Treating the Whole Disease: A Call for Holistic Care for Patients with Inflammatory Bowel Disease.

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

Winter Is Coming! Clinical, Immunologic, and Practical Considerations for Vaccinating Patients With Inflammatory Bowel Disease During the Coronavirus Disease-2019 Pandemic

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Cost Analysis and Cost Determinants in a European Inflammatory Bowel Disease Inception Cohort With 10 Years of Follow-up Evaluation

Innovation in Inflammatory Bowel Disease Care During the COVID-19 Pandemic: Results of a Global Telemedicine Survey by the International Organization for the Study of Inflammatory Bowel Disease

Inflammatory Bowel Disease Clinical

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by recurring inflammation and severe mucosal damage in the intestine. In Taiwan, there has been a rapid increase in the incidence and prevalence of IBD, posing significant challenges for patient care.1 A newly diagnosed patient with IBD may face uncertainty about the future and worry about their prognosis. Unfortunately, IBD is a chronic condition that can vary significantly in terms of its extent, severity, and activity. Some patients may develop disease that is refractory to available treatments, leading to a significant decline in quality of life.1, 2 Refractory IBD patients are at increased risk of malnutrition and psychological complications.3 When assessing the reasons for treatment failure, it is essential to rule out any concomitant clinical conditions, evaluate potential disease complications, assess patient adherence to therapy, and explore opportunities for treatment optimization.2 There are numerous factors that can influence medication adherence, including infections, pregnancy, drug delivery methods, and patient concerns about potential complications.1, 4 Among patients with IBD, medication nonadherence rates range from 7% to 72%. This is a significant contributing factor to treatment refractoriness or loss of response.5 According to the study, regarding concerns about adverse reactions, 38.8% of patients reported never or rarely feeling worried, while 40.3% felt sometimes worried, 12.8% often worried, and 6.1% always worried.5 A study revealed that the COVID-19 pandemic led to changes in the medical behavior of IBD patients. However, educational interventions by clinicians and IBD nurses successfully reduced anxiety levels and enhanced medication adherence.4 During pregnancy, clinicians or patients may also change the drug regimen due to concerns about side effects.1 A multidisciplinary team (MDT) in IBD care consists of healthcare professionals from various disciplines who collaborate to provide comprehensive patient care. However, nursing roles within MDTs for IBD patients can vary significantly across different regions of the world.3 According to the second N-ECCO consensus statements on European IBD care, nurses working in any setting that involves contact with IBD patients need a fundamental understanding of the diseases, including the distinction between Crohn's disease and ulcerative colitis. They must also recognize the importance of timely therapeutic interventions. Nurses should cultivate empathy and active listening skills, and be able to provide essential IBD-related information and holistic support.6 In Taiwan, the institutionalization of IBD nurse specialists occurred in the late 2010s. According to the study, regarding the usefulness of IBD nursing services for disease education, medication education, and outpatient clinic scheduling, ~10.9%–12.5% of patients rated them as useful, while 78.1% rated them as very useful.5 Effective IBD management requires strict control of disease progression, utilizing an interdisciplinary, holistic approach. This is especially crucial for hospitalized IBD patients, where close collaboration between gastroenterologists and colorectal surgeons is essential.3 Furthermore, IBD nurses play a crucial role in the IBD MDT, acting as a bridge between gastroenterologists and colorectal surgeons. They address a wide range of patient care needs, from communication and therapeutic education to the management of more complex issues such as fistulas care. The psychological morbidity of refractory IBD should be also recognized; this is driven by the impact of multiple treatment failures, the realization that disease outcome may be undesirable, frequent exposure to opioids, and the significant distress caused by fluctuation or unremitting symptom.3 The IBD clinician was unable to allocate sufficient time to discuss the entire disease course with patients. IBD nurses play a pivotal role in patient care, often encompassing patient education, disease management, nutrition counseling, and wound care. In addition, they assist patients with daily life aspects that can impact the course of the disease, such as diet and sexuality. They also address the psychological challenges that IBD patients may face.7 In conclusion, the role of IBD nursing is increasingly recognized globally, including in Taiwan, as a fundamental component of effective IBD healthcare services and is firmly established within the MDT. The authors declare no conflicts of interest.

