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Hoang TT, Leung Y, Rosenfeld G, Bressler B. High-definition chromoendoscopy results in more significant dysplasia detection than white light endoscopy with random biopsies in ulcerative colitis patients: A single-center retrospective study. Medicine (Baltimore) 2024; 103:e36836. [PMID: 38306575 PMCID: PMC10843359 DOI: 10.1097/md.0000000000036836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/12/2023] [Indexed: 02/04/2024] Open
Abstract
The goal of this study was to determine whether high-definition white light endoscopy with random biopsies (HD-WLR) or chromoendoscopy (HDCE) yielded a higher dysplasia detection rate in ulcerative colitis patients. Ulcerative colitis (UC) patients have a 2.4-fold increased future risk of developing colorectal cancer compared to the general population and require careful dysplasia screening modalities. Both HD-WLR and HDCE are regularly used, and recent guidelines do not suggest a preference. UC patients who underwent dysplasia surveillance at our site between January 2019 and 2021 were retrospectively reviewed. We calculated the dysplasia detection rate of both techniques at the first CRC screening colonoscopy. Eighteen dysplastic lesions were detected in total, 3 by HD-WLR and fifteen by HDCE. Dysplasia was detected in 4% (3/75) and 20% (15/75) of UC patients by HD-WLR and HDCE respectively, with significantly fewer biopsies (4.44 ± 4.3 vs 29.1 ± 13.0) required using the former. HD-WLR detected 2 polypoid and one non-polypoid lesion, while HDCE detected eleven polypoid and 4 non-polypoid lesions. No invisible dysplasia or colorectal cancer was detected. Screening was performed at 10.8 ± 4.8 and 9.72 ± 3.05 years following UC diagnosis for HDCE and HD-WLR respectively. Median withdrawal time was 9.0 ± 2.7 minutes (HD-WLR) vs 9.6 + 3.9 minutes (HDCE). HDCE is associated with higher dysplasia detection rates compared to HD-WLR in a UC patient population. Given the former technique is less tedious and costly, our findings complement existing studies that suggest HDCE may be considered over HD-WLR for UC dysplasia surveillance.
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Affiliation(s)
- Thomas T. Hoang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Yvette Leung
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Gregory Rosenfeld
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Brian Bressler
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Squirell E, Meade S, Leung Y. The Fundamentals of Inflammatory Bowel Disease Management in Pregnancy: A Practical Review for the Gastroenterologist. J Can Assoc Gastroenterol 2024; 7:121-131. [PMID: 38314178 PMCID: PMC10836983 DOI: 10.1093/jcag/gwad056] [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] [Indexed: 02/06/2024] Open
Abstract
This narrative review explores the management of Inflammatory Bowel Disease (IBD) during pregnancy, emphasizing its unique challenges to maternal and fetal health, particularly within the Canadian Gastroenterology setting. Seven key principles are highlighted: 1) Preconception counselling, aiming for steroid-free remission confirmed by objective markers, should be routine for female IBD patients. 2) Medication safety, with an eye to future pregnancies, should be addressed upon initiation. Methotrexate and small molecules are contraindicated during pregnancy, while most 5-ASA therapies, biologics, and thiopurines can be continued throughout pregnancy and breastfeeding. Steroids, though not without risks, can be utilized if necessary. 3) Routine monitoring during remission should include serum biomarkers and fecal calprotectin each trimester. 4) Routine endoscopy and imaging are not required, but if indicated, lower GI endoscopy, ultrasound, and unenhanced MRI can be used. Computed tomography and gadolinium enhanced MRI should be avoided. 5) Caesarean section is advised for patients with previous ileal pouch surgeries or active perianal disease, but other patients should follow obstetric indications for delivery. 6) Postpartum period may see more active disease, requiring continued monitoring. Breastfeeding is encouraged, and routine childhood vaccinations are advised, but live vaccinations in the first 6 months warrant detailed review. 7) Complex IBD patients may benefit from a multidisciplinary approach with robust communication between gastroenterologists and obstetricians.
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Affiliation(s)
| | - Susanna Meade
- Department of Gastroenterology, North Bristol NHS Trust, BS105NBUK
| | - Yvette Leung
- IBD Centre of BC, Department of Medicine, Division of Gastroenterology, University of British Columbia, V6Z 2L2Canada
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Yeaman F, Stritzke A, Kuret V, Sharifi N, Seow CH, Metcalfe A, Leung Y. Thiopurine Exposure During Pregnancy is Not Associated With Anemia in Infants Born to Mothers With IBD. Crohns Colitis 360 2023; 5:otad066. [PMID: 37941596 PMCID: PMC10629965 DOI: 10.1093/crocol/otad066] [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: 07/26/2023] [Indexed: 11/10/2023] Open
Abstract
Background Thiopurines are commonly used to treat inflammatory bowel disease (IBD). Thiopurines are considered safe throughout pregnancy. However, a published study suggested the risk of neonatal anemia was increased if exposed to thiopurines in utero. This prospective cohort study aimed to determine if there is an increased risk of cytopenia among infants born to pregnant people with IBD, exposed or unexposed to thiopurines, compared to infants born to those without IBD. Methods Pregnant IBD patients, with and without thiopurine exposure, and one cohort of control individuals were recruited over a 5-year period. Consenting individuals completed a questionnaire and infants had a complete blood cell count at the newborn heel prick. Anemia was defined as hemoglobin (Hb) < 140g/L. Descriptive statistics were used to characterize the study population. Fisher exact tests were used to examine differences in outcomes between groups, a P-value of < 0.05 was deemed significant. Results Three cohorts were recruited: 19 IBD patients on thiopurines, 50 IBD patients not on thiopurines, and 37 controls (total of 106). Neonatal median Hb was not different with 177g/L (IQR 38g/L) for the IBD thiopurine group, 180.5g/L (IQR 40g/L) for the IBD non-thiopurine group, and 181g/L (IQR 37g/L) for the controls. Nineteen infants (18%) were cytopenic with 12 (11%) anemic, 6 (5.6%) thrombocytopenic, and 1 (0.94%) lymphopenic. Thiopurine exposure was only in one, mildly anemic, infant. Conclusions These findings further support physicians and IBD patients contemplating pregnancy that current guidelines recommending thiopurine adherence do not lead to increased perinatal risk of anemia or cytopenia.
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Affiliation(s)
- Fiona Yeaman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Internal Medicine, University of Western Australia, Perth, WA, Australia
| | - Amelie Stritzke
- Department of Pediatrics University of Calgary, Calgary, AB, Canada
| | - Verena Kuret
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Nastaran Sharifi
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences; University of Calgary, Calgary, AB, Canada
| | - Amy Metcalfe
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences; University of Calgary, Calgary, AB, Canada
| | - Yvette Leung
- Department of Medicine and Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
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Sharma S, Mathias H, Jones E, Heisler C, Rohatinsky N, Novak K, Leung Y, Fowler S, Kaczur M, Targownik L, Jones JL. Time for a Gut Check: A Qualitative Study of Proposed Interventions to Address Gender Inequality in Gastroenterology. J Can Assoc Gastroenterol 2023; 6:155-161. [PMID: 37811530 PMCID: PMC10558195 DOI: 10.1093/jcag/gwad022] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Background Gender inequalities persist in medicine, particularly in some speciality fields where fewer women are employed. Although previous research has suggested potential interventions to broadly address gender inequality in medicine, no research has focused on interventions in the field of gastroenterology. The purpose of this research was to engage women in the field of gastroenterology in Canada, to identify interventions with potential to be effective in addressing gender inequality. Methods A World Café was hosted in 2019 to discuss gender inequality and interventions in gastroenterology. Twelve women employed in the field of gastroenterology (i.e. physicians, nurses, research staff, and trainees) were purposively recruited and participated in the event. The discussion rounds were audio-recorded, transcribed, and thematic analyses was conducted using Braun and Clarke's principles. Results Three key themes identifying potential interventions to address gender inequality in gastroenterology were generated: (1) Education; (2) Addressing institutional structures and polices; and 3) Role modelling and mentorship. Participants indicated that interventions should target various stakeholders, including both women and men in gastroenterology, young girls, patients, and administrators. Conclusion Many of the interventions identified by participants correspond with existing research on interventions in general medicine, suggesting that institutional changes can be made for maximum effectiveness. Some novel interventions were also identified, including publicizing instances of gender parity and supporting interventions across the educational and professional lifecourse. Moving forward, institutions must assess their readiness for change and evaluate existing policies, programs, and practices for areas of improvement.
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Affiliation(s)
- Sowmya Sharma
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore 21231, USA
| | - Holly Mathias
- School of Public Health, University of Alberta, Edmonton T6G 2R3, Canada
| | - Emma Jones
- Department of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Halifax B3H 1V7, Canada
| | - Courtney Heisler
- Department of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Halifax B3H 1V7, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon S7N 2Z4, Canada
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary T2N 4Z5, Canada
| | - Yvette Leung
- Department of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver V5Z 1M9, Canada
| | - Sharyle Fowler
- Division of Gastroenterology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon S7N 0W8, Canada
| | - Melaine Kaczur
- Canadian Hub for Applied and Social Research, University of Saskatchewan, Saskatoon S7N 5B5, Canada
| | - Laura Targownik
- Department of Gastroenterology, University of Toronto, Toronto M5G 1X5, Canada
- Department of Gastroenterology, University of Manitoba, Winnipeg R3E 3P4, Canada
| | - Jennifer L Jones
- Department of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Halifax B3H 1V7, Canada
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Lo HY, Fung KFK, Yam F, Leung Y, Liu A, Cheng KK, Cho D, Kan EYL, Chao N. Height-based formulas for predicting intravascular length of tunnelled neck central venous catheter in paediatric population. Pediatr Surg Int 2023; 39:262. [PMID: 37668756 DOI: 10.1007/s00383-023-05537-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure. METHODS 124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children's Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites-9 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes. RESULT The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1 cm in 70% of CVC with mean absolute difference of 0.63 cm (SD 0.48 cm), and the RIJV formula was predictive of intravascular CVC length within 1 cm in 80% of CVC with mean absolute difference of 0.67 cm (SD 0.53 cm). CONCLUSION Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.
