Crohn’s disease: considerations for treatment choice during pregnancy

IgE antibodies to prohevein, hevein, and rubber elongation factor in children with latex allergy

Background Zinc deficiency is common in patients with inflammatory bowel disease (IBD), and the frequency is about 42.1% in Crohn’s disease (CD) and 38.5% in ulcerative colitis (UC). Patients with IBD with serum zinc deficiency are more likely to have adverse disease-specific outcomes. However, there are few studies about the effect of administering zinc preparations in IBD patients with zinc deficiency. The purpose of this study was to investigate the efficacy of zinc acetate hydrate (Nobelzin®︎) preparation for patients with IBD with zinc deficiency. Methods 56 IBD patients who were treated with Nobelzin®︎ for zinc deficiency from March 2017 to November 2019 were analyzed. We conducted a multicenter retrospective observational study to investigate changes in serum zinc concentration or changes in disease activity before and after administration and their contributing factors. Results Among 56 cases, 4 cases were excluded due to self-interruption of internal use, and 52 cases (39 cases of CD, 13 cases of UC) were included. The median observation period was 27.5 (13–47) weeks, the median serum zinc concentration before administration was 58.5 (50.8–65.3) μg/dl, and the average of starting dose of Nobelzin®︎ was 67.8±31.1 mg/day. Nobelzin®︎ administration normalised serum zinc concentration(Zn ≥80 μg/dl) in 94.2 % (49/52) of patients. The median administration period required for normalisation of serum zinc concentration was 5 (3–8) weeks. In the group of CD patients who achieved zinc normalisation, the median CDAI score significantly improved after the normalisation from 171.5 to 129.5 (p < 0.001). Similarly, the partial Mayo score in the same group of UC significantly improved after the normalisation (p = 0.035). There were 77.6 % patients who did not have additional treatment without Nobelzin®︎ administration until zinc was normalised. In CD patients of this group, the median CDAI score significantly improved after the normalisation from 152 to 120 (p = 0.029). All 3 cases in which zinc normalisation was not achieved within the observation period were CD cases, and they had a history of multiple surgeries, changes in biologics, or a long medical history. In one patient, side effects of Nobelzin®︎ administration were observed and these were abdominal discomfort and nausea. During the observation period, serum copper concentration was measured in 27 patients after administration of Nobelzin®︎, and one patient presented with copper deficiency. Conclusion Our findings show that administration of zinc acetate hydrate preparations may be effective in improving zinc deficiency and contribute to improve disease activity in IBD patients with zinc deficiency.

Adherence of Infusible Biologics During the Time of COVID-19 Among Patients With Inflammatory Bowel Disease: A Nationwide Veterans Affairs Cohort Study

Background: The study aimed to study knowledge, attitude and practice of husband and factors affecting in supporting activities during pregnancy, delivery and postpartum period at Khairahani VDC of Chitwan district. The general objective of the study was to identify husband’s involvement in making safe pregnancy, delivery and postpartum period. Methods: A cross sectional, descriptive and non-experimental study design was conducted using quantitative methods. Sampling method was purposive and study population was father of fewer than one year age group children. Data was collected using structured questionnaire by interview method. Results: Majority of husbands had low knowledge about support during pregnancy, delivery and postpartum period while activities did for support was very negligible regardless of knowledge. Most of the husbands don’t know about danger signs during pregnancy. Very low level of knowledge was found about birth preparedness, emergency obstetric conditions during delivery period. Husbands took decision regarding place of delivery in majority. Half of the respondent’s don’t know about complications during postpartum period. Education level was found to be non-supporting factor for knowledge of support during pregnancy. Education of husband increased the knowledge of birth preparedness during pregnancy. Family size has influence the support during postpartum period. There was no association between income of husband and support provided during delivery. Conclusion: The knowledge level of support was found to be low during pregnancy, delivery & postpartum period along with supporting activities. Similarly there was low knowledge of emergency obstetric condition; danger signs during pregnancy and post-partum period. The practice of birth preparedness was found to be unsatisfactory regardless of knowledge.DOI: http://dx.doi.org/10.3126/jonmc.v1i1.7287 Journal of Nobel Medical College Vol.1(1) 2011 45-52

BackgroundSpondyloarthritis (SpA) associated with inflammatory bowel diseases (IBD) is a subtype of SpA affecting the axial spine (AxSpA) and peripheral musculoskeletal system causing arthritis, enthesitis and dactylitis (peripheral SpA) in...

Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66-2.73) and postpartum (RR 2.61, 95% CI 1.84-3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73-4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6-3.11; postpartum period: RR 2.85, 95% CI 1.79-4.52).Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.

The Birds, the Bees, and Inflammatory Bowel Disease: Preconception Care in Inflammatory Bowel Disease.

