Inflammatory Bowel Disease Care Research Articles

P815 Diet, nutrition, and the multidisciplinary approach in adults with Inflammatory Bowel Disease

Abstract Background Patients with Inflammatory Bowel Disease (IBD) may associate dietary triggers with symptoms and even relapse of the disease, yet this is rarely acknowledged and included in treatment plans. Patients often self-impose dietary restrictions and manipulate their diet which can have significant health complications including nutrient deficiencies and malnutrition1. This often leads to a worse disease state, poorer clinical outcomes, and a reduced quality of life for these patients2. Methods A self-administered survey was digitally created with Crohn’s and Colitis UK (CCUK) and advertised through the CCUK website and their social media accounts. Patients with IBD aged ≥18 years were identified through convenience sampling. Those who were three months peri-operative or had a stoma were excluded from the study as their nutritional needs and experiences were likely to be more complex. Statistical Package for Social Sciences (version 27) was used for statistical analysis. A P-value of <0.05 was considered statistically significant. Results 267 participants completed the survey, 77.5% were female, 30% of participants were aged 36-45 years and 53.9% had Crohn’s disease. 44.9% of participants had been diagnosed with IBD for >10 years. 90% of participants believed that food impacted on their disease at least some of the time. 77% reported that dietary therapy may be useful in managing their disease (P-value < 0.001). Table 1 highlights where patients with IBD source dietary information. 93% of patients report a ‘trial and error’ approach to dietary manipulation to reduce their symptoms. Access to formal dietetic advice is extremely limited and reported by only 13% of participants. The majority of participants (78.7%) reported that a multidisciplinary approach was ‘very important’ in IBD care despite 68.2% reporting no access to a multidisciplinary team (P-value = 0.006). Table 1. Sources of IBD dietary information Conclusion Diet plays an important role in the disease course for patients with IBD; however, our respondents reported poor dietary support from healthcare professionals. This may lead to unsupervised dietary restrictions based on poor sources of information that can cause or worsen nutrient deficiencies and lead to adverse health outcomes. Patients with IBD should have access to high quality dietary advice to help manage the disease.

P028 Transitioning patients from intravenous to subcutaneous infliximab and vedolizumab for inflammatory bowel disease – what is the opportunity cost of improving access to health care?

Abstract Background Biologic drugs are highly effective for inflammatory bowel disease (IBD) management but are key drivers of costs of care especially when administered intravenously (IV). Availability of subcutaneous (SC) formulations has increased convenience for patients and improved access to care but at the cost of revenue to health services. The aim of this study was to evaluate the economic impact of transitioning a tertiary centre IBD cohort from IV to SC biologic administration and assess the implications for key stakeholders. Methods A retrospective analysis of all patients that received IV infliximab or vedolizumab in the outpatient infusion centre of a tertiary, IBD centre between July 2019 and June 2021 was undertaken. Data were extracted from electronic medical records, pharmacy dispensing systems and the hospital business intelligence unit. An economic analysis and theoretical financial/capacity impact analysis of a transition to a SC model was estimated under two theoretical scenarios, using a random 10% and 30% of the patient cohort. Results Transitioning our IBD cohort from IV to SC administration would result in a loss of $2,732,123.75, comprised of $1,463,003.75 in Weighted Inlier Equivalent Separation (WIES) and $1,269,120 in drug procurement revenue. However, it would ease capacity in the infusion centre by up to 5256 hours. Conclusion Transitioning patients to SC administration results in improved access to infusion centres and substantial savings to state governments; however, switching results in a loss of IV-biologic generated WIES to health services. Alternative funding models are required to achieve sustainability in IBD care and reduce reliance on IV biologic generated income.

P367 Significant impact on health care utilization upon implementation of an electronic IBD care management program.