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Affiliation(s)
- H Y Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China.
| | - K F K Fung
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - F Yam
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Y Leung
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - A Liu
- Department of Paediatrics, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K K Cheng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - D Cho
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - E Y L Kan
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - N Chao
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
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Lee S, Seow CH, Nerenberg K, Bertazzon S, Leung Y, Huang V, Whitten T, Coward S, Panaccione R, Kaplan GG, Metcalfe A. Despite Increased Disease Activity, Women who Attended a Dedicated Inflammatory Bowel Disease and Pregnancy Clinic Had Infants With Higher Apgar Scores: A Population-Based Study. Inflamm Bowel Dis 2023:izad147. [PMID: 37499061 DOI: 10.1093/ibd/izad147] [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: 01/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Attendance at a subspecialty pregnancy clinic for women with inflammatory bowel disease (IBD) improves disease-specific pregnancy knowledge. We examined the impact of attendance at a dedicated IBD-pregnancy clinic on IBD and perinatal outcomes. METHODS Using linked administrative databases in Alberta, Canada (2012-2019), we identified 1061 pregnant women with IBD who delivered singleton liveborn infants in-hospital who did (n = 314) and did not attend (n = 747) the clinic. Propensity score weighted multivariable log-binomial and multinomial logistic regression models were used to determine the risk of IBD and perinatal outcomes. RESULTS The median number of clinic visits was 3 (Q1-Q3, 3-5), with 34.7% completing a preconception consultation. A greater proportion of women who attended lived near the clinic, were nulliparous, had a disease flare prior to pregnancy, and were on maintenance IBD medication (P < .05). Women who attended had increased risks of a disease flare during pregnancy (adjusted risk ratio [aRR], 2.02; 95% CI, 1.45-2.82), an IBD-related emergency department visit during pregnancy (aRR, 2.66; 95% CI, 1.92-3.68), and cesarean delivery (aRR, 1.78; 95% CI, 1.23-2.57). Despite this, clinic attendees had a decreased risk of delivering an infant with a low Apgar score at 1 minute (risk ratio [RR], 0.49; 95% CI, 0.32-0.76) and 5 minutes (RR, 0.32; 95% CI, 0.12-0.87). CONCLUSIONS Women who attended a dedicated IBD-pregnancy clinic were more likely to have a disease flare prior to pregnancy, reflecting a more severe disease phenotype, but had similar perinatal outcomes and infants with better Apgar scores at birth. Our study suggests the value of these subspecialty clinics in providing enhanced IBD-specific prenatal care.
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Affiliation(s)
- Sangmin Lee
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Stefania Bertazzon
- Department of Geography, University of Calgary, Calgary, Alberta, Canada
| | - Yvette Leung
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vivian Huang
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tara Whitten
- Provincial Research Data Services, Alberta Health Services, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data and Research Services Platform, Alberta, Canada
| | - Stephanie Coward
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Hoang TT, Leung Y, Rosenfeld G, Bressler B. A200 HIGH-DEFINITION CHROMOENDOSCOPY RESULTS IN MORE SIGNIFICANT DYSPLASIA DETECTION THAN WHITE LIGHT ENDOSCOPY WITH RANDOM BIOPSIES IN ULCERATIVE COLITIS PATIENTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991159 DOI: 10.1093/jcag/gwac036.200] [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: 03/09/2023] Open
Abstract
Background Ulcerative colitis (UC) is an inflammatory bowel disease that results in inflammation of the colonic mucosa, leading to abdominal pain, rectal bleeding, weight loss, and diarrhea. This chronic inflammation results in a 2.4-fold increased future risk of developing colorectal cancer (CRC) in UC patients compared to the general population. Thus, careful dysplasia screening modalities are required to prevent progression to CRC. Currently, both high-definition white light endoscopy with non-targeted biopsies (HD-WLR) and dye-spray chromoendoscopy (HDCE) are regularly used across Canada for dysplasia surveillance given existing research has been inconclusive regarding superiority of one particular method, and that recent guidelines do not suggest a preference. Purpose The primary objective of this study was to determine which surveillance modality yielded a higher dysplasia detection rate in UC patients, both by calculating the total number of dysplastic lesions detected, as well as calculating the number of patients with at least one dysplastic lesion detected using either technique. Method We conducted a single-centre retrospective chart review of 150 UC patients who underwent dysplasia surveillance at our site between January 2019-2021. We calculated the dysplasia detection rate of both techniques at the time of the first CRC screening colonoscopy. Result(s) Eighteen dysplastic lesions were detected in total, three by HD-WLR and fifteen by HDCE. Dysplasia was detected in 4% (3/75) and 14.5% (15/75) of UC patients by HD-WLR and HDCE respectively, with significantly fewer biopsies (4.44 + 4.3 vs 29.1 + 13.0) required. HD-WLR detected two polypoid and one non-polypoid lesion, while HDCE detected eleven polypoid and four non-polypoid lesions. No invisible dysplasia or colorectal cancer was detected. Screening was performed at 10.8 + 4.8 and 9.72 + 3.05 years following UC diagnosis for HDCE and HD-WLR respectively. Median withdrawal time was 9.0 + 2.7 min (HD-WLR) vs 9.6 + 3.9min (HDCE). Image ![]()
Conclusion(s) HDCE resulted in higher dysplasia detection rates compared to HD-WLR in a UC patient population. Given the former technique is less tedious and costly, our findings suggest HDCE should be considered over HD-WLR for UC dysplasia surveillance. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- T T Hoang
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Y Leung
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Rosenfeld
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - B Bressler
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, Canada
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Bedi H, Rosenfeld D, Hoang T, Reise-Filteau M, Bressler B, Leung Y, Singh S, Rosenfeld G. A175 REAL-WORLD EXPERIENCE ON SWITCHING FROM ADALIMUMAB TO BIOSIMILARS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE – AN OBSERVATIONAL STUDY FROM THREE TERTIARY CARE CENTRES. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991257 DOI: 10.1093/jcag/gwac036.175] [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: 03/09/2023] Open
Abstract
Background Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition of the bowel which includes ulcerative colitis (UC), Crohn’s disease (CD) or unspecific IBD (IBDu). Adalimumab (ADA), a humanized monoclonal IgG antibody against tumour necrosis factor-alpha (TNFa), is an effective treatment for IBD. HumiraTM is an anti-TNFa agent that was approved by Health Canada for the treatment of IBD. In May of 2019, the British Columbia government pharmaceutical benefit plan implemented a biosimilar initiative in May 2019, mandating a non-medical switch from HumiraTM to one of the biosimilar drugs. Purpose We aimed to evaluate the real-world experience on the comparative safety and effectiveness of adalimumab biosimilar therapy after a mandatory, non-medical switch. Method We performed a retrospective chart review of all patients with IBD who either remained on HumiraTM or were switched to an adalimumab biosimilar agent, Idacio, at three tertiary care centres. Patients’ demographic data, disease status including CRP and fecal calprotectin before and after switch, and hospital visits or admission after switch were collected. Statistical analysis was performed using ANOVA and t-test. Result(s) Of the 191 patients included in the study, 145 patients underwent the provincial mandated switch from HumiraTM to a biosimilar agent, Idacio® , whereas 46 patients remained on HumiraTM. The median age at IBD diagnosis was 27 years (range 3-76 years), and at biosimilar switch was 43.5 years (15-78 years). Median disease duration prior to biosimilar switch was 13.5 years (range 0-69 years). 55.1% of patients were male, and 12.9% of patients were active smokers. CD was found in 78.9% of patients, and 19.9% of patients had UC. After biosimilar switch, adverse events, such as rash, nausea, or vomiting, were noted in 10 patients in the biosimilar group, and 7 patients required switch back to HumiraTM. All patients in the HumiraTM group stayed on that therapy. One patient stopped the biosimilar agent due to development of a new cancer requiring chemotherapy. None of the patients required IBD-related emergency department visit or hospital admission. Additionally, there was no difference in CRP or fecal calprotectin values measured before and after the biosimilar switch, and when compared to the patients who stayed on HumiraTM (p=0.48, and p=0.142, respectively). Conclusion(s) We conclude that the clinical benefit of HumiraTM was sustained after a non-medical switch to an adalimumab biosimilar. There was no risk of relapse, emergency visit, or hospital admission seen in this study. This is the first Canadian study to establish the safety and efficacy of switch to non-medical switch to an adalimumab biosimilar agent. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- H Bedi
- Gastroenterology, University of British Columbia, Vancouver
| | | | - T Hoang
- Medicine, University of British Columbia
| | | | - B Bressler
- Gastroenterology, University of British Columbia, Vancouver,Gastroenterology , St. Paul's Hospital, Vancouver
| | - Y Leung
- Gastroenterology, University of British Columbia, Vancouver,Gastroenterology , St. Paul's Hospital, Vancouver
| | - S Singh
- Gastroenterology, University of British Columbia,Gastroenterology, Kelowna General Hospital , Kelowna, Canada
| | - G Rosenfeld
- Gastroenterology, University of British Columbia, Vancouver,Gastroenterology , St. Paul's Hospital, Vancouver
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Sandborn WJ, Sands BE, Vermeire S, Leung Y, Guo X, Modesto I, Su C, Wang W, Panés J. Modified Mayo score versus Mayo score for evaluation of treatment efficacy in patients with ulcerative colitis: data from the tofacitinib OCTAVE program. Therap Adv Gastroenterol 2022; 15:17562848221136331. [PMID: 36506749 PMCID: PMC9726836 DOI: 10.1177/17562848221136331] [Citation(s) in RCA: 4] [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: 06/10/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The subjectivity of the Physician Global Assessment (PGA) is a limitation of the Mayo score in assessing severity of ulcerative colitis (UC). We compared treatment efficacy using endpoint definitions based on modified Mayo (mMayo) score, versus those based on Mayo score, using data from the tofacitinib OCTAVE program. DESIGN This post hoc analysis included data from two 8-week induction studies (OCTAVE Induction 1 and 2) and a 52-week maintenance study (OCTAVE Sustain). METHODS Remission and clinical response [with nonresponder imputation (NRI)] were assessed using mMayo (without PGA) and Mayo scores, and further stratified by prior tumor necrosis factor inhibitor (TNFi) failure status. RESULTS At week 8 of OCTAVE Induction 1 and 2, remission rates with placebo and tofacitinib 10 mg twice daily (BID), respectively, were 7.7% and 24.8% (mMayo) and 6.0% and 17.6% (Mayo). At week 52 of OCTAVE Sustain, remission rates with placebo, tofacitinib 5 and 10 mg BID, respectively, were 12.1%, 35.9%, and 42.1% (mMayo) and 11.1%, 34.3%, and 40.6% (Mayo). A statistically significant (p < 0.05) treatment effect of tofacitinib versus placebo was observed for remission and clinical response at all time points, regardless of scoring definition or prior TNFi failure status. CONCLUSIONS A significant effect of tofacitinib versus placebo was demonstrated across efficacy endpoints using mMayo score, consistent with previously reported data using Mayo score. Treatment effect sizes were generally similar regardless of scoring definition. This observation may help contextualize tofacitinib therapy outcomes with those of new UC therapies and support the use of Mayo score-based endpoints in UC clinical trials. TRAIL REGISTRATION ClinicalTrials.gov identifiers: NCT01465763; NCT01458951; NCT01458574.