BACKGROUND: Evidence informing providers and payers regarding the appropriate management of women with reproductive potential continues to grow and was primarily stimulated by the FDA's Pregnancy and Lactation Labeling Rule. The objective of this analysis was to examine the unmet clinical needs of patients with Crohn's disease (CD) during pregnancy. METHODS: CD patients with pregnancies resulting in live births were identified in the MarketScan® database (1/2010-9/2016) using ICD-CM/CPT/MS-DRG codes. The estimated conception date (index date) was calculated based on the gestational age indicated by the diagnosis or procedure code for delivery. Continuous enrollment from the baseline (BL) period (6-months pre-index) through the postpartum period (6-months post-delivery) was required. Clinical proxies were developed to assess flares during the study period: (1) At least 2 ICD-CM codes for CD-related symptoms: abdominal pain, blood in stool, diarrhea, fatigue, fever, loss of appetite, weight loss, rashes; (2) ICD-CM code for CD-related complication: abscess, anal fissure, arthritis, bowel obstruction/stricture, fissure, fistula, gallstone, inflammation of the eye/mouth, kidney stone, liver disease, ulcers; (3) CD-related hospitalization/ER visit; (4) 60% increase in CD-related outpatient visits from BL; (5) addition or potency increase of oral corticosteroid from BL; (6) addition or dose increase in biologic therapy from BL; and (7) addition of other CD indicated therapies from BL. An assumption was made that only a single flare could occur within 30 days. RESULTS: 1,726 successful pregnancies among CD patients were identified. The mean age was 30.3 years, mean (SD) Deyo-Charlson comorbidity index was 0.1 (0.4), most patients had commercial PPO coverage (63.4%), and the most prevalent comorbid condition was infection (42.5%). There were no significant differences in BL characteristics between pregnancies with and without flares. Among the 1,726 pregnancies, there were a total of 5,074 flares (1,268 flares [25.0%] during the BL period, 2,227 flares [43.9%] during the pregnancy period, and 1,579 flares [31.1%] during the post-partum period). To account for differences in the duration of each peri-pregnancy period (baseline [6.0 months], pregnancy [9.2 months], postpartum [6 months]), average monthly flare rates were calculated. The rates were 211.3, 241.7, and 263.2 flares/month, respectively, for the BL, pregnancy and post-partum periods. The most frequent clinical proxies for flares during the BL period were an increase in CD-related outpatient visits from BL (23.7%) and CD-related symptoms (23.0%). The most frequent clinical proxies for flares during both the pregnancy and postpartum periods were the addition or increase in dose of CD-indicated therapies (45.6% pregnancy period, 35.8% postpartum period) and CD-related complications (25.0% pregnancy period, 35.4% postpartum period). CONCLUSION(S): The consistently high risk of flares during the peri-pregnancy period demonstrates the need for optimizing the management of CD. While sole reliance on claims data is a limitation in assessing poor CD control, the use of clinical proxies to explore national trends in CD disease control might help uncover unmet needs. Healthcare professionals should aim for disease control prior to pregnancy and have a treatment plan during and after pregnancy to optimize clinical outcomes and minimize CD-related complications for women.

Ambient air pollution and the risk of pediatric-onset inflammatory bowel disease: A population-based cohort study

Inflammatory bowel disease (IBD) poses significant challenges in its management, encompassing a spectrum of conditions from Crohn’s disease to ulcerative colitis. Dietary interventions have emerged as integral components of the multidisciplinary approach to IBD management, with implications ranging from disease prevention to treatment of active manifestations and addressing complications such as malnutrition. While dietary interventions show promise in improving outcomes for some patients with IBD, there is no consensus in the existing literature regarding remission maintenance in those patients. Furthermore, many patients explore dietary modifications often guided by anecdotal evidence or personal experiences and this could lead to malnutrition and decreased quality of life. This comprehensive review synthesizes existing literature to elucidate the complex interplay between diet and IBD, offering insights into the efficacy and safety of various dietary modalities in maintaining disease remission. It also highlights the importance of patient education in navigating dietary choices and potential risks associated with food avoidance, including the heightened risk of micronutrient deficiencies. Furthermore, it emphasizes the pivotal role of a multidisciplinary care team comprising clinicians and dietitians in providing personalized dietary guidance tailored to individual patient needs and goals. By synthesizing the latest evidence and providing insights into both the potential benefits and risks of dietary interventions, this review could be used as a resource for healthcare professionals and patients alike in navigating the complex landscape of dietary management in IBD.

Ulcerative colitis and Crohn’s disease, collectively known as inflammatory bowel disease (IBD), are chronic, spontaneously relapsing disorders of unknown cause. These diseases appear to be immunologically mediated and have genetic and environmental influences. Although the cause of these diseases remains obscure, the pathogenesis of chronic intestinal inflammation is becoming clearer, due to improved animal models of enterocolitis and important advances in immunological techniques. Traditional therapy for IBD, although helping to induce and maintain disease remission, does little to alter the underlying fundamental disease process. New IBD therapy has not developed significantly over the past twenty years and includes 5-aminosalicylic acid preparations, corticosteroids and immunomodulatory agents, such as azathioprine, 6-mercaptopurine and methotrexate. There is, therefore, a need for new, specific disease-modifying therapy and the development of such therapy has been hastened by a greater understanding of the pathophysiology of IBD. This review examines the most recent novel therapies for IBD, with specific emphasis on immunomodulatory and novel anti-inflammatory therapies. Recent clinical trials are reviewed, and the potential advances and clinical impact that these novel agents may provide are discussed.

