson-Piercy C. Live vaccinations for infants exposed to maternal infliximab in utero and via breast milk - the need for nuanced decision making. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-001029. [PMID: 36216381 PMCID: PMC9557327 DOI: 10.1136/bmjgast-2022-001029] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust Gastroenterology, Manchester, UK,The University of Manchester, Manchester, UK
| | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, West Midlands, UK
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Kok KB, Byrne P, Ibarra AR, Martin P, Rampton DS. Understanding and managing psychological disorders in patients with inflammatory bowel disease: a practical guide. Frontline Gastroenterol 2022; 14:78-86. [PMID: 36561780 PMCID: PMC9763641 DOI: 10.1136/flgastro-2022-102094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
Mood disturbances such as anxiety and depression are common in patients with inflammatory bowel disease (IBD), and impact negatively on their quality of life and disease course. An integrated multidisciplinary IBD team, which includes access to psychology and psychiatry opinion, makes possible the prompt recognition and management of psychological disturbance in patients with IBD. Based on our experience and existing literature, including systematic reviews of the effectiveness of available treatment modalities, a stepwise approach to the maintenance and restoration of psychological well-being is recommended, evolving upwards from lifestyle advice, through behavioural therapies to pharmacotherapy.
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Affiliation(s)
- Klaartje Bel Kok
- Gastroenterology, Barts and The London NHS Trust, London, UK,Centre for Immunobiology, Barts and The London School of Medicine and Dentistry Blizard Institute, London, UK
| | - Peter Byrne
- Gastroenterology, Barts and The London NHS Trust, London, UK
| | - Ana R Ibarra
- Gastroenterology, Barts and The London NHS Trust, London, UK
| | - Peter Martin
- Gastroenterology, Barts and The London NHS Trust, London, UK
| | - David S Rampton
- Gastroenterology, Barts and The London NHS Trust, London, UK
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Honap S, Al-Hillawi L, Baillie S, Bancil A, Matini L, Lau R, Kok KB, Patel K, Walsh A, Irving PM, Samaan MA. Ustekinumab for the treatment of moderate to severe ulcerative colitis: a multicentre UK cohort study. Frontline Gastroenterol 2022; 13:517-523. [PMID: 36250172 PMCID: PMC9555129 DOI: 10.1136/flgastro-2022-102168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Ustekinumab is an interleukin-12/interleukin-23 receptor antagonist licensed for the treatment of ulcerative colitis (UC). Clinical trial data were promising; however, real-world data are limited. We assessed the safety and effectiveness of ustekinumab in UC in a real-world setting. DESIGN/METHOD This was a multicentre, retrospective, observational cohort study between February 2020 and January 2022. Disease activity was assessed using the Simple Clinical Colitis Activity Index (SCCAI). Clinical remission was defined as a SCCAI≤2. The primary endpoints were rates of corticosteroid-free remission (CSFR) at week 16 and at week 26. Objective outcomes, including faecal calprotectin (FCAL), were also collected. RESULTS 110 patients with UC (65% male; median age 40 (IQR range 29-59); 96% with prior biologic and/or tofacitinib exposure) had a median follow-up of 28 weeks (IQR 17-47). CSFR was 36% (18/50) at week 16% and 33% (13/39) at week 26, corresponding with a significant fall in SCCAI from 6 (IQR 4-8) at baseline to 3 (IQR 0-5) at week 26, p<0.001. By week 16, there was improvement of median FCAL measurements, which fell from a baseline of 610 µg/g (IQR 333-1100) to 102 µg/g (IQR 54-674) at week 16. At the end of follow-up, 15% (17/110) had discontinued treatment; 13 patients due to primary non-response or loss of response, and 1 patient for family planning. Treatment was discontinued in three patients due to adverse events. CONCLUSION In the largest real-world study to date, ustekinumab was effective with a reassuring safety profile in a refractory cohort of patients.