Abstract Background The management of Inflammatory Bowel Diseases (IBD) remains to be a significant challenge because of its unpredictable clinical course and high associated costs. Recently, we implemented an electronic IBD care management program, provided by DEARhealth BV, which offers care-pathways that configurate according to individual IBD risk profiles, called THINK. High-risk (HR) IBD patients (current biochemical disease activity) will receive more intense monitoring and provider interactions compared to Low-risk (LR) (>3 years in remission) and Intermediate-risk (IR) (other patients) individuals (figure 1). In this project, before implementation of THINK, we aimed to assess whether 1. Current healthcare utilisation (HCU) (consultations, lab tests, calprotectin) differs between risk groups and 2, what the effect of implementing THINK would be on HCU (focused on consultations and laboratory tests) in a retrospective-analysed population. Methods 161 consecutive IBD patients in hospital A, categorized in either the HR or IR group, were studied prospectively during 1 year before implementation of THINK. HCU was captured using an electronical medical record (EMR) and included consultations, blood tests and calprotectin. Furthermore, HCU in the years 2018-2019 in the IBD population of hospital B was studied (extraction of EMR). This historical data was compared to the THINK care path (see figure 1) when optimal implemented. The analysis focused on the activities present in de THINK care pathway (consultations and laboratory tests) to uncover the potential of the electronic IBD care management program. Results Baseline characteristics for hospital A cohort (N=161) are summed in Table 1. We followed 102 patients (60 Crohn) in the IR group and 59 patients in the HR group (29 Crohn). As expected, significant more HCU was present in the HR group (table 2). In hospital B, the utilization impact assessment was performed in the IBD cohort of 543 Crohn and 495 colitis patients. A difference in clinic consults was observed of -52,7% (HR), -53.5% (IR) and -29,3% (LR). The difference in laboratory tests utilization was found -54,0% (HR), -27.8% (IR) and -3,1% (LR). Conclusion Our initial experiences with a novel IBD management program demonstrated the feasibility of accurate remote disease activity monitoring and significant impact on utilization patterns due to the risk-based care pathway configurations. However, the analysis shows the ideal fictive situation when using standardized care pathways which cannot fully be considered the real-time situation. In this analysis no unexpected events are included. Future research should investigate the realization of these predictions.

N05 Highlighting the critical contributions of Inflammatory Bowel Disease nurses in Canada: Perspectives from nurses, gastroenterologists, individuals living with IBD, and caregivers.

Abstract Background Multidisciplinary teams are essential in managing Inflammatory Bowel Disease (IBD). IBD nurses play a critical role in improving patient outcomes and providing cost-effective quality of care. In Canada, access to IBD nurses remain inconsistent. There are more than 270,000 people living with IBD in Canada and fewer than 90 IBD nurses to care for them. This study was conducted to capture the value of IBD nurses, to identify gaps in resources, and to generate strategies for building IBD nurse capacity and enhancing the contributions of IBD nurses in Canada. Methods A convergent mixed-methods design was utilized to gather input from 4 stakeholder groups: IBD nurses, gastroenterologists, individuals living with IBD, and caregivers. Data collection was done through completing a review of the literature, stakeholder surveys, and one-on-one online semi-structured interviews with all stakeholders. Descriptive statistics were used for the quantitative analysis. Semi-structured interviews were audio recorded and transcribed verbatim then thematically analyzed. Results The IBD nurse’s role in clinical care was recognized as a value-add across all stakeholder groups. Having access to a specialized IBD nurse was recognized as a service that elevates the quality and continuity of patient care. As the interface between patients and other healthcare providers, there was recognition amongst stakeholders that IBD nurses are ideally positioned to educate patients about IBD management, general health promotion in the context of chronic disease and may support other aspects of care such as psychosocial, nutrition, and other extraintestinal manifestations or to help guide patients toward appropriate care channels. Many IBD nurses view advocacy as a logical extension of their official responsibilities, helping IBD patients to make treatment decisions and assisting them with disease challenges that affect their quality of life. Conclusion IBD nurses represent an underused resource in Canadian IBD care. Canada currently falls short of the recommended 2.5 full-time IBD nurse equivalents per 250,000 population. Achieving this objective will require a commitment to train IBD nurses and additional funding for their education and employment. The government can work with nursing institutions to set benchmarks, establish training programs, and create opportunities for IBD nurses in Canada. Introducing more IBD nurses into the system and using them to their full capacity makes sense from both a clinical and economic standpoint. It lifts the burden on gastroenterologists and primary care physicians, reduces costs to health systems while improving the overall quality of care for IBD patients.