INTRODUCTION: Inflammatory Bowel disease (IBD) management involves a delicate balance between medications, diet, and psychosocial care. Dietary factors like sugar consumption have been associated with disease onset. However, it is unknown how sugar intake complicates the medical regimen necessary to induce and maintain disease remission. We sought to characterize differences in IBD treatment regimens among patients with high and low sugar consumption and if medication patterns exist within subgroups that are in remission. METHODS: Using a longitudinal, prospective natural history of consented IBD patients, we meticulously tracked consented IBD patients at a large tertiary referral hospital. Sugar consumption was prospectively assessed using the 2005 National Health Interview Survey Diet and Questionnaire. Patients completed these questionnaires at routine outpatient appointments. The USDA estimates that the average American consumes 73 grams of added sugars on a daily basis. Patients who consumed above this average figure, were allocated to the high consumption group and those below comprised the low sugar consumption group. The primary outcome, medication use, was approximated using prescription data harvested from the electronic medical records. We focused on standard medications used in the management of IBD. We also conducted subgroup analyses to identify potential subpopulations with treatment patterns. Remission was defined as a score of ≤ 3 on the Harvey-Bradshaw index or ≤4 on the Ulcerative Colitis Activity Index. RESULTS: The study population consisted of 1259 adult IBD patients (70%CD, 30%UC, 57% Female). The median age was 40 years old. The mean sugar consumption of this study cohort was 71 grams. About 66% of patients had low sugar consumption while 34% of patients had high sugar consumption. High sugar consumption was associated with increased anti-TNF medication use, higher combination therapy use, and lower 5-ASA use. Among the subgroup of high sugar consumers, those not in remission used more adalimumab and steroids. Deeper analysis with only patients with Crohn’s Disease (CD), revealed differences in Azathioprine, 5-ASA, and steroid use. CONCLUSION: IBD patients consuming high sugar diets require more immunomodulator, biologic and combination therapy. These data suggest that optimal IBD treatment may benefit from incorporating nutritional counseling for healthy diet with low added sugar.Table 1Table 2Table 3

Inflammatory bowel diseases and reproductive health.

Purpose of reviewThis review serves as a summary of healthcare maintenance items that should be addressed when managing patients with inflammatory bowel disease (IBD). This manuscript discusses vaccine-preventable illnesses, cancer prevention recommendations, and other screenings that are important to gastroenterologists and primary care physicians caring for patients with IBD.Recent findingsPatients with IBD often require immunomodulator agents and/or biologics to induce and maintain disease remission which can increase the risk of developing several infections. Also, subsets of patients with IBD are at an increased risk for a number of malignancies including colon, cervical, and skin cancers.SummaryStaying up-to-date with health care maintenance of patients with IBD is critical, especially given their increased risk for vaccine-preventable infections as well as comorbidities such as cancers, bone health, and mood disorders. Gastroenterologists and primary care physicians should familiarize themselves with the required screenings and vaccines that are recommended for adult patients with IBD, particularly those who are immunosuppressed.

Inflammatory bowel disease (IBD) comprises 2 major types-ulcerative colitis (UC) and Crohn's disease (CD). A remote collaborative medical care fee has been established for patients with suspected intractable diseases since 2020. Remote collaborative medical care is a type of telemedicine wherein a hospital specialist for intractable diseases, the patient, and an attending physician at a community hospital communicate via video calls. In IBD cases, however, treating patients who have already been diagnosed with severe or intractable diseases is difficult. As a part of the Hokkaido Intractable Disease Medical Care System Development Project, we have started providing free remote collaborative medical care services for all IBD patients, including those with a confirmed diagnosis and attending regional hospitals. We set up the telemedicine system using Microsoft365, a commercial cloud, and Nextcloud, a PaaS, to ensure robust security and enable rapid and massive sharing of medical details by information and communication technology. Since April 2021, we have examined 27 patients (36 times). Among these patients, 5 patients from regional hospitals were undiagnosed (1 patient of suspected CD, 3 patients of suspected IBD unclassified (IBD-U), and 1 patient of undiagnosed enteritis). Twenty-two patients from regional hospitals had a confirmed diagnosis (17 UC and 5 CD patients). Eight patients required a second time remote collaborative medical care, and 1 patient required a third time remote collaborative medical care. There was no equipment failure such as communication failure or system trouble, and all patients could be examined smoothly. The maintenance cost of the telemedicine system was 2500yen/month per hospital. Among all cases receiving remote collaborative medical care, 86% were consultations for refractory or severe active cases with a confirmed diagnosis of IBD. At present, the remote collaborative medical care fee for diagnosed patients is not permitted. Since remote collaborative medical care has the potential to correct regional disparities in medical standards, there is an urgent need to review the criteria for remote collaborative medical care fees.