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Affiliation(s)
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Yvette Leung
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Julian Panés
- Inflammatory Bowel Disease Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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10
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Irving PM, Leung Y, Dubinsky MC. Review article: guide to tofacitinib dosing in patients with ulcerative colitis. Aliment Pharmacol Ther 2022; 56:1131-1145. [PMID: 35993338 PMCID: PMC9544682 DOI: 10.1111/apt.17185] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/27/2022] [Accepted: 07/31/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). The induction dose is 10 mg twice daily (b.d.), whilst for maintenance therapy, the lowest effective dose should be used. AIM To examine published evidence on the two tofacitinib dosing strategies used in UC treatment, including expert interpretation of the data and how they could inform clinical practice. METHODS The use of tofacitinib 5 or 10 mg b.d. was assessed using data from the tofacitinib UC clinical programme in the context of different clinical scenarios. We include experts' opinions on the clinical implications of dose adjustment to inform the benefit/risk of using tofacitinib 5 or 10 mg b.d., based on clinical scenarios and real-world data. RESULTS Factors to consider when adjusting the tofacitinib dose include disease severity, comorbidities and previous biological exposure. The endoscopic subscore can determine whether a patient is a good candidate for dose reduction. Following disease relapse, the response can be recaptured in a substantial number of patients with a dose increase. Furthermore, data are now published showing real-world use of tofacitinib and, so far, these are consistent with data from the clinical trials. CONCLUSION Clinicians must consider the benefit/risk balance of tofacitinib 10 versus 5 mg b.d. in terms of dose-related side effects, as well as the safety implications of undertreating active disease. All patients should be closely monitored for disease relapse following dose reduction or interruption for early recapture of response.
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Affiliation(s)
| | - Yvette Leung
- Department of MedicineUniversity of British ColumbiaVancouverCanada
| | - Marla C. Dubinsky
- Susan and Leonard Feinstein IBD Clinical CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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11
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Jones E, Sharma S, Heisler C, Rohatinsky N, Novak K, Leung Y, Fowler S, Kaczur M, Jones J. Perceived Barriers to Professional Equality Among Women in Gastroenterology. J Can Assoc Gastroenterol 2022; 5:226-233. [PMID: 36196275 PMCID: PMC9527661 DOI: 10.1093/jcag/gwac023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although significant progress relating to professional equality among men and women in medicine has been made over the past few decades, evidence derived from the medical literature suggests that inequity persists with respect to income, attainment of leadership positions, and professional advancement. These inequities have been observed to be more pronounced in gastroenterology. Literature relating to gender-specific barriers to professional equity in gastroenterology is limited. This qualitative study explored perceived barriers to professional equality among women in gastroenterology in Canada through focus groups using a World Café Approach. Several perceived barriers to professional equality were identified. Identification of barriers to professional equality is an important first step to creating meaningful interventions that address the root causes of gender-related inequity in gastroenterology.
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Affiliation(s)
- Emma Jones
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Sharma Sharma
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Courtney Heisler
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Kerri Novak
- Department of Medicine, University of Calgary , Calgary, Alberta , Canada
| | - Yvette Leung
- Department of Medicine, University of British Columbia , Vancouver, British Columbia , Canada
| | - Sharyle Fowler
- College of Nursing, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Melanie Kaczur
- Canadian Hub for Applied and Social Research, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Jennifer Jones
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
- Department of Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
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12
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Levitt W, Kamalakannan B, Leung Y. 1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1058] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present.
Method
A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings.
Results
334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009)
Conclusions
The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.
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Affiliation(s)
- W Levitt
- Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - B Kamalakannan
- Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Y Leung
- Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom
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13
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Williams AJ, Karimi N, Chari R, Connor S, De Vera MA, Dieleman LA, Hansen T, Ismond K, Khurana R, Kingston D, O'Connor K, Sadowski DC, Fang-Hwa F, Wine E, Leung Y, Huang V. Shared decision making in pregnancy in inflammatory bowel disease: design of a patient orientated decision aid. BMC Gastroenterol 2021; 21:302. [PMID: 34330215 PMCID: PMC8325254 DOI: 10.1186/s12876-021-01853-y] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background Research has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased “voluntary childlessness”. Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. This study aimed to develop and test the feasibility of a decision aid encompassing reproductive decisions in the setting of IBD. Methods The International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed; patient interviews were conducted to obtain further insight into patient perspectives and to test the prototype for feasibility. Results Issues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Emphasis was placed on the provision of preconception counselling early in the disease course. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received. Conclusions The novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.
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Affiliation(s)
- Astrid-Jane Williams
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Elizabeth St, Liverpool, Sydney, NSW, 1871, Australia. .,South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.
| | - Neda Karimi
- South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | | | - Susan Connor
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Elizabeth St, Liverpool, Sydney, NSW, 1871, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | | | | | - Tawnya Hansen
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Katie O'Connor
- Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | | | | | - Eytan Wine
- University of Alberta, Edmonton, AB, Canada
| | - Yvette Leung
- University of British Columbia, Vancouver, BC, Canada
| | - Vivian Huang
- University of Alberta, Edmonton, AB, Canada.,Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, ON, Canada
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14
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Woo KS, Chook P, Hu YJ, Lao XQ, Lin CQ, Lee P, Kwok C, Wei AN, Guo DS, Yin YH, Lau K, Leung KS, Leung Y, Celermajer DS. The impact of particulate matter air pollution (PM2.5) on atherosclerosis in modernizing China: a report from the CATHAY study. Int J Epidemiol 2021; 50:578-588. [PMID: 33349857 DOI: 10.1093/ije/dyaa235] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/27/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Air pollution has been associated with an increase in cardiovascular diseases incidence. To evaluate whether air pollution can accelerate atherogenic processes, we assessed the effects of air pollution on important surrogate markers of atherosclerosis [brachial flow-mediated dilation (FMD) and carotid intima-media thickness (IMT)]. METHODS A total of 1656 Han Chinese (mean age 46.0 + 11.2 years; male 47%) in Hong Kong, Macau, Pun Yu, Yu County and the 3-Gorges Territories (Yangtze River) were studied between 1996 and 2007 [Chinese Atherosclerosis in the Aged and Young Project (the CATHAY Study)]. Cardiovascular risk profiles were evaluated. Particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) parameters were computed from satellite sensors. Brachial FMD and carotid IMT were measured by ultrasound. RESULTS Health parameters [age, gender, body mass index, waist : hip ratio (WHR) and glucose)] were similar in lowest and highest PM2.5 exposure tertiles, systolic and diastolic blood pressures and triglycerides were higher (P < 0.001) and low-density cholesterol (LDL-C) was lower in the top PM2.5 tertile (P < 0.001). Brachial FMD [7.84 ± 1.77, 95% confidence interval (CI) 7.59-8.10%, vs 8.50 ± 2.52, 95% CI 8.23-8.77%, P < 0.0001) was significantly lower and carotid IMT (0.68 ± 0.13 mm, 95% CI 0.67-0.69 mm vs 0.63 mm ± 0.15 mm 95% CI 0.62-0.64 mm; P < 0.0001) was significantly thicker in the top PM2.5 tertile compared with the lowest tertile. On multiple regression, FMD was inversely related to PM2.5 (beta = 0.134, P = 0.015) independent of gender, age and blood pressure (model R2 = 0.156, F-value = 7.6, P < 0.0001). Carotid IMT was significantly correlated with PM2.5 exposure (beta = 0.381, P < 0.0001) independent of age, location, gender, WHR, blood pressure and LDL-C (model R2 = 0.408, F-value = 51.4, P-value <0.0001). CONCLUSIONS Air pollution is strongly associated with markers of early atherosclerosis, suggesting a potential target for preventive intervention.
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Affiliation(s)
- K S Woo
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - P Chook
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR.,Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Y J Hu
- Nineth Peoples' Hospital of Chongqing, China
| | - X Q Lao
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - C Q Lin
- Department of Civil and Environment and Engineering, Hong Kong University of Science and Technology, Hong Kong SAR
| | - Pwa Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - Cyt Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - A N Wei
- Xuefu Hospital of Chongqing, Second Hospital of Chongqing Medical University, China
| | - D S Guo
- Department of Medicine, Yu County Provincial Hospital, China
| | - Y H Yin
- Second Hospital of Chongqing Medical University, China
| | - Kha Lau
- Department of Civil and Environment and Engineering, Hong Kong University of Science and Technology, Hong Kong SAR
| | - K S Leung
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR.,Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Y Leung
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR.,Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - D S Celermajer
- Faculty of Medical and Health Science, The University of Sydney, Sydney, Australia
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15
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Donaldson K, Mitchell RA, Enns RA, Bressler B, Rosenfeld G, Leung Y, Ramji A, Ko H. A164 PATTERNS IN MEDICAL THERAPY AND CLINICAL OUTCOMES IN PATIENTS WITH CONCOMITANT INFLAMMATORY BOWEL DISEASE AND PRIMARY SCLEROSING CHOLANGITIS: A SINGLE CENTRE RETROSPECTIVE ANALYSIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.162] [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: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) in patients with primary sclerosing cholangitis (PSC) is characterized by pancolitis with rectal sparing and is associated with an increased risk of colorectal and biliary malignancies. Currently, pharmacologic management of IBD in the setting of PSC is the same as in IBD alone.
Aims
To assess patterns in medical therapy, and incidence of adverse outcomes in patients with concomitant IBD and PSC.
Methods
A retrospective review was conducted on all PSC-IBD patients followed between January 2010 and June 2018. The Endoscopic Mayo Score was used to grade IBD severity in PSC-ulcerative colitis (UC).