P883 Parental and perinatal risk factors associated with onset of Inflammatory Bowel Disease: A systematic literature review and meta-analysis

Abstract Background Several risk factors have been associated with the onset of Inflammatory Bowel Disease (IBD), including pre and early life exposures occurring during gestation and up to the end of an infant’s first year of life. Perinatal factors linked to the subsequent development of IBD include parental and environmental exposures. It is postulated that exposure to such factors impacts immune system development leading to alterations in immune responses and increased susceptibility to disease. Limited evidence evaluates this association systematically whilst focusing specifically on the perinatal period. The purpose of this review was to systematically determine whether parental and perinatal factors are associated with IBD onset. Methods We searched the following electronic databases: Ovid MEDLINE, Web of Science, and the Cochrane Library. Searches were conducted from 01/01/2002 until 26/01/2022. Keywords and search terms related to ‘perinatal’ and ‘inflammatory bowel disease’ were applied. Case control studies, RCTs and cohort studies evaluating the association between parental and perinatal factors and IBD were included. Study protocol details have been published on the International Prospective Register of Systematic Reviews (PROSPERO). Available from: http://https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290798Databases Results Our initial search identified 14,989 potentially relevant articles to include (see Figure 1). After title and abstract screening there were 119 articles that met the eligibility criteria. After full-text review and further assessment of these 119 articles, 18 articles were deemed suitable for study synthesis based on the eligibility criteria. Across the 18 articles, a range of parental and perinatal factors were included: family history IBD (n=8), breastfeeding (n=7), disease during pregnancy (n=4), maternal age (n=4), birth delivery method (n=4), antibiotic exposure (n=3), pre-term birth (n=3), birth weight (n=2), environmental exposures in infancy (e.g. pet exposure, rural dwelling) (n=2), diet (n=1), vaccination (n=1) and maternal smoking (n=1). Conclusion This review provides a detailed summary of parental and perinatal factors associated with the onset of IBD. The evidence generated will influence the development of diagnostic risk assessment tools and detailed patient pathway paradigms to address current shortcomings within the delivery of IBD care, providing opportunities to improve efficiency and reduce healthcare costs. The findings will inform on key targets for primary prevention strategies at this early life stage and provide valuable insight on IBD onset to academics, clinicians, patients and policy makers.

P761 Negative Body Image in Inflammatory Bowel Disease persists despite Modern IBD care

Abstract Background Body image dissatisfaction (BID) is prevalent in patients with Inflammatory Bowel Disease (IBD). Historically female sex, previous IBD surgery, impaired QoL have been associated with negative body image. The introduction of biologic therapies and modern IBD care in Australia in 2007 has improved disease control and endoscopic outcomes, but it is unclear if body image has improved in parallel with this. We aimed to determine whether body image and QoL have improved amongst IBD patients with modern IBD car Methods Tertiary IBD service patients were offered inclusion in the study in 2006 by postal survey (pre-biologic era), and in 2021 by electronic survey (biologic era). Surveys included demographics and history of IBD surgery. In the pre-biologic era (PBE) body image dissatisfaction (BID) and QoL were assessed using a patient reported yes/no question, followed by an open question about how IBD or treatment has changed the way they view their body’s appearance. In the biologic era (BE) the validated modified Body Image Scale and Short Inflammatory Bowel Disease Questionnaire were used. Results The BE included 135 patients, 59% female, mean age 45.9. The PBE included 215 patients, 66% female and mean age 35.5. PBE had 40% reporting IBD surgery vs 36% in BE (P=0.489). BID was observed in 67% vs 39% of the PBE and BE respectively (p<0.01). In the PBE free text responses elicited themes of dissatisfaction with medication or steroid-related appearance changes (41%), bloating (30%), weight gain (28%), weight loss (12%), and specific appearance changes. The link between body image and QoL was mentioned by 33% of patients, with 8% specifically mentioning its impact on their mental health. Females were affected to a greater extent in both PBE (75% vs 52% p<0.01), and BE (50.5% versus 22% p<0.01). In the PBE patients with surgical intervention for IBD had higher rates of BID than those without surgery (81% vs 58%, p<0.01). This association between surgery and BID was not observed in the BE (47% vs 34.9%, p=0.168). In the PBE those with BID were significantly more likely to report impaired QoL(97% vs 71%, p<0.01). This association persisted with time with BE patients with BID also having higher rates of QoL impairment (85% vs 45% p<0.01). Conclusion Whilst the rate of BID has decreased with modern IBD treatment; it remains highly prevalent and is associated with impaired QoL. Whilst females remain disproportionately affected, the historically observed association between IBD surgery and impaired body image was not demonstrated in the BE. This may reflect improved surgical techniques and biologic down staging prior to surgery. However, body image remains an important Patient Reported Outcome in IBD and warrants further attention.