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Affiliation(s)
- Sailish Honap
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Lulia Al-Hillawi
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Aaron Bancil
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Lawrence Matini
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rebecca Lau
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alissa Walsh
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter M Irving
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Mark A Samaan
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Miller C, Kwok H, Harrow P, Vega R, Seward E, Mehta S, Rahman F, McCartney S, Parisi I, Lim SH, Sharma E, Samaan MA, Bancil A, Kok KB, Shalabi A, Johnston EL, Katarey D, Taherzadeh N, Murray C, Sharip MT, Carter MJ, Radhakrishnan ST, Peake S, Khakoo I, Wahed M, Povlsen S, Patel M, DuBois P, Finkel J, Onnie C, Bloom S. Comparative effectiveness of a second-line biologic in patients with ulcerative colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab. Frontline Gastroenterol 2022; 13:392-401. [PMID: 36051959 PMCID: PMC9380760 DOI: 10.1136/flgastro-2021-101906] [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: 05/10/2021] [Accepted: 10/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sequential drug treatment with biological agents in ulcerative colitis (UC) is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second-line treatments. The study assesses whether using anti-tumour necrosis factor (anti-TNF)-α therapy following the α4β7 integrin blocker vedolizumab (VDZ) or VDZ after an anti-TNF has more favourable clinical outcomes in UC in a real-world outpatient setting. METHODS Patients with UC who were exposed to first-line anti-TNF (adalimumab or infliximab) or VDZ who subsequently switched to the alternate class between May 2013 and August 2020 were identified by reviewing patient databases at 10 hospitals. Data were collected retrospectively using patient records. Baseline demographics, disease activity indices, biochemical markers, endoscopic Mayo score, colectomy rates, treatment persistence and urgent hospital utilisation composite endpoint (UHUC) rates were examined over a 52-week period. RESULTS Second-line week 52 treatment persistence was higher in the VDZ group (71/81, 89%) versus the anti-TNF group (15/34, 44%; p=0.0001), as were week 52 colectomy-free survival (VDZ: 77/80, 96%, vs anti-TNF: 26/32, 81%; p=0.009), week 52 UHUC survival (VDZ: 68/84, 81%, vs anti-TNF: 20/34, 59%; p=0.002) and week 52 corticosteroid-free clinical remission (CFCR) rates (VDZ: 22/34, 65%, vs anti-TNF: 4/20, 20%; p=0.001). CONCLUSION Compared with second-line anti TNF usage, the VDZ second-line cohort had significantly higher 52-week treatment persistence, UHUC survival, higher colectomy-free survival rates and higher week 52 CFCR. These data suggest that VDZ is an effective biologic in UC as a second-line therapy after anti-TNF exposure. It highlights the effect of biological order on clinically important outcomes.
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Affiliation(s)
- Charles Miller
- Department of Gastroenterology, University College Hospital, London, UK
| | - Hanson Kwok
- Department of Gastroenterology, University College Hospital, London, UK
| | - Paul Harrow
- Department of Gastroenterology, University College Hospital, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College Hospital, London, UK
| | - Edward Seward
- Department of Gastroenterology, University College Hospital, London, UK
| | - Shameer Mehta
- Department of Gastroenterology, University College Hospital, London, UK
| | - Farooq Rahman
- Department of Gastroenterology, University College Hospital, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Ioanna Parisi
- Department of Gastroenterology, University College Hospital, London, UK
| | - Samuel Hsiang Lim
- Department of Gastroenterology, Guy's and Thomas' Hospital, London, UK
| | - Esha Sharma
- Department of Gastroenterology, Guy's and Thomas' Hospital, London, UK
| | - Mark A Samaan
- Department of Gastroenterology, Guy's and Thomas' Hospital, London, UK
| | - Aaron Bancil
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Ahmed Shalabi
- Department of Gastroenterology, West Middlesex Hospital, London, UK
| | - Emma L Johnston
- Department of Gastroenterology, West Middlesex Hospital, London, UK
| | - Dev Katarey
- Department of Gastroenterology, Royal Free Hospital London, London, UK
| | - Nina Taherzadeh
- Department of Gastroenterology, Royal Free Hospital London, London, UK
| | - Charles Murray
- Department of Gastroenterology, Royal Free Hospital London, London, UK
| | | | - Martyn J Carter
- Department of Gastroenterology, Lister Hospital, Stevenage, UK
| | - Shiva T Radhakrishnan
- Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Peake
- Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Imran Khakoo
- Departments of Gastroenterology, Chelsea and Westminster Hospital, London, UK
| | - Mahmood Wahed
- Departments of Gastroenterology, Chelsea and Westminster Hospital, London, UK
| | | | - Mehul Patel
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Patrick DuBois
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Jemima Finkel
- Department of Gastroenterology, Whittington Hospital, London, UK
| | - Clive Onnie
- Department of Gastroenterology, Whittington Hospital, London, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
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Selinger CP, Fraser A, Collins P, Gunn M, Chew TS, Kerry G, Patel KV, Roysam M, Bel Kok K, Bancil A, Hall V, Cooney R, Smith L, Steed H, Segal J, Kent A, Limdi J, Sebastian S. Impact of the coronavirus infectious disease (COVID-19) pandemic on the provision of inflammatory bowel disease (IBD) antenatal care and outcomes of pregnancies in women with IBD. BMJ Open Gastroenterol 2021; 8:e000603. [PMID: 33753426 PMCID: PMC7985978 DOI: 10.1136/bmjgast-2021-000603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes. METHODS Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters. RESULTS We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded. CONCLUSION IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.