Results
69 patients were identified, 44 (63.8%) were male. The mean ages of IBD and PSC diagnosis were 28.6 (SD 14.9) and 37.0 (SD 18.9) years, respectively. The median length of follow up was 12 (range 2–49) years. 52 (75.4%) patients had UC, and 17 (24.6%) had Crohn’s disease (CD). 28 (87.5%) PSC-UC patients had pancolitis, and 4 (12.5 %) had proctitis. Among those with pancolitis, 8 (28.6%) had relative rectal sparing. 4 (14.3%) patients had more severe inflammation proximally, whereas only 1 (3.6%) had more severe distal inflammation. 23 (82.1%) patients had the same degree of inflammation throughout. 14 (93.3%) PSC-CD patients had colitis/ileocolitis and 1 (6.7%) had ileitis. Among those with PSC-UC, 16 (50.0%), 12 (37.5%), and 4 (12.5%) patients had grade 1, 2, and 3 disease, respectively. 62 (89.9%) PSC-IBD patients were treated with aminosalicylates, and 26 (37.7%) with biologics at some point in their IBD course. 26 (37.7%) were treated with aminosalicylates alone. 4 (5.8%) did not require any IBD therapy. Cholangiocarcinoma, colorectal cancer, and gallbladder cancer developed in 8 (11.6%), 1 (1.4%), and 1 (1.4%) PSC-IBD patients, respectively. 16 (23.2%) patients required partial or total colectomy. Indication for surgery was inflammation or stenosis, dysplasia, and neoplasia in 13 (81.3%), 2 (12.5%), and 1 (6.3%) patients, respectively.
Conclusions
The majority of this cohort had UC with mild disease activity. Pancolitis was common, with frequent rectal sparing and more severe right-sided inflammation. Despite the predominance of low-grade colitis, a large portion of patients required treatment with biologics. The incidence of adverse outcomes underscores the need for strict adherence to recommended surveillance practices. Low grade endoscopic activity, typical of the quiescent IBD course in PSC-IBD, may mask low grade histologic inflammation, which in turn may contribute to the increased risk of colonic neoplasia. Further studies are needed to determine the best management strategy for IBD in patients with PSC.
Funding Agencies
None
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Affiliation(s)
- K Donaldson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R A Mitchell
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R A Enns
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - B Bressler
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - G Rosenfeld
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Y Leung
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Ko
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Seow CH, Leung Y, Novak KL. Towards Routine Non-invasive Monitoring of Disease Activity Using Gastrointestinal Ultrasound and Faecal Calprotectin in Pregnant Women With IBD. J Crohns Colitis 2020; 14:1790-1791. [PMID: 32544230 DOI: 10.1093/ecco-jcc/jjaa122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/26/2022]
Affiliation(s)
- C H Seow
- Department of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Y Leung
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K L Novak
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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17
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Jijon H, Ueno A, Sharifi N, Leung Y, Ghosh S, Seow CH. Elevated interferon-gamma levels during pregnancy are associated with adverse maternofetal outcomes in IBD. Gut 2020; 69:1895-1897. [PMID: 31722975 DOI: 10.1136/gutjnl-2019-319656] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/08/2022]
Affiliation(s)
- Humberto Jijon
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Aito Ueno
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nastaran Sharifi
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Yvette Leung
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Subrata Ghosh
- Institute of Translational Medicine, University of Birmingham Edgbaston Campus, Birmingham, UK
| | - Cynthia H Seow
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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18
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Khil J, Picardo S, Seow CH, Leung Y, Metcalfe A, Afshar EE, Sharifi N, Campbell T, Letourneau N, Dewey D, Giesbrecht GF. Physiological and psychological stress in pregnant women with quiescent inflammatory bowel disease: A pilot study using salivary biomarkers. JGH Open 2020; 4:692-697. [PMID: 32782958 PMCID: PMC7411654 DOI: 10.1002/jgh3.12317] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 12/08/2019] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
Background Pregnant women with inflammatory bowel disease (IBD) are more likely than the general pregnant population to experience adverse maternofetal outcomes, especially if the disease is active at the time of conception and during pregnancy. Elevated stress is often seen in patients with chronic diseases and could account for these outcomes. Salivary cortisol and alpha‐amylase (sAA) are novel biomarkers of stress, reflecting the hypothalamic‐pituitary‐adrenal (HPA) axis and sympathetic nervous system, respectively. Our aim in this pilot study was to assess stress differences between pregnant women with inactive IBD and matched controls using psychometric questionnaires and salivary biomarker measures. Methods Thirteen pregnant women with quiescent IBD (6 Crohn's disease, 7 ulcerative colitis) were matched (1:3) to 39 expectant mothers without IBD by parity and gestational age. Participants completed several psychometric questionnaires assessing stress, and salivary cortisol and sAA were collected as objective biomarkers of stress during pregnancy. Results Pregnant women with quiescent IBD did not demonstrate significant differences on any psychometric measures of stress or salivary biomarker measures when compared with controls (all P > 0.05). Pregnant women with quiescent IBD demonstrated similar cortisol and sAA awakening responses (both P > 0.05) and total levels of cortisol and sAA production (both P > 0.05) when compared with controls. Conclusions Pregnant women with well‐controlled IBD do not experience demonstrable differences in psychological stress or dysregulation of salivary stress biomarkers when compared with non‐IBD controls. The effect of chronic disease may be evaluated in future studies by including a comparative group of pregnant women with active IBD.
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Affiliation(s)
- Jennifer Khil
- Department of Psychology University of Calgary Calgary Canada
| | - Sherman Picardo
- Cumming School of Medicine University of Calgary Calgary Canada
| | - Cynthia H Seow
- Cumming School of Medicine University of Calgary Calgary Canada
| | - Yvette Leung
- Cumming School of Medicine University of Calgary Calgary Canada.,Department of Medicine University of British Columbia Vancouver Canada
| | - Amy Metcalfe
- Cumming School of Medicine University of Calgary Calgary Canada
| | - Elnaz E Afshar
- Cumming School of Medicine University of Calgary Calgary Canada
| | | | - Tavis Campbell
- Department of Psychology University of Calgary Calgary Canada
| | | | - Deborah Dewey
- Cumming School of Medicine University of Calgary Calgary Canada
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19
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Williams A, Leung Y, Huang V. A237 SHARED DECISION MAKING: DESIGN OF A PREGNANCY IN IBD DECISION AID (PIDA). J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.236] [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: 11/12/2022] Open
Abstract
Abstract
Background
Given a significant proportion of women with inflammatory bowel disease (IBD) are of child-bearing age, the development of a pregnancy IBD decision aid would benefit patients and clinicians. Lack of IBD-specific reproductive knowledge has been associated with increased “voluntary childlessness” and may contribute to inappropriate medication changes during or after pregnancy. Decision aids support decision making in pregnancy in general, as well as in multiple other chronic diseases. However existing literature has not identified such a resource for women with IBD.
Aims
To develop a decision aid to improve decision making regarding preconception and pregnancy in IBD among women with IBD.
Methods
We followed the International Patient Decision Aids Standards (IPDAS). A steering committee of Canadian and Australian health care professionals with an interest in IBD management in pregnancy, in addition to patient representatives, was established. Themes chosen for discussion included inheritance, fertility, nutrition, medications, mode of delivery, breastfeeding, infant health. Initial patient and clinician focus groups were conducted and responses recorded with written/audio mediums. We developed an electronic PIDA draft that incorporates individualised information (type of IBD, pre-conception or pregnant, surgical history, medications) in personalized decision making. Further patient focus groups and interviews were conducted to obtain user opinion of the PIDA draft.
Results
In July 2017, patient and clinician focus groups were conducted at a Canadian site. Three patients (pre-conception) attended the focus group. Patient concerns - impact of disease and surgery on fertility and preterm delivery; impact of drug therapies on the fetus/ infant; impact of active disease on maternal and fetal/infant health. The clinician focus group included 3 IBD specialists, 2 IBD fellows, 2 IBD nurses, an obstetrician and a neonatal intensivist. Clinician concerns - absence of pre-conception counselling and lack of patient understanding about the impact of disease activity and IBD medication use in pregnancy. Additional patient feedback obtained through interviews (n=15) at two Canadian sites since March 2019 regarding the current electronic PIDA was positive, with comments about content, personalization, readability and unbiased presentation. Suggestions were made for inclusion of additional content such as impact of IBD on sexual function, laboratory changes during pregnancy, and timing of medications post-partum.
Conclusions
The pre and post PIDA design patient and clinician focus groups and interviews affirmed the role for PIDA. Main decisions considered necessary to address included ideal timing of conception pending disease activity, management of medications, and delivery methods. Ongoing user feedback will be obtained at Australian and Canadian sites during planned alpha testing.
Funding Agencies
WCHRI, Sinai Health System, UBC
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Affiliation(s)
- A Williams
- University of New South Wales, Liverpool, New South Wales, Australia
| | - Y Leung
- University of British Columnbia, Vancouver, BC, Canada
| | - V Huang
- Mount Sinai Hospital, Toronto, ON, Canada
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20
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Moskovitz M, Jao K, Su J, Brown MC, Naik H, Eng L, Wang T, Kuo J, Leung Y, Xu W, Mittmann N, Moody L, Barbera L, Devins G, Li M, Howell D, Liu G. Combined cancer patient-reported symptom and health utility tool for routine clinical implementation: a real-world comparison of the ESAS and EQ-5D in multiple cancer sites. ACTA ACUST UNITED AC 2020; 26:e733-e741. [PMID: 31896943 DOI: 10.3747/co.26.5297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population. Methods Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses. Results Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: -0.204 to -0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = -0.416), tiredness (R = -0.387), and depression (R =-0.354). Multivariable analyses identified pain and depression as highly associated (both p < 0.0001) and tiredness as associated (p = 0.03) with the hus. The ability of the esas to predict the hus was low, at 0.25. However, by mapping esas pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the hus using partial esas data, with Spearman correlations of 0.83-0.91 in comparisons with direct EQ-5D measurement of the hus. Conclusions The hus derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the esas. The esas scores alone could not predict EQ-5D scores with high accuracy. However, esas-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the hus, with high correlation to the directly measured hus. That finding suggests a potential approach to integrating routine symptom and hus evaluations after confirmatory studies.
