The Effects of the COVID Pandemic on Patients with IBD: Lessons Learned and Future Directions.

Risk of Severe Coronavirus Disease 2019 in Patients With Inflammatory Bowel Disease in the United States: A Multicenter Research Network Study

espanolLa politica europea de energia lleva varios anos en primera linea de actuacion de la UE. Su incorporacion al Tratado de Lisboa, asi como su relacion estrecha con otras politicas de la UE tales como competencia, mercado interior, tecnologia o medio ambiente, han convertido a la energia en un actor principal en lo que respecta a la accion y legislacion europeas y hay que mencionar las politicas y actuacion en el campo internacional, incluida la ayuda al desarrollo. No debe olvidarse en este contexto el transporte como gran consumidor de energia y uno de los mayores responsables de emision de gases de efecto invernadero. Tampoco hay que dejar de lado la tecnologia como tal. Las tres dimensiones de la politica de energia, competitividad, sostenibilidad y seguridad de abastecimiento, estan al mismo nivel de importancia, pero el equilibrio que se establezca entre las tres necesita decisiones politicas cuidadosas, que no suponen necesariamente alcanzar los optimos individuales de manera separada. La dimension exterior habria de anadirse a las tres anteriores. La UE persigue ejercer un cierto liderazgo mundial en relacion con sus objetivos para los horizontes 2020 y 2050. EnglishEuropean energy policy has been at the forefront of EU action for several years now. Its inclusion in the Lisbon Treaty, as well as its connection with other key EU policies such as competition, internal market, technology or environment, has made energy a major player in terms of EU action and legislation, let alone in its international policies and action including development aid. Transport as a major energy user - and greenhouse gas emitter - should not be forgotten in this context. Neither should technology as such. The three pillars of energy policy, that is to say competitiveness, sustainability, and security of supply are on an equal footing, but the balance to be struck between them requires delicate political set-offs, which means that the optimum objective for each of them separately is unlikely to be attainable. A pillar on external relations should also be added to the former three. The EU pursues exert world leadership in view of its 2020 and 2050 objectives.

COVID-19 Vaccination Is Safe and Effective in Patients With Inflammatory Bowel Disease: Analysis of a Large Multi-institutional Research Network in the United States

Incidence of Clostridium difficile Infection in Inflammatory Bowel Disease

BackgroundSince almost its 1 year outbreak declared by the World Health Organization on 11th March 2020, COVID-19 pandemic still cannot be controlled successfully. Inflammatory bowel disease potentially elevates the risk of infections, independently from the age, while disease activity and medical treatment(s) can increase the risk as well. Based on international data, in total, 4% receives the infection. Furthermore, 1.8% of the patients on biologic therapy needs intensive therapeutic care and 1% passes away.MethodsThis was an observational, questionnaire based study, carried out in Hungary, between February and March 2021. Our questionnaire consisted of 45 questions, that surveyed the impact of the pandemic among IBD patients, and the severity and outcome of the infection. Participants were on biologic therapy. Our aim was to determine the frequency and outcome of SARS-CoV2 infection in patients with inflammatory bowel disease on different biological therapy.ResultsIn total, 387 respondents completed the questionnaire, and 47 participants (12%) developed COVID-19 infection. 66.9% of them were receiving anti-TNF inhibitor, 16.8% vedolizumab, 12.1% ustekinumab, and 4.1% tofacitinib. Based on our cohort, different biologic therapies didn’t elevate the risk of infection (p=0.3486), nor the hospitalization rate (p=0.277). No one was in ICU or ventilator, and nobody passed away. Furthermore, 38.3% suspended the current biologic therapy, but it didn’t decrease the rate of hospitalization (p=0.533), however, it didn’t cause flare-ups either in the primary disease (p=0.415). Based on our cohort, neither vitamin supplementations meant protection against the infection (p=0.117), only regular mask wearing seems to protect patients with IBD (p=0.009).ConclusionBased on our cohort, more IBD patients develop the infection in Hungary, compared to international data, however, the outcome of the infection is more favourable. It seems, that the different biological treatments don’t affect the infection rate, and neither elevates the hospitalization rate. In generally, there is no need to suspend the current biologic therapy, however, it should be a matter of individual judgment. After all, we claim that mask-wearing still seems to be the most effective form of prevention.