P670 “What Matters To You?” – How do patient views compare with a patient experience framework and UK national standards of care?

Abstract Background There is increasing focus on the organisation of services for people with IBD. Patient experience of care is an important consideration in service delivery. The United Kingdom NHS Long Term Plan indicates the importance of support that is more differentiated for individuals, with more personalised care when needed, which starts with the question ‘What matters to you?”. This is particularly important for people with inflammatory bowel disease (IBD). Methods The aim was to identify ‘What matters to you?’ for people attending a single UK teaching centre IBD service and to relate it to patient experience and national standards of care. Invitations to take part in the AWARE-IBD quality improvement programme were sent to 4082 patients receiving IBD care at a single UK teaching centre in 2 rounds (October 2021 and May 2022). Invitation letters included an anonymous open-ended questionnaire asking patients “what matters to you?”. Responses were extracted as qualitative data and coded using two frameworks: Patient experience domains (Bull et al) (Communication, Patient-centred Care, Quality, Integration, Involvement, Accessibility, Environment and Facilities, Discomfort) and national IBD UK Standards. Frequencies for each coding strategy were calculated to determine the most important patient experience domains and IBD UK standards. Results Responses were received from 408 and 205 patients from each recruitment round (n=613). Figure 1 displays frequencies for each patient experience domain. Accessibility (47.5% and 53.2% respectively), Communication (19.6% and 12.7%) and Patient-Centred Care (15.7% and 11.2%) were expressed most frequently. Sub-themes included access to and contact with IBD nurse specialists, timely and accessible appointments and regular contact with a specialist IBD health care professional (HCP). Responses were coded to IBD UK standards, where possible (Table 1). Responses most frequently coded to statements relating to shared decision making, having a personalised care plan, access to an IBD nurse specialist including helpline and regular clinical review. 77 responses could not be coded to an IBD UK standard. Conclusion Access to the IBD service when needed matters most to patients with good communication of information and personalised, patient-centred care. Service organisation should therefore reflect these facets of patient experience and defined standards. Patient views that are not currently represented in published standards should be considered in future iterations. This study also highlights personalised written care plans and improved access to the IBD Nurse Advice line.

P766 Practical application of evidence-based dietary therapy into inflammatory bowel disease care shows high patient satisfaction, compliance, and efficacy. The Delectable Program