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Affiliation(s)
- M Moskovitz
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - K Jao
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Hôpital du Sacré-Coeur, McGill University, Montreal, QC
| | - J Su
- Department of Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - M C Brown
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - H Naik
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Department of Medicine, University of British Columbia, Vancouver, BC
| | - L Eng
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - T Wang
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Pharmacy, University of Toronto, Toronto, ON
| | - J Kuo
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - Y Leung
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - W Xu
- Department of Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - N Mittmann
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, University of Toronto, Toronto, ON
| | - L Moody
- Cancer Care Ontario, Toronto, ON
| | - L Barbera
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, University of Toronto, Toronto, ON
| | - G Devins
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON.,Department of Psychiatry, University of Toronto, Toronto, ON
| | - M Li
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - D Howell
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON.,Lawrence Bloomberg School of Nursing, University of Toronto, Toronto, ON
| | - G Liu
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Department of Epidemiology, Dalla Lana School of Public Health, Department of Medical Biophysics, and Institute of Medical Science, University of Toronto, Toronto, ON
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Tammemagi M, Nguyen K, Mcgarry C, Schmidt H, Leung Y, Darling G. P2.10-04 Predicting Non-Compliance in Routine Lung Cancer Screening for High-Risk Adults. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Hansen TM, Targownik LE, Karimuddin A, Leung Y. Management of Biological Therapy Before Elective Inflammatory Bowel Disease Surgeries. Inflamm Bowel Dis 2019; 25:1613-1620. [PMID: 30794289 DOI: 10.1093/ibd/izz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/13/2018] [Accepted: 01/04/2019] [Indexed: 12/11/2022]
Abstract
Increasing uptake of biologic therapy has contributed to declining surgical rates for inflammatory bowel disease (IBD). However, a significant number of patients on biologic therapy will go on to require surgery. The literature is conflicted with regard to the preoperative management of biologic therapy before urgent or elective IBD surgery. This article reviews the available data on postoperative complications following preoperative treatment with anti-tumor necrosis factor alpha therapy, anti-integrin therapy, and anti-interleukin therapy.
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Affiliation(s)
- Tawnya M Hansen
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmer Karimuddin
- Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yvette Leung
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Pi S, Rosenfeld G, Enns R, Bressler B, Wong A, Enns C, MacDonnell C, Leung Y. Patterns and motivations of
Cannabis
use amongst patients with inflammatory bowel disease. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/ygh2.338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Steven Pi
- Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Greg Rosenfeld
- Division of Gastroenterology, Department of Medicine University of British Columbia, St. Paul’s Hospital Vancouver British Columbia Canada
| | - Robert Enns
- Division of Gastroenterology, Department of Medicine University of British Columbia, St. Paul’s Hospital Vancouver British Columbia Canada
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine University of British Columbia, St. Paul’s Hospital Vancouver British Columbia Canada
| | - Amy Wong
- Pacific Gastroenterology Associates Vancouver British Columbia Canada
| | - Chasyn Enns
- Pacific Gastroenterology Associates Vancouver British Columbia Canada
| | - Chris MacDonnell
- Pacific Gastroenterology Associates Vancouver British Columbia Canada
| | - Yvette Leung
- Division of Gastroenterology, Department of Medicine University of British Columbia, St. Paul’s Hospital Vancouver British Columbia Canada
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24
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Moore AC, Huang VW, Bourdages R, Fedorak RN, Reinhard C, Leung Y, Bressler B, Rosenfeld G. IBDoc Canadian User Performance Evaluation. Inflamm Bowel Dis 2019; 25:1107-1114. [PMID: 30535387 DOI: 10.1093/ibd/izy357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fecal calprotectin (FC) is a stool biomarker that has been shown to be sensitive and specific for mucosal inflammation in patients with inflammatory bowel disease (IBD). The test is limited by the requirement for patients to collect and return stool samples. A home-based FC test may improve test adherence. The aim of this study is to evaluate the usability of the IBDoc, a home-based FC measuring test, and to determine the accuracy of results compared with traditional lab-based ELISA values. METHODS Patients were prospectively enrolled from 3 tertiary sites across Canada between May and August 2017. Patients completed a questionnaire establishing ease-of-use of the IBDoc. Patients completed a FC measurement using the IBDoc, and results were compared with an ELISA-determined FC measurement on the same stool sample. RESULTS Sixty-one participants were enrolled in the study (29 CD, 32 UC). Seventy-nine percent of patients (48 of 61) agreed that the IBDoc was easy to use, with 85% (52 of 61) of patients strongly agreeing that they were willing use the home kit in the future. The IBDoc and ELISA measurement comparison showed an 88% agreement across all values. There were no false positives or negatives using qualitative comparison. CONCLUSIONS The home-based IBDoc FC measuring test is acceptable to patients and correlates extremely well with the standard ELISA-determined FC value. The IBDoc enables clinicians to more easily adopt a treat-to-target approach, improve long-term outcomes, and patients' quality of life with IBD. This study is registered at ClinicalTrials.gov, number NCT03408249.
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Affiliation(s)
- Alice C Moore
- Department of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - Vivian W Huang
- Division of Gastroenterology, University of Toronto, Toronto, Canada
| | | | - Richard N Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | | | - Yvette Leung
- Department of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - Brian Bressler
- Department of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - Greg Rosenfeld
- Department of Gastroenterology, University of British Columbia, Vancouver, Canada
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25
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Picardo S, Panaccione R, Kaplan GG, Seow C, deBruyn J, Leung Y. A124 IMPROVEMENT IN DISEASE ACTIVITY IS ASSOCIATED WITH LESS DISABILITY IN A PROSPECTIVE STUDY OF PEDIATRIC TRANSITION PATIENTS WITH IBD. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Picardo
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - R Panaccione
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Seow
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - J deBruyn
- Department of Pediatric Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - Y Leung
- Inflammatory Bowel Disease Unit, University of British Columbia, Vancouver, BC, Canada
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26
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Bergeron F, Rosenfeld P, Leung Y, Bressler B, Rosenfeld G. A118 FECAL CALPROTECTIN COMPLETION RATES AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Bergeron
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - P Rosenfeld
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Y Leung
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - B Bressler
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
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27
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Picardo S, Panaccione R, Kaplan GG, Seow C, deBruyn J, Leung Y. A133 PEDIATRIC ONSET INFLAMMATORY BOWEL DISEASE IS NOT ASSOCIATED WITH MORE DISABILITY COMPARED TO ADULT ONSET DISEASE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Picardo
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - R Panaccione
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Seow
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - J deBruyn
- Department of Pediatric Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - Y Leung
- Inflammatory Bowel Disease Unit, University of British Columbia, Vancouver, BC, Canada
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28
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Doherty MK, Leung Y, Su J, Naik H, Patel D, Eng L, Kong QQ, Mohsin F, Brown MC, Espin-Garcia O, Vennettilli A, Renouf DJ, Faluyi OO, Knox JJ, MacKay H, Wong R, Howell D, Mittmann N, Darling GE, Cella D, Xu W, Liu G. Health utility scores from EQ-5D and health-related quality of life in patients with esophageal cancer: a real-world cross-sectional study. Dis Esophagus 2018; 31:5037798. [PMID: 29905764 DOI: 10.1093/dote/doy058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/11/2022]
Abstract
Esophageal cancer and its treatment can cause serious morbidity/toxicity. These effects on health-related quality of life (HRQOL) can be measured using disease-specific scales such as FACT-E, generic scales such as EQ-5D-3L, or through symptoms. In a two-year cross-sectional study, we compared HRQOL across esophageal cancer patients treated in an ambulatory clinic and across multiple disease states, among patients with all stages of esophageal cancer. Consenting patients completed FACT-E, EQ-5D, a visual analog scale, and patient reported (PR)-ECOG. Symptom complexes were constructed from FACT-E domains. Responses were categorized by disease state: pre-, during, and post-treatment, surveillance, progression, and palliative chemotherapy. Spearman correlation and multivariable linear regression characterized these associations. In total, 199 patients completed 317 questionnaires. Mean FACT-E and subscale scores dropped from baseline through treatment and recovered during post-treatment surveillance (P < 0.001); EQ-5D health utility scores (HUS) displayed a similar pattern but with smaller differences (P = 0.07), and with evidence of ceiling effect. Among patients with stage II/III esophageal cancer, mean EQ-5D HUS varied across disease states (P < 0.001), along with FACT-E and subscales (P < 0.001). Among patients with advanced disease, there was no significant difference between baseline and on-treatment total scores, but improved esophageal cancer-specific scales were noted (P = 0.003). Strong correlation was observed between EQ-5D and FACT-E (R = 0.73), along with physical and functional subscales. In addition, the association between FACT-E and EQ-5D HUS was maintained in a multivariable model (P < 0.001). We interpret these results to suggest that in a real-world clinic setting, FACT-E, EQ-5D HUS, and symptoms were strongly correlated. Most HRQOL and symptom parameters suggested that patients had worse HRQOL and symptoms during curative therapy, but recovered well afterwards. In contrast, palliative chemotherapy had a neutral to positive impact on HRQOL/symptoms when compared to their baseline pre-treatment state.
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Affiliation(s)
- M K Doherty
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Y Leung
- Department of Psychosocial Oncology, Princess Margaret Cancer Centre, British Colombia, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - H Naik
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Patel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Eng
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Q Q Kong
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - F Mohsin
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - M C Brown
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - O Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - A Vennettilli
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D J Renouf
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,BC Cancer Agency, University of British Columbia, Vancouver, British Colombia, Canada
| | - O O Faluyi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, UK
| | - J J Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - H MacKay
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - R Wong
- Radiation Medicine Program, University of Toronto, Toronto, Ontario
| | - D Howell
- Department of Psychosocial Oncology, Princess Margaret Cancer Centre, British Colombia, Canada
| | - N Mittmann
- Cancer Care Ontario, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - G E Darling
- Department of Surgery, Princess Margaret Cancer Centre, Chicago, Illinois, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - G Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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29
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Leung Y, Shim HH, Wilkens R, Tanyingoh D, Afshar EE, Sharifi N, Pauls M, Novak KL, Kaplan GG, Panaccione R, Wilson SR, Seow CH. The Role of Bowel Ultrasound in Detecting Subclinical Inflammation in Pregnant Women with Crohn's Disease. J Can Assoc Gastroenterol 2018; 2:153-160. [PMID: 31616856 PMCID: PMC6785691 DOI: 10.1093/jcag/gwy062] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 10/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background and Aims Maintaining disease remission improves outcomes for pregnant women with Crohn’s disease (CD). As symptoms may correlate poorly with disease activity in the gravid state, we investigated the utility of bowel sonography during pregnancy to assess disease activity. Methods We conducted a prospective observational cohort study of pregnant women with CD undergoing bowel sonography between July 1, 2012, and December 1, 2016. Clinically active disease was defined using standardized clinical indices (Harvey Bradshaw Index >4 for active disease). Sonographic findings were graded as inactive (normal, mild) or active (moderate, severe) by expert radiologists. Results There were 91 pregnancies in 82 CD patients. Symptoms were present in 12 pregnancies; however, eight (67%) had sonographic findings of inactive disease, and escalation of therapy was not initiated. Conversely, sonographically active disease in seven asymptomatic pregnancies resulted in four women escalating therapy. The remaining three women declined escalation of therapy, one had a miscarriage, and the other two women had persistently active disease on sonography and endoscopy at one-year postpartum. Conclusions Bowel ultrasound may detect subclinical inflammation in asymptomatic pregnant women with CD and stratify CD activity in symptomatic patients. Therefore, bowel sonography should be considered as a useful adjunct for the assessment of the pregnant woman with Crohn’s disease.