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Affiliation(s)
| | - Aileen Fraser
- Department of Gastroenterology, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Paul Collins
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Melanie Gunn
- Department of Gastroenterology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Thean Soon Chew
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Kerry
- Department of Gastroenterology, St Georges Hospital, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St Georges Hospital, London, UK
| | - Maya Roysam
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Aaron Bancil
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Veronica Hall
- Department of Gastroenterology, Bolton NHS Foundation Trust, Bolton, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Lyn Smith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Helen Steed
- Gastroenterology, University of Wolverhampton, Wolverhampton, UK
| | - Jonathan Segal
- Department of Gastroenterology, The Hillingdon Hospital, Uxbridge, UK
| | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jimmy Limdi
- Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
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Selinger CP, Nelson-Piercy C, Fraser A, Hall V, Limdi J, Smith L, Smith M, Nasur R, Gunn M, King A, Mohan A, Mulgabal K, Kent A, Kok KB, Glanville T. IBD in pregnancy: recent advances, practical management. Frontline Gastroenterol 2020; 12:214-224. [PMID: 33912333 PMCID: PMC8040511 DOI: 10.1136/flgastro-2019-101371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) poses complex issues in pregnancy, but with high-quality care excellent pregnancy outcomes are achievable. In this article, we review the current evidence and recommendations for pregnant women with IBD and aim to provide guidance for clinicians involved in their care. Many women with IBD have poor knowledge about pregnancy-related issues and a substantial minority remains voluntarily childless. Active IBD is associated with an increased risk of preterm birth, low for gestation weight and fetal loss. With the exception of methotrexate and tofacitinib the risk of a flare outweighs the risk of IBD medication and maintenance of remission from IBD should be the main of care. Most women with IBD will experience a normal pregnancy and can have a vaginal delivery. Active perianal Crohn's disease is an absolute and ileal pouch surgery a relative indication for a caesarean section. Breast feeding is beneficial to the infant and the risk from most IBD medications is negligible.
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Affiliation(s)
| | | | - Aileen Fraser
- Gastroenterology, United Hospitals Bristol, Bristol, Avon, UK
| | - Veronica Hall
- Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
| | - Jimmy Limdi
- Section of iBD- Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Lyn Smith
- Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
| | - Marie Smith
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Reem Nasur
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Melanie Gunn
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Andrew King
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Aarthi Mohan
- Obstetrics, United Hospitals Bristol, Bristol, Avon, UK
| | | | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
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Selinger C, Carey N, Cassere S, Nelson-Piercy C, Fraser A, Hall V, Harding K, Limdi J, Smith L, Smith M, Gunn MC, Mohan A, Mulgabal K, Kent A, Kok KB, Glanville T. Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society. Frontline Gastroenterol 2020; 12:182-187. [PMID: 33912332 PMCID: PMC8040496 DOI: 10.1136/flgastro-2020-101459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD. AIM To develop a position statement on service set-up and minimum standards of care in the UK. METHODS A working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters' feedback after each round. Statements with ≥80% agreement were accepted. RESULTS All 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended. CONCLUSION Position statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.
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Affiliation(s)
- Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicola Carey
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Aileen Fraser
- Gastroenterology, United Hospitals Bristol, Bristol, UK
| | - Veronica Hall
- Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
| | - Kate Harding
- Obstetrics, Guy’s and Saint Thomas’ Hospitals NHS Trust, London, UK
| | - Jimmy Limdi
- Section of IBD—Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Lyn Smith
- Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
| | - Marie Smith
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Melanie Catherine Gunn
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aarthi Mohan
- Obstetrics, United Hospitals Bristol, Bristol, UK
| | | | - Alexandra Kent
- Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
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9
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Ibraheim H, Samaan MA, Srinivasan A, Brain O, Digby-Bell J, Irving PM, Norman I, Jawad I, Biedermann J, Ibarra A, Kok KB, Parkes G, Rimmer J, Compot E, Parkes M, Segal J, Oppong P, Hart A, Hayee B, Powell N. Effectiveness and safety of vedolizumab in inflammatory bowel disease patients aged 60 and over: an observational multicenter UK experience. Ann Gastroenterol 2020; 33:170-177. [PMID: 32127738 PMCID: PMC7049246 DOI: 10.20524/aog.2020.0447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022] Open
Abstract
Background The GEMINI trials established the efficacy of vedolizumab in moderate-to-severe inflammatory bowel disease (IBD) and demonstrated a favorable safety profile, suggesting it may be advantageous in older patients at greater risk of treatment-related complications. However, there is a paucity of data exploring the outcomes of vedolizumab in this group. Our objective was to determine the clinical effectiveness and safety of vedolizumab in older IBD patients within a real-world multicenter UK cohort. Methods A retrospective review of electronic records across 6 UK hospitals was undertaken to evaluate the clinical effectiveness and safety outcomes of vedolizumab in IBD patients aged ≥60 at start of therapy. Rates of clinical response, remission and corticosteroid-free remission were assessed at weeks 14 and 52, using validated clinical indices, and were compared to historical controls from real-world vedolizumab-treated cohorts unstratified by age. Results Of 74 patients aged 60 years or above (median 66 years), 48 were included in our effectiveness analysis (29 ulcerative colitis, 19 Crohn’s disease). Rates of clinical response, remission and corticosteroid-free remission at week 14 were 64%, 48% and 30%, respectively. By week 52, the rates of clinical response, remission, and corticosteroid-free remission were 52%, 38%, and 32%, respectively. Six (8%) patients experienced adverse effects. Effectiveness and safety outcomes were comparable to those of age-unstratified vedolizumab-treated cohorts. Conclusion Our 1-year outcome data suggests that vedolizumab is safe and effective in older IBD patients and broadly comparable to cohorts unselected by age.