With the onset of COVID-19, there were rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to determine the impact of changes in healthcare delivery during the COVID-19 pandemic on patients with inflammatory bowel disease (IBD), in both well-resourced and vulnerable populations. Using a mixed methods, observational study design, patients receiving IBD care at a university or a safety-net hospital were identified by the electronic health record. Patient demographics, IBD history, and disease activity were acquired from the electronic health record. IBD-related outcomes were compared from the onset of the pandemic in the United States until December 2020 (COVID-19 pandemic year 1) and compared with outcomes in the previous year. A subset of participants provided their perspective on how changes in healthcare delivery and financial stability impacted their IBD through a standardized questionnaire and semi-structured interview. Data from a total of 1449 participants were captured, 1324 at the tertiary care university hospital and 125 at the safety-net hospital. During COVID-19, there was a decrease in healthcare utilization at both sites. Race/ethnicity and primary language were not associated with IBD-related hospitalizations or admissions. Patients that were employed and those with insurance had a higher number of IBD-related emergency department visits at both the university and safety-net hospitals (P = .03 and P = .01, respectively). Patients who did not speak English were more likely to report challenges using technology with telehealth and difficulty contacting IBD providers. For IBD populations, during COVID-19, in both hospital settings, emergency department visits, hospitalizations, outpatient surgery, and clinic visits were reduced compared with the year prior. Patients with lower socioeconomic status and limited English proficiency reported facing more challenges with changes to healthcare delivery, healthcare access, and conveying changes in IBD activity. These results highlight the need for payors and providers to specifically attend to those populations most susceptible to these systemic and lasting changes in care delivery and promote greater equity in healthcare.

Aims Spirituality is the search for meaning or purpose in life (Delgado, 2005), not strictly from a religious perspective. Spiritual well-being is positively connected with physical and psychic well-being, and achieving the first is likely to help to maintain the latter (Bożek et al., 2020). Individuals with chronic disorders or experiencing a life-changing condition (e.g. Inflammatory Bowel Disease - IBD), may have gone through a spiritual quest of some sort that can produce spiritual anguish or 'spiritual distress', interpreting the disease as a punishment, feeling as a victim of 'superior injustice', losing faith in prayer (Klimasiński et al., 2022), but data on the spiritual needs (SpNs) of IBD patients are lacking. The main objective of this project is to describe the SpNs of IBD patients to provide information to IBD nurses on how to address these needs. Methods A multilingual cross-sectional electronic survey will be carried on assessing the SpNs of patients using the Spiritual Needs Questionnaire (SpNQ). The tool is made up of items assessing the importance attributed by patients to SpNs using a 4-point Likert scale (Büssing et al., 2010), and is available in ten European languages, but it could be translated and validated in other European languages inside the project in case of anticipated participation by a country that need the questionnaire available in the local language if a collaboration with IBD clinicians and patients in that country will be possible. Anticipated Impact The findings of such a study can provide better consideration of SpNs in the treatment of IBD patients, emphasizing the importance of addressing SpNs for IBD nurses in managing IBD patients, adopting the tools to screen patients for these needs; furthermore, the results of this project can provide additional evidence of the importance of nursing in IBD patients’ care.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Trust in telemedicine from IBD outpatients during the COVID-19 pandemic

Previous studies have reported that Clostridium difficile infection [CDI] is more common, and has a worse outcome, in patients with inflammatory bowel disease [IBD] than in those without. We have now reassessed the incidence and outcome of CDI in in-patients with and without IBD, and the outcomes of admissions for IBD patients with and without CDI. In-patients who had stool samples submitted for C. difficile testing [2007-2013] were collated. Two matched pools were generated: patients with IBD and CDI vs non-IBD patients with CDI [matched for age, sex and date] and patients with IBD and CDI vs IBD patients without CDI [matched for age and IBD type]. For each group, admission details, pre-admission and outcome data were compared. Four per cent [1079/21035] of samples were positive for CDI; 5% [49] of these were from IBD in-patients. The incidence of CDI in IBD patients decreased from 8.7% in 2007/08 to 0.4% in 2012/13 [p < 0.0001]. Length of stay was shorter in IBD patients with CDI than in non-IBD CDI patients (hazard ratio [HR] 0.335 [0.218-0.513]) and was no different between IBD patients with and without CDI (HR 0.661 [0.413-1.06]). IBD patients were diagnosed with CDI earlier in their admission than non-IBD patients (HR 0.182 [0.093-0.246]). No differences in mortality were found. The incidence of CDI complicating IBD has fallen since 2007. CDI is no longer associated with worse short-term outcomes in patients with IBD than in those without. Patients with CDI and IBD have similar outcomes to those with IBD alone.

Morbid obesity is an emerging problem in the inflammatory bowel disease [IBD] population. Bariatric and IBD surgeries share technical difficulties and elevated morbidity. However, nothing is known about the possibility of performing bariatric surgery in patients with a definite diagnosis of IBD. The aim of this study was to evaluate safety and efficacy of restrictive bariatric surgical procedures in IBD patients. Six patients with morbid obesity and IBD were operated on with restrictive bariatric surgery and concomitant or deferred IBD surgery. We compared BMI, excess weight loss, and perioperative complications of restrictive bariatric surgery in IBD with a control group of 95 bariatric patients. We also evaluated clinical, biochemical, pharmacological, and endoscopic characteristics before and after surgery in IBD patients. Perioperative results, in terms of BMI, excess weight loss, and complications after restrictive bariatric surgery, were comparable between obese IBD and control patients. IBD patients experienced a significant postoperative reduction in BMI, CRP levels, WCC, and systolic blood pressure and a significant increment in hemoglobin levels. None of the patients reported signs of malabsorption. All the patients except one were able to discontinue steroids, were in endoscopic remission at 1 year, and were in clinical remission at the latest follow-up visit. Two patients halved azathioprine dosage. One patient had a postoperative clinical recurrence treated with adalimumab. Bariatric surgery seems to be safe and effective in IBD patients. Concomitant ileocolic resection does not increase perioperative complications. Relationship between IBD and obesity remains unclear, but weight loss could be useful in the pharmacological control of IBD.

ABSTRACTInflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn's disease (CD) and irritable bowel syndrome (IBS) are distinct gastrointestinal disorders. Mycobacterium avium subspecies paratuberculosis (MAP) is implicated in IBD pathogenesis, while the roles of human endogenous retroviruses (HERVs) are under investigation. We aimed (a) to investigate whether the levels of humoral response to MAP‐3865c, HERV‐K envelope and HERV‐W envelope against the epitopes in IBD/IBS patients; (b) to determine the frequency of micronuclei in IBD patients and (c) to evaluate the possible correlation between genomic damage and humoral response. This study investigates antibody titres against MAP 3865c, HERV‐K env and HERV‐W env in plasma from 102 IBD, 20 IBS patients and 92 healthy controls (HCs). Micronuclei (MNi) frequency in IBD patients is assessed, correlating with humoral responses and patient genotype profiles. IBD patients exhibited elevated antibody responses to MAP 3865c, with those carrying the GA genotype for TNF‐α showing higher anti‐MAP 3865c IgG levels. A significant positive correlation was observed between MNi frequency and the humoral response against MAP 3865c in IBD patients. Higher antibody responses to HERV‐K env were detected in both IBD and IBS patients compared to HCs, with significant positive correlations found between MAP 3865c and HERV‐K env peptide responses in IBD patients. HERV‐W env antibody levels were higher in IBS patients than in HCs. Our findings highlight the association between UC and CD and immune responses targeting MAP and HERV‐Kenv. Specific genetic profiles may exacerbate inflammation, potentially amplifying genetic damage observed in IBD patients, as indicated by MNi frequencies.

Women with inflammatory bowel disease [IBD] have an increased risk for caesarean section [CS], but perineal obstetric outcomes, which may have significant consequences for women with IBD, have not been previously studied. Maternal outcomes in singleton pregnancies of IBD and non-IBD patients [2014-2018] in a single centre were studied. In 31 528 non-IBD and 179 IBD patients delivery by CS was more likely in IBD patients (p = 0.0021, relative risk [RR] 1.45, confidence interval [CI] 1.16-1.81). Elective CS in IBD patients occurred in 40% for IBD indications, all in accordance with current international guidelines. Perineal trauma, including tears involving the anal sphincter, were equally uncommon in IBD [2.23%] and non-IBD patients [3.40%; p = 0.35, RR 0.64, CI 0.24-1.68]. Of the four IBD patients with clinically significant tears, none had pelvic floor dysfunction or incontinence at follow-up in a specialist postnatal perineal trauma clinic. One IBD patient who had a clinically non-significant second-degree perineal tear reported incontinence a year after giving birth. Previous perianal disease was not associated with significant perineal trauma. The low rate of perineal trauma is reassuring for promotion of vaginal delivery in most IBD patients. In those who experienced tears involving the anal sphincter no continence issues occurred. Women with IBD having a greater incidence of delivery by CS was only partially explained by IBD indications.

Association Between Inflammatory Bowel Disease and Colorectal Cancer Stage of Disease and Survival

Race and socioeconomic status (SES) significantly affect the content and delivery of healthcare for multiple chronic disease states. Inflammatory bowel disease (IBD) is a set of complex, chronic diseases with the potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to race, SES, and IBD remains fragmented. Using guidelines published by the Centre for Reviews and Dissemination, we performed a systematic review of the world's literature to identify studies related to: 1) IBD, 2) race/ethnicity, 3) SES, 4) healthcare delivery, and 5) healthcare effectiveness. We identified 40 studies that met inclusion criteria. Twenty-four studies (60%) assessed the role of SES and 21 (53%) evaluated race. Topics addressed by these studies included: 1) Utilization of Medical and Surgical Therapy; 2) Adherence to Medical Therapy; 3) Clinical Outcomes; 4) Healthcare Access and Utilization; 5) Disease Perception and Knowledge; and 6) Employment/Insurance. We identified race- and SES-based disparities in the content of medical and surgical healthcare, utilization of inpatient and ambulatory medical care, adherence to medical therapy, and disease perceptions and knowledge. Several studies also identified race- and SES-based disparities in outcomes for IBD, including in-hospital mortality rates and health-related quality of life. Race- and SES-based disparities in the delivery and effectiveness of healthcare for patients with IBD exist in numerous domains, yet studies remain limited in their scope and breadth. Concerted, prospective, multicenter efforts are needed to address underlying causes for disparities and to identify methods of reducing and eliminating disparities.