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Affiliation(s)
- Yvette Leung
- Division of Gastroenterology and Hepatology, Department of Medicine, University of British Columbia, British Columbia, Canada.,Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Hang Hock Shim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Bukit Merah, Singapore
| | - Rune Wilkens
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Hospital, Silkeborg, Denmark.,Department of Radiology and Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | | | - Elnaz Ehteshami Afshar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Nastaran Sharifi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Mehrnoosh Pauls
- Department of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kerri L Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Stephanie R Wilson
- Department of Radiology and Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
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Jain S, Cohen AK, Jagannathan P, Leung Y, Bassey H, Bedford S. Evaluating the Implementation of a Collaborative Juvenile Reentry System in Oakland, California. Int J Offender Ther Comp Criminol 2018; 62:3662-3680. [PMID: 29426252 DOI: 10.1177/0306624x18755480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traditional juvenile reentry systems often inadequately meet offenders' complex needs. Policymakers and researchers increasingly recognize the importance of a collaborative community- and development-based reentry system to improve recidivism, youth developmental outcomes, and public safety. Yet, system-level process evaluations of integrated reentry systems are scarce. California's Alameda County juvenile reentry system implemented evidence-based strategies and practices to better serve reentry youth. We report findings from a process evaluation, using data from 15 key stakeholder interviews, focus groups with community-based providers, a reentry system-wide stakeholder survey, site visit observations, and document reviews. We identified strengths, challenges, and lessons learned. System-level strengths included increased multidisciplinary assessments, interagency collaboration, and specialty courts. Challenges included differing agency agendas, limited family and youth engagement, and data sharing. We recommend future researchers and practitioners to further examine and implement integrated system-level processes and organizational change, informed by the ecological-developmental perspective, to help promote positive outcomes for reentry youth.
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Affiliation(s)
| | - Alison K Cohen
- 1 DNA Global, LLC, Oakland, CA, USA
- 2 University of California, Berkeley, School of Public Health & Graduate School of Education, USA
| | | | - Yvette Leung
- 4 Y's Change, Oakland, CA, USA
- 5 Alameda County Health Care Services Agency, San Leandro, CA, USA
| | | | - Sara Bedford
- 3 Department of Human Services, Oakland, CA, USA
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31
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Nagle C, Crosbie E, Brand A, Obermair A, Oehler M, Quinn M, Leung Y, Spurdle A, Webb P. The association between diabetes, comorbidities, body mass index and all-cause and cause-specific mortality among women with endometrial cancer. Gynecol Oncol 2018; 150:99-105. [DOI: 10.1016/j.ygyno.2018.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 01/10/2023]
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32
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Tam D, Leung Y, Lam W, Lai M, Yau B, Lee W, Mak Y. An electron microscopic study of human amniotic membrane derived epithelial and stromal stem cells. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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33
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Lee S, Metcalfe A, Raman M, Leung Y, Aghajafari F, Letourneau N, Panaccione R, Kaplan GG, Seow CH. Pregnant Women with Inflammatory Bowel Disease Are at Increased Risk of Vitamin D Insufficiency: A Cross-Sectional Study. J Crohns Colitis 2018; 12:702-709. [PMID: 29546360 PMCID: PMC5972591 DOI: 10.1093/ecco-jcc/jjy030] [Citation(s) in RCA: 9] [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: 12/13/2017] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Vitamin D insufficiency is prevalent in individuals with inflammatory bowel disease [IBD], as well as in pregnant women; however, the prevalence of vitamin D insufficiency in pregnant women with IBD is unknown. This study assessed the prevalence of vitamin D insufficiency in pregnant women with IBD and the adequacy of recommended supplementation. METHODS A cross-sectional study was conducted in pregnant women with inflammatory bowel disease [Crohn's disease = 61, ulcerative colitis = 41] and without inflammatory bowel disease [n = 574]. Chi square tests and log binomial regression were used to examine the prevalence of vitamin D insufficiency. Covariates included ethnicity and season. Adequacy of vitamin D supplementation during pregnancy was also assessed. RESULTS The prevalence of vitamin D insufficiency [25-OHD ≤75 nmol/L] in those with Crohn's disease was 50.8% (95% confidence interval [CI]: 38.4%-63.2%) and 60.9% [95% CI: 45.3%-74.7%] with ulcerative colitis compared with 17.4% [95% CI: 14.6%-20.8%] without inflammatory bowel disease. Women with inflammatory bowel disease were more likely to be vitamin D insufficient after adjusting for ethnicity and season (Crohn's disease-adjusted relative risk [aRR] = 2.98,;: 2.19-4.04; ulcerative colitis-aRR = 3.61; 95% CI: 2.65-4.93). Despite vitamin D supplementation, 32.3% [95% CI: 17.8%-51.2%] of those with Crohn's disease, 58.3% [95% CI: 37.1%-76.9%] of those with with ulcerative colitis, and 10.8% [95% CI: 6.9%-16.6%] of those without inflammatory bowel disease were still vitamin D insufficient. CONCLUSIONS Pregnant women with inflammatory bowel disease are at increased risk of vitamin D insufficiency compared with those without inflammatory bowel disease. The current guidelines for vitamin D supplementation may be inadequate for pregnant women with inflammatory bowel disease.
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Affiliation(s)
- Sangmin Lee
- University of Calgary Cumming School of Medicine, Community Health Sciences, Calgary, AB, Canada
| | - Amy Metcalfe
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada,Obstetrics & Gynecology, Calgary, AB, Canada,Community Health Sciences, Medicine, Calgary, AB, Canada
| | - Maitreyi Raman
- University of Calgary Cumming School of Medicine, Medicine, Calgary, AB, Canada
| | - Yvette Leung
- University of British Columbia, Medicine, Vancouver, BC, Canada
| | - Fariba Aghajafari
- University of Calgary Cumming School of Medicine, Community Health Sciences, AB, Canada,Family Medicine, Calgary, AB, Canada
| | - Nicole Letourneau
- University of Calgary Cumming School of Medicine, Community Health Sciences, AB, Canada,University of Calgary Cumming School of Medicine, Medicine, AB, Canada,University of Calgary Cumming School of Medicine, Pediatrics & Psychiatry, AB, Canada,University of Calgary Faculty of Nursing, Nursing, Calgary, AB, Canada
| | - Remo Panaccione
- University of Calgary, Inflammatory Bowel Disease Clinic, Calgary, AB, Canada
| | - Gilaad G Kaplan
- University of Calgary, Division of Gastroenterology, Departments of Medicine, Calgary, AB, Canada
| | - Cynthia H Seow
- University of Calgary, Department of Medicine, Calgary, AB, Canada,Corresponding author: Dr Cynthia H. Seow, TRW building, Room 6D18, 3280 Hospital Drive NW, Calgary, AB, Canada, T2N 4Z6.
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Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A108 USTEKINUMAB IS EFFECTIVE FOR INDUCING CLINICAL, ENDOSCOPIC, AND RADIOGRAPHIC RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - N Stern
- University of Alberta, Edmonton, AB, Canada
| | | | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of Calgary, Calgary, AB, Canada
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - S Ghosh
- University of Birmingham, Birmingham, United Kingdom
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Kuenzig E, Mathivanan M, Seow C, Benchimol EI, Panaccione R, MacLean A, Raman M, Leung Y. A228 GASTROENTEROLOGISTS DIFFER IN THEIR PREFERRED MODE OF DELIVERY FOR PREGNANT WOMEN WITH ILEAL ANAL-POUCH ANASTOMOSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/14/2022] Open
Affiliation(s)
- E Kuenzig
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - C Seow
- Medicine, University of Calgary, Calgary, AB, Canada
| | - E I Benchimol
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - A MacLean
- University of Calgary, Calgary, AB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of British Columbia, Vancouver, BC, Canada
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36
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Altuwaijri M, Leung Y, Whittaker S, Bressler B, Rosenfeld G. A151 FECAL CALPROTECTIN RETURN RATE IN IBD PATIENTS ON INFLIXIMAB. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Altuwaijri
- University of British Columbia and King Saud University, Vanouver, BC, Canada
| | - Y Leung
- University of British Columbia, Vancouver, BC, Canada
| | - S Whittaker
- University of British Columbia, Vancouver, BC, Canada
| | - B Bressler
- University of British Columbia, Vancouver, BC, Canada
| | - G Rosenfeld
- University of British Columbia, Vancouver, BC, Canada
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Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A106 USTEKINUMAB IS EFFECTIVE FOR MAINTAINING CLINICAL RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - N Stern
- University of Alberta, Edmonton, AB, Canada
| | | | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of Calgary, Calgary, AB, Canada
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - S Ghosh
- University of Calgary, Calgary, AB, Canada
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38
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Pi S, Rosenfeld G, Wong A, MacDonnell C, Enns C, Enns RA, Bressler B, Leung Y. A118 PATTERNS AND MOTIVATIONS FOR MARIJUANA USE AMONGST PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Pi
- Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - A Wong
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
| | - C MacDonnell
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
| | - C Enns
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
| | - R A Enns
- Medicine, St Paul, Vancouver, BC, Canada
| | - B Bressler
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
| | - Y Leung
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
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39
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Iacucci M, Kaplan GG, Panaccione R, Akinola O, Lethebe BC, Lowerison M, Leung Y, Novak KL, Seow CH, Urbanski S, Minoo P, Gui X, Ghosh S. A Randomized Trial Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy. Am J Gastroenterol 2018; 113:225-234. [PMID: 29134964 DOI: 10.1038/ajg.2017.417] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [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: 05/24/2017] [Accepted: 09/12/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Dye spraying chromoendoscopy (DCE) is recommended for the detection of colonic neoplastic lesions in inflammatory bowel disease (IBD). The majority of neoplastic lesions are visible endoscopically and therefore targeted biopsies are appropriate for surveillance colonoscopy. To compare three different techniques for surveillance colonoscopy to detect colonic neoplastic lesions in IBD patients: high definition (HD), (DCE), or virtual chromoendoscopy (VCE) using iSCAN image enhanced colonoscopy. METHODS A randomized non-inferiority trial was conducted to determine the detection rates of neoplastic lesions in IBD patients with longstanding colitis. Patients with inactive disease were enrolled into three arms of the study. Endoscopic neoplastic lesions were classified by the Paris classification and Kudo pit pattern, then histologically classified by the Vienna classification. RESULTS A total of 270 patients (55% men; age range 20-77 years, median age 49 years) were assessed by HD (n=90), VCE (n=90), or DCE (n=90). Neoplastic lesion detection rates in the VCE arm was non-inferior to the DCE arm. HD was non-inferior to either DCE or VCE for detection of all neoplastic lesions. In the lesions detected, location at right colon and the Kudo pit pattern were predictive of neoplastic lesions (OR 6.52 (1.98-22.5 and OR 21.50 (8.65-60.10), respectively). CONCLUSIONS In this randomized trial, VCE or HD-WLE is not inferior to dye spraying colonoscopy for detection of colonic neoplastic lesions during surveillance colonoscopy. In fact, in this study HD-WLE alone was sufficient for detection of dysplasia, adenocarcinoma or all neoplastic lesions.