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Affiliation(s)
- Hajir Ibraheim
- IBD Centre, Guy's and St. Thomas' NHS Foundation Trust, London (Hajir Ibraheim, Mark A. Samaan, Jonathan Digby-Bell, Peter M. Irving, Irena Norman, Nick Powell).,Centre for Inflammation Biology and Cancer Immunology (CIBCI), King's College London (Hajir Ibraheim, Nick Powell)
| | - Mark A Samaan
- IBD Centre, Guy's and St. Thomas' NHS Foundation Trust, London (Hajir Ibraheim, Mark A. Samaan, Jonathan Digby-Bell, Peter M. Irving, Irena Norman, Nick Powell)
| | - Ashish Srinivasan
- Translational Gastroenterology Unit, Oxford University Hospitals Trust, Oxford (Ashish Srinivasan, Oliver Brain)
| | - Oliver Brain
- Translational Gastroenterology Unit, Oxford University Hospitals Trust, Oxford (Ashish Srinivasan, Oliver Brain)
| | - Jonathan Digby-Bell
- IBD Centre, Guy's and St. Thomas' NHS Foundation Trust, London (Hajir Ibraheim, Mark A. Samaan, Jonathan Digby-Bell, Peter M. Irving, Irena Norman, Nick Powell)
| | - Peter M Irving
- IBD Centre, Guy's and St. Thomas' NHS Foundation Trust, London (Hajir Ibraheim, Mark A. Samaan, Jonathan Digby-Bell, Peter M. Irving, Irena Norman, Nick Powell)
| | - Irena Norman
- IBD Centre, Guy's and St. Thomas' NHS Foundation Trust, London (Hajir Ibraheim, Mark A. Samaan, Jonathan Digby-Bell, Peter M. Irving, Irena Norman, Nick Powell)
| | - Issrah Jawad
- Department of Gastroenterology, University College London Hospital, London (Issrah Jawad)
| | - Julia Biedermann
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London (Julia Biedermann, Bu'Hussain Hayee)
| | - Ana Ibarra
- Department of Gastroenterology, Barts Health NHS Trust, London (Ana Ibarra, Klaartje Bel Kok, Gareth Parkes)
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London (Ana Ibarra, Klaartje Bel Kok, Gareth Parkes)
| | - Gareth Parkes
- Department of Gastroenterology, Barts Health NHS Trust, London (Ana Ibarra, Klaartje Bel Kok, Gareth Parkes)
| | - Joanna Rimmer
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge (Joanna Rimmer, Elisabeta Compot, Miles Parkes)
| | - Elisabeta Compot
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge (Joanna Rimmer, Elisabeta Compot, Miles Parkes)
| | - Miles Parkes
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge (Joanna Rimmer, Elisabeta Compot, Miles Parkes)
| | - Jonathan Segal
- St. Mark's Hospital, IBD Unit, Harrow, London (Jonathan Segal, Philip Oppong, Ailsa Hart).,Division of Integrative Systems Medicine and Digestive disease, Department of Surgery and Cancer, Faculty of medicine, Imperial College London, London (Jonathan Segal, Ailsa Hart), UK
| | - Philip Oppong
- St. Mark's Hospital, IBD Unit, Harrow, London (Jonathan Segal, Philip Oppong, Ailsa Hart)
| | - Ailsa Hart
- St. Mark's Hospital, IBD Unit, Harrow, London (Jonathan Segal, Philip Oppong, Ailsa Hart).,Division of Integrative Systems Medicine and Digestive disease, Department of Surgery and Cancer, Faculty of medicine, Imperial College London, London (Jonathan Segal, Ailsa Hart), UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London (Julia Biedermann, Bu'Hussain Hayee)
| | - Nick Powell
- IBD Centre, Guy's and St. Thomas' NHS Foundation Trust, London (Hajir Ibraheim, Mark A. Samaan, Jonathan Digby-Bell, Peter M. Irving, Irena Norman, Nick Powell).,Centre for Inflammation Biology and Cancer Immunology (CIBCI), King's College London (Hajir Ibraheim, Nick Powell)
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