Beyond Gene Discovery in Inflammatory Bowel Disease: The Emerging Role of Epigenetics

Selected Summary

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

Inflammatory Bowel Diseases and COVID-19: The Invisible Enemy

The logistic issues facing the inflammatory bowel disease (IBD) clinician in 2016 are of equal magnitude to the scientific issues that are advancing the field at such a rapid rate. The expansion of therapies and therapeutic strategies, especially in the last 10 years, has not been matched by an increase in the resources that are required to deliver this state of the art care to our patients. Dr. Greg Moore, the current chair of the Australian IBD Association and Director of IBD at Monash Health, outlined national initiatives to quantify and subsequently improve the quality of IBD care in Australia. The high economic burden of IBD in Australia was discussed, as illustrated by an external accounting review in 2013, followed by presentation of results of the UK IBD audit. This demonstrated that IBD was grossly under-resourced compared with other chronic diseases, but that quantification of this disparity with accurate audit data resulted in improvements in resources such as the number of IBD nurses within a short period of time. This lead to an introduction to the Crohn's and Colitis Australia IBD Audit currently underway. The audit data will be used as advocacy for improved IBD funding, and all centers with an IBD service are urged to participate. Without data, funding requests to state and federal governments are unlikely to be successful. Dr. Peter de Cruz, Director of IBD at Austin Health, gave an informative overview of the changing models of care in IBD that are emerging as means of managing increasingly complex treatment strategies expanding beyond the boundaries of the usual patient clinic or office visits. These new models of care have arisen concurrent with advances in digital technology and new treatment strategies in IBD that are incorporating objective treatment endpoints rather than traditional symptom-based care. Research into the use of “E-Health” in IBD from Europe has demonstrated that digital algorithmic patient self-management plans can provide an efficient alternative to cumbersome, time-consuming hospital clinic visits, particularly in patients with milder disease phenotypes. Dr. de Cruz's research team are currently researching the use of E-Health strategies in patients with mild–moderate ulcerative colitis, a patient subgroup in whom non-clinic-based treatment strategies have been used effectively. Belinda Headon, IBD nurse consultant at Alfred Health, discussed the enormous administrative workload that is required to effectively deliver biologic therapy to IBD clinic patients. Using the Alfred's clinic as a model to demonstrate the increasing use of biologic therapies, the presentation contained multiple practical tips to help navigate the complex logistic and paperwork processes required to obtain these therapies via the Pharmaceutical Benefits Schemes. This presentation was consistent with recent local data that has shown that IBD nurses now devote more than half of their time to the logistics of delivering biologic therapy—an increase in workload that has not been matched by an increase in personnel. Professor Jane Andrews from Royal Adelaide Hospital has been at the forefront of recent advocacy efforts to improve IBD resources and IBD nurse funding in particular. She presented data her research team obtained from two South Australian hospitals that have been instrumental in forming a business case demonstrating the cost-effectiveness of IBD nurses to hospitals and health services. Her message to those seeking to obtain hospital-funded IBD nursing positions was clear—“Speak Up!”. She discussed the firm negotiating that was required to achieve funded positions at her institution, backed up by accurate local data that will hopefully be replicated by the current Crohn's and Colitis Australia IBD Audit. Finally, Dr. Mark Ward, from Alfred Health, outlined a creative solution to managing the increasing workload of IBD care—the virtual clinic. Beginning with his experiences with virtual clinics at St. Thomas' Hospital in London, he then discussed the virtual clinic that The Alfred has set up to manage the subset of patients receiving additional compassionate anti-tumor necrosis factor therapy. In addition to data on clinic numbers and outcomes, a potential business model including reimbursement billing options was presented. This novel concept requires validation in the Australian healthcare environment, but it may emerge as another model of care that can be used in our increasingly complex therapeutic landscape.

Systematic review on failure to adhere to IBD therapies during the COVID-19 pandemic: Correct information is crucial

Few studies report the impact of depression on inflammatory bowel disease (IBD)-related hospitalizations. We evaluated the association between depression and pediatric IBD-related hospitalizations. Our primary aim was to test the hypothesis that depression is associated with hospital length of stay (LOS); our secondary goal was to evaluate if patients with depression are at higher risk for undergoing additional imaging and procedures. Data were extracted from the 2012 Kids Inpatient Database (KID), the largest nationally representative publicly available all-payer pediatric inpatient cross-sectional database in the United States. Hospitalizations for patients less than 21 years with a primary diagnosis Crohn disease (CD) or ulcerative colitis (UC) by ICD-9 code were included. Multivariable logistic regression was used to predict long LOS controlling for patient- and hospital-level variables and for potential disease confounders. For primary IBD-related hospitalizations (N = 8222), depression was associated with prolonged LOS (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.19-1.90) and total parenteral nutrition use (OR 1.54; 95% CI 1.04-2.27). Depression was not associated with increased likelihood of surgery (OR 0.97; 95% CI 0.72-1.30), endoscopy (OR 0.91; 95% CI 0.74-1.14), blood transfusion (OR 0.85; 95% CI 0.58-1.23), or abdominal imaging (OR 1.15; 95% CI 0.53-2.53). Depression is associated with prolonged LOS in pediatric patients with IBD, even when controlling for gastrointestinal disease severity. Future research evaluating the efficacy of standardized depression screening and early intervention may be beneficial to improving inpatient outcomes in this population.

American Gastroenterological Association Consensus Development Conference on the Use of Biologics in the Treatment of Inflammatory Bowel Disease, June 21–23, 2006