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Affiliation(s)
- Marietta Iacucci
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada.,Division of Gastroenterology & Institute of Translational Medicine, NIHR Biomedical Research Center, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gilaad G Kaplan
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Oluseyi Akinola
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Brendan Cord Lethebe
- Department of Community Health Sciences, Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark Lowerison
- Department of Community Health Sciences, Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yvette Leung
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Kerri L Novak
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Cynthia H Seow
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada.,Department of Community Health Sciences, Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Stefan Urbanski
- Department of Pathology, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Parham Minoo
- Department of Pathology, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Xianyong Gui
- Department of Pathology, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Subrata Ghosh
- Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada.,Division of Gastroenterology & Institute of Translational Medicine, NIHR Biomedical Research Center, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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40
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Moskovits M, Jao K, Brown C, Su S, Naik H, Eng L, Wang T, Leung Y, Xu W, Liu G, Li M, Devins G, Howell D. Real world comparison of common patient reported symptoms with health utility scores in cancer outpatients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx375.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Codde E, Munro A, Stewart C, Spilsbury K, Bowen S, Codde J, Steel N, Leung Y, Tan J, Salfinger SG, Mohan GR, Cohen PA. Risk of persistent or recurrent cervical neoplasia in patients with 'pure' adenocarcinoma-in-situ (AIS) or mixed AIS and high-grade cervical squamous neoplasia (cervical intra-epithelial neoplasia grades 2 and 3 (CIN 2/3)): a population-based study. BJOG 2017; 125:74-79. [PMID: 28678394 DOI: 10.1111/1471-0528.14808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma. DESIGN Retrospective cohort study. SETTING Statewide population in Western Australia. POPULATION Women diagnosed with AIS between 2001 and 2012. METHODS We conducted a retrospective, population-based cohort study. MAIN OUTCOME MEASURES De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma. RESULTS 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence. CONCLUSION In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease. TWEETABLE ABSTRACT Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.
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Affiliation(s)
- E Codde
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - A Munro
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia
| | - Cjr Stewart
- Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - K Spilsbury
- Centre for Population Health Research, Curtin University, Bentley, WA, Australia
| | - S Bowen
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia
| | - J Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - N Steel
- WA Cervical Cancer Prevention Program, WA Health, Perth, WA, Australia
| | - Y Leung
- Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - J Tan
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia.,WOMEN Centre, West Leederville, WA, Australia
| | - S G Salfinger
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - G R Mohan
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - P A Cohen
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia.,WOMEN Centre, West Leederville, WA, Australia
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Ma C, Fedorak RN, Kaplan GG, Dieleman LA, Devlin SM, Stern N, Kroeker KI, Seow CH, Leung Y, Novak KL, Halloran BP, Huang VW, Wong K, Blustein PK, Ghosh S, Panaccione R. Clinical, endoscopic and radiographic outcomes with ustekinumab in medically-refractory Crohn's disease: real world experience from a multicentre cohort. Aliment Pharmacol Ther 2017; 45:1232-1243. [PMID: 28252210 DOI: 10.1111/apt.14016] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 12/06/2016] [Revised: 12/22/2016] [Accepted: 02/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ustekinumab is a monoclonal antibody targeting interleukins-12 and -23, with efficacy in Crohn's disease (CD) demonstrated in clinical trials. AIM To assess the real-world clinical, endoscopic and radiographic response and remission outcomes achieved with ustekinumab in medically-refractory CD. METHODS A retrospective multicentre cohort study was performed on CD patients receiving ustekinumab between 2011 and 2016. The primary outcome was achievement of clinical and objective steroid-free response and remission at 3, 6 and 12 months. Clinical response and remission were defined by reduction in Harvey Bradshaw Index (HBI) of ≥3 points and an HBI ≤4 points respectively. Objective response was defined by improvement in endoscopic or radiographic CD, as assessed by ileocolonoscopy, contrast-enhanced ultrasound or CT/MR enterography. Objective remission was defined by endoscopic mucosal healing or complete resolution of inflammatory parameters on radiographic assessment. RESULTS A total of 167 CD patients were treated with ustekinumab. 95.2% (159/167) previously failed anti-TNF therapy. Median follow-up was 45.6 weeks (IQR: 24.4-88.9). At 3 months, clinical response was achieved in 38.9% (65/167) and remission in 15.0% (25/167) of patients. At 6 months, clinical response was achieved in 60.3% (91/151) and remission in 25.2% (38/151) of patients. At 12 months, clinical response was achieved in 59.5% (66/111) and remission in 27.9% (31/111) of patients. Endoscopic or radiographic response was demonstrated in 54.5% (67/123) at 6 months and 55.8% (48/86) of patients at 12 months. CONCLUSIONS Ustekinumab is an effective therapeutic option for inducing and maintaining clinical, endoscopic and radiographic response in patients with Crohn's disease failing anti-TNF therapy.
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Affiliation(s)
- C Ma
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - R N Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - G G Kaplan
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - L A Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - S M Devlin
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - N Stern
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - K I Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - C H Seow
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Y Leung
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - K L Novak
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - B P Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - V W Huang
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - K Wong
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - P K Blustein
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - S Ghosh
- University of Birmingham, Birmingham, UK
| | - R Panaccione
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
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Seow CH, Leung Y, Vande Casteele N, Ehteshami Afshar E, Tanyingoh D, Bindra G, Stewart MJ, Beck PL, Kaplan GG, Ghosh S, Panaccione R. The effects of pregnancy on the pharmacokinetics of infliximab and adalimumab in inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45:1329-1338. [PMID: 28318043 DOI: 10.1111/apt.14040] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 12/30/2016] [Revised: 01/26/2017] [Accepted: 02/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transplacental transfer of infliximab and adalimumab results in detectable drug levels in the cord blood and infant. AIM To determine if pregnancy influenced the pharmacokinetics of anti-TNF agents in women with inflammatory bowel disease. METHODS Twenty-five women from the University of Calgary inflammatory bowel disease(IBD) pregnancy clinic on maintenance infliximab or adalimumab were recruited prospectively with serum bio-banking performed each trimester. Infliximab trough and adalimumab steady-state levels were the outcomes of interest and were analysed using the ANSER infliximab and adalimumab assays. Multivariate linear mixed-effects models were constructed to assess infliximab and adalimumab drug levels during pregnancy adjusting for the clinical covariates of albumin, BMI and CRP. RESULTS Fifteen women (eight Crohn's disease, seven ulcerative colitis) received infliximab and 10 women with 11 pregnancies were treated with adalimumab. Median age was 29.6 years (IQR: 27.6-31.2 years). Median disease duration was 9.2 years (IQR: 3.16-15.0 years). Median trough infliximab concentrations were 8.50 μg/mL (IQR: 7.23-10.07 μg/mL), 10.31 μg/mL (IQR: 7.66-15.63 μg/mL) and 21.02 μg/mL (IQR: 16.01-26.70 μg/mL) at trimesters 1, 2 and 3 respectively. Significant changes in albumin and BMI (P < 0.05) but not CRP (P > 0.05) were documented throughout pregnancy. After adjusting for albumin, BMI and CRP, infliximab trough levels increased during pregnancy, by 4.2 μg/mL per trimester (P = 0.02), while adalimumab drug levels remained stable (P > 0.05). CONCLUSIONS Infliximab levels rise during pregnancy, whereas adalimumab levels remain stable after accounting for changes in albumin, BMI and CRP. Therapeutic drug monitoring in the second trimester may be useful in guiding dosing in the third trimester.
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Affiliation(s)
- C H Seow
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Y Leung
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - N Vande Casteele
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - E Ehteshami Afshar
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - D Tanyingoh
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - G Bindra
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - M J Stewart
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - P L Beck
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - G G Kaplan
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - S Ghosh
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - R Panaccione
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
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Gasia MF, Ghosh S, Panaccione R, Ferraz JG, Kaplan GG, Leung Y, Novak KL, Seow CH, Iacucci M. Targeted Biopsies Identify Larger Proportions of Patients With Colonic Neoplasia Undergoing High-Definition Colonoscopy, Dye Chromoendoscopy, or Electronic Virtual Chromoendoscopy. Clin Gastroenterol Hepatol 2016; 14:704-12.e4. [PMID: 26804384 DOI: 10.1016/j.cgh.2015.12.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 08/22/2015] [Revised: 12/05/2015] [Accepted: 12/30/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is unclear what are the best and most appropriate endoscopic procedures for detecting colonic neoplasia in patients with long-term colonic inflammatory bowel disease (IBD). Dye chromoendoscopy (DCE) is the standard used in IBD surveillance colonoscopies. However, studies are needed to determine the optimal endoscopic technique for detecting dysplastic lesions. We investigated current practices used in surveillance colonoscopies by IBD gastroenterologists at a single tertiary center. We also determined the rate of neoplasia detection among different surveillance endoscopic techniques in an analysis of random or targeted biopsies. METHODS We collected data on 454 patients with IBD (54.5% male; mean age, 50 y; mean disease duration, 14.5 y; 55.9% with ulcerative colitis, 42.7% with Crohn's disease, and 1.3% with indeterminate colitis) who underwent surveillance colonoscopy from April 2011 through March 2014 at the University of Calgary in Canada. Subjects were examined using white-light standard-definition endoscopy (WLE), high-definition (HD) colonoscopy, virtual electronic chromoendoscopy (VCE), or DCE; random or targeted biopsy specimens were collected. Endoscopic and histologic descriptions with suspected neoplasia were recorded. Rates of neoplasia detection by the different endoscopic procedures were compared using chi-square analysis. RESULTS Of the patients analyzed, 27.7% had WLE endoscopy with random collection of biopsy specimens, 27.3% had HD colonoscopy with random collection of biopsy specimens, 14.1% had VCE with random collection of biopsy specimens, 0.9% had DCE with random collection of biopsy specimens, 12.8% had HD colonoscopy with collection of targeted biopsy specimens, 11.9% had VCE with collection of targeted biopsy specimens, and 5.3% had DCE with collection of targeted biopsy specimens. Neoplastic lesions were detected in 8.2% of the procedures performed in the random biopsy group (95% confidence interval, 5.6-11.7) and 19.1% of procedures in the targeted biopsy group (95% confidence interval, 13.4-26.5) (P < .001). Neoplasias were detected in similar proportions of patients by HD colonoscopy, VCE, or DCE, with targeted biopsy collection. CONCLUSIONS In a large cohort of IBD patients undergoing surveillance colonoscopy, targeted biopsies identified greater proportions of subjects with neoplasia than random biopsies. Targeted collection of biopsy specimens appears to be sufficient for detecting colonic neoplasia in patients undergoing HD colonoscopy, DCE, or VCE, but not WLE.
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Affiliation(s)
- Miriam F Gasia
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Subrata Ghosh
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Jose G Ferraz
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Yvette Leung
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Kerri L Novak
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Marietta Iacucci
- Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada.
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Nguyen GC, Seow CH, Maxwell C, Huang V, Leung Y, Jones J, Leontiadis GI, Tse F, Mahadevan U, van der Woude CJ. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology 2016; 150:734-757.e1. [PMID: 26688268 DOI: 10.1053/j.gastro.2015.12.003] [Citation(s) in RCA: 306] [Impact Index Per Article: 38.3] [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
BACKGROUND & AIMS The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. METHODS A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk patients. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. Endoscopy or urgent surgery should not be delayed during pregnancy if indicated. Decisions regarding cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone, with the exception of women with active perianal Crohn's disease. With the exception of methotrexate, the use of medications for IBD should not influence the decision to breast-feed and vice versa. Live vaccinations are not recommended within the first 6 months of life in the offspring of women who were on anti-TNF therapy during pregnancy. CONCLUSIONS Optimal management of IBD before and during pregnancy is essential to achieving favorable maternal and neonatal outcomes.
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Affiliation(s)
- Geoffrey C Nguyen
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Cynthia H Seow
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Huang
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yvette Leung
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Frances Tse
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Uma Mahadevan
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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46
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Singh S, Al-Darmaki A, Frolkis AD, Seow CH, Leung Y, Novak KL, Ghosh S, Eksteen B, Panaccione R, Kaplan GG. Postoperative Mortality Among Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis of Population-Based Studies. Gastroenterology 2015; 149:928-37. [PMID: 26055136 DOI: 10.1053/j.gastro.2015.06.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [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: 10/22/2014] [Revised: 05/02/2015] [Accepted: 06/01/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS There have been varying reports of mortality after intestinal resection for the inflammatory bowel diseases (IBDs). We performed a systematic review and meta-analysis of population-based studies to determine postoperative mortality after intestinal resection in patients with IBD. METHODS We searched Medline, EMBASE, and PubMed, from 1990 through 2015, to identify 18 articles and 3 abstracts reporting postoperative mortality among patients with IBD. The studies included 67,057 patients with ulcerative colitis (UC) and 75,971 patients with Crohn's disease (CD), from 15 countries. Mortality estimates stratified by emergent and elective surgeries were pooled separately for CD and UC using a random-effects model. To assess changes over time, the start year of the study was included as a continuous variable in a meta-regression model. RESULTS In patients with UC, postoperative mortality was significantly lower among patients who underwent elective (0.7%; 95% confidence interval [CI], 0.6%-0.9%) vs emergent surgery (5.3%; 95% CI, 3.8%-7.4%). In patients with CD, postoperative mortality was significantly lower among patients who underwent elective (0.6%; 95% CI, 0.2%-1.7%) vs emergent surgery (3.6%; 95% CI, 1.8%-6.9%). Postoperative mortality did not differ for elective (P = .78) or emergent (P = .31) surgeries when patients with UC were compared with patients with CD. Postoperative mortality decreased significantly over time for patients with CD (P < .05) but not UC (P = .21). CONCLUSIONS Based on a systematic review and meta-analysis, postoperative mortality was high after emergent, but not elective, intestinal resection in patients with UC or CD. Optimization of management strategies and more effective therapies are necessary to avoid emergent surgeries.
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Affiliation(s)
- Sunny Singh
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Ahmed Al-Darmaki
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra D Frolkis
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Yvette Leung
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Kerri L Novak
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Subrata Ghosh
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Bertus Eksteen
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
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Batcheller A, Christensen G, Leung Y, Biesiada J, Zhang X, Medvedovic M, Thomas M, Ho S. Dietary Bisphenol-A exposure alters the methylome of rat tropectoderm as determined by reduced representation bisulfite sequencing. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Munro A, Leung Y, Spilsbury K, Stewart C, Semmens J, Codde J, Williams V, O'Leary P, Steel N, Cohen P. Comparison of cold knife cone biopsy and loop electrosurgical excision procedure in the management of cervical adenocarcinoma in situ: What is the gold standard? Gynecol Oncol 2015; 137:258-63. [DOI: 10.1016/j.ygyno.2015.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Coleman BI, Skillman KM, Jiang RHY, Childs LM, Altenhofen LM, Ganter M, Leung Y, Goldowitz I, Kafsack BFC, Marti M, Llinás M, Buckee CO, Duraisingh MT. A Plasmodium falciparum histone deacetylase regulates antigenic variation and gametocyte conversion. Cell Host Microbe 2015; 16:177-186. [PMID: 25121747 DOI: 10.1016/j.chom.2014.06.014] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/06/2014] [Accepted: 06/06/2014] [Indexed: 01/20/2023]
Abstract
The asexual forms of the malaria parasite Plasmodium falciparum are adapted for chronic persistence in human red blood cells, continuously evading host immunity using epigenetically regulated antigenic variation of virulence-associated genes. Parasite survival on a population level also requires differentiation into sexual forms, an obligatory step for further human transmission. We reveal that the essential nuclear gene, P. falciparum histone deacetylase 2 (PfHda2), is a global silencer of virulence gene expression and controls the frequency of switching from the asexual cycle to sexual development. PfHda2 depletion leads to dysregulated expression of both virulence-associated var genes and PfAP2-g, a transcription factor controlling sexual conversion, and is accompanied by increases in gametocytogenesis. Mathematical modeling further indicates that PfHda2 has likely evolved to optimize the parasite's infectious period by achieving low frequencies of virulence gene expression switching and sexual conversion. This common regulation of cellular transcriptional programs mechanistically links parasite transmissibility and virulence.
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Affiliation(s)
- Bradley I Coleman
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Kristen M Skillman
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Rays H Y Jiang
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Lauren M Childs
- Department of Epidemiology and Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston MA 02115 USA
| | - Lindsey M Altenhofen
- Department of Molecular Biology and Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton NJ 08544 USA
| | - Markus Ganter
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Yvette Leung
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Ilana Goldowitz
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Björn F C Kafsack
- Department of Molecular Biology and Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton NJ 08544 USA
| | - Matthias Marti
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
| | - Manuel Llinás
- Department of Molecular Biology and Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton NJ 08544 USA
| | - Caroline O Buckee
- Department of Epidemiology and Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston MA 02115 USA
| | - Manoj T Duraisingh
- Department of Immunology & Infectious Diseases Harvard School of Public Health, Boston, MA 02115 USA
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50
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Kaplan GG, Lim A, Seow CH, Moran GW, Ghosh S, Leung Y, Debruyn J, Nguyen GC, Hubbard J, Panaccione R. Colectomy is a risk factor for venous thromboembolism in ulcerative colitis. World J Gastroenterol 2015; 21:1251-1260. [PMID: 25632199 PMCID: PMC4306170 DOI: 10.3748/wjg.v21.i4.1251] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/05/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare venous thromboembolism (VTE) in hospitalized ulcerative colitis (UC) patients who respond to medical management to patients requiring colectomy.
METHODS: Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of UC and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information. UC patients were stratified by: (1) responsive to inpatient medical therapy (n = 382); (2) medically refractory requiring emergent colectomy (n = 309); and (3) elective colectomy (n = 329). The primary outcome was the development of VTE during hospitalization or within 6 mo of discharge. Heparin prophylaxis to prevent VTE was assessed. Logistic regression analysis determined the effect of disease course (i.e., responsive to medical therapy, medically refractory, and elective colectomy) on VTE after adjusting for confounders including age, sex, smoking, disease activity, comorbidities, extent of disease, and IBD medications (i.e., corticosteroids, mesalamine, azathioprine, and infliximab). Point estimates were presented as odds ratios (OR) with 95%CI.
RESULTS: The prevalence of VTE among patients with UC who responded to medical therapy was 1.3% and only 16% of these patients received heparin prophylaxis. In contrast, VTE was higher among patients who underwent an emergent (8.7%) and elective (4.9%) colectomy, despite greater than 90% of patients receiving postoperative heparin prophylaxis. The most common site of VTE was intra-abdominal (45.8%) followed by lower extremity (19.6%). VTE was diagnosed after discharge from hospital in 16.7% of cases. Elective (adjusted OR = 3.69; 95%CI: 1.30-10.44) and emergent colectomy (adjusted OR = 5.28; 95%CI: 1.93-14.45) were significant risk factors for VTE as compared to medically responsive UC patients. Furthermore, the odds of a VTE significantly increased across time (adjusted OR = 1.10; 95%CI: 1.01-1.20). Age, sex, comorbidities, disease extent, disease activity, smoking, corticosteroids, mesalamine, azathioprine, and infliximab were not independently associated with the development of VTE.
CONCLUSION: VTE was associated with colectomy, particularly, among UC patients who failed medical management. VTE prophylaxis may not be sufficient to prevent VTE in patients undergoing colectomy.
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