Abstract Background Diet is an accepted therapy for Inflammatory Bowel Disease (IBD). Controlled trials have demonstrated that exclusive enteral nutrition (EEN) and the Crohn’s Disease Exclusion Diet (CDED) induce remission in Crohn’s disease. Low sulphur and plant-based diets are being investigated in ulcerative colitis (UC). Reducing ultra-processed, additive-containing food intake is emerging as important, given its role in initiating and perpetuating disease. IBD patients believe in the value of the diet, but there is no evidence for diet tolerability and benefit outside of clinical trials. The DELECTABLE program, a dietitian-led telehealth service, aims to evaluate structured, evidence-based dietary therapy as part of routine clinical care. Here we present satisfaction, compliance and efficacy results. Methods In this open-label, prospective, observational program, Crohn’s disease and pouchitis patients were offered the CDED or a wholefood additive-free diet, UC patients were offered a low-sulphur plant-based diet or wholefood diet, and patients with microscopic colitis were offered the wholefood diet. The primary outcome was diet satisfaction (modified DSAT-28; possible range: 28 to 140). Dietitian-rated compliance, patient-rated compliance, disease activity score (CDAI, partial Mayo score), CRP, and faecal calprotectin were secondary outcomes. Baseline to week 12 differences were assessed using the Mann-Whitney-U-test or Wilcoxon-sign-test for continuous variables and McNemar’s test for categorical variables. Results Of 165 patients referred, 79 enrolled in the program. Fifty-seven (72%) enrolled patients have completed 12 weeks of diet therapy. Across all diet arms combined, diet satisfaction score increased from week 1 (89.3) to week 12 (93.7; P<0.001). Dietitian and patient-rated compliance were 4/6 and 3/5, respectively, at week 1 and did not change at week 12. CDAI was reduced on all diet arms combined (60.0 to 41.5, P=0.003) and on the CDED (128.9 to 46.6, P=0.004), with a trend for reduced CDAI on the wholefood diet. There was a trend towards reduced CRP across all diet arms and on the wholefood diet (49.5 to 25.3, P=0.363). The proportion of patients in remission, based on CDAI, increased when all diet arms were combined and on the CDED and wholefood diet (P<0.001). Faecal calprotectin was numerically reduced on the CDED (95.0 ug/g to 53.5 ug/g) and UC diet (184.0 ug/g to 159.0 ug/g), but these results did not reach statistical significance. Conclusion Half of the referred patients are interested in pursuing a supervised, long-term diet program. Implementation of well-balanced, effective diet therapies is feasible and well-accepted by patients, with a promising impact on disease activity.

SPATIAL CONCORDANCE OF LEFT AND RIGHT COLON FINDINGS IN PEDIATRIC PATIENTS WITH ULCERATIVE COLITIS AFTER TREAMTENT

Abstract OBJECTIVES Achieving endoscopic remission has become the preferred clinical endpoint in the care of inflammatory bowel disease (IBD) patients. This requires repeat colonoscopy in patients with ulcerative colitis (UC) after initiation of therapy. Recent adult data suggests findings in the left colon on flexible sigmoidoscopy can be highly predictive of the findings if a full colonoscopy was performed; however, pediatric data is lacking for this association. The primary aim our study to assess the accuracy of findings on the left colon with the right colon for repeat endoscopy in pediatric patients with UC. METHODS This was a retrospective chart review of pediatric patients with UC seen at a single, academic center between 2010-2021. Patient demographics, clinical disease activity, laboratory values and endoscopic findings were collected. The Mayo Endoscopy Score (MES) was used to assess the findings in the right and left colon by a single reader (JM). Histologic findings were assessed using the Geobes index by a pathology resident (AKA) and over-read by an attending pathologist (SS). Weighted kappa correlation was used to assess concordance between left and right colon endoscopic and histologic findings. Receiver operator curve (ROC) analysis was used to assess the accuracy of left-sided findings predicting right-sided findings. RESULTS We analyzed repeat endoscopies from 57 patients, of which 31 (54.4%) were male, mean age at UC diagnosis was 13.5 ± 4.1 years, 53 (93%) were Caucasian. Most common medication was oral mesalamine (67.2%) and most common distribution was pancolitis (53.4%). Mean time between index and repeat colonoscopy was 11.3 months. On repeat colonoscopy, endoscopic findings on the left colon moderately correlated with findings on the right colon [(κ = 0.53 (0.30-0.75)], similarly histologic findings for the left and right colon had a moderate correlation [(κ = 0.41 (0.17-0.64)]. Area under the ROC (AUC) was 0.89 for endoscopic remission anywhere in the colon and 0.98 for complete endoscopic healing anywhere in the colon. Longer interval between the index and follow-up colonoscopy did not affect odds of concordance. CONCLUSIONS We found that endoscopic and histologic severity correlated between the right and left colon for repeat assessment after initiation of biologic therapy. Left sided findings were highly accurate for endoscopic remission and complete endoscopic healing anywhere in the colon. This data suggest a flexible sigmoidoscopy could be feasible in lieu of full colonoscopy when assessing for endoscopic remission in pediatric patients with UC, to reduce the burden to the family and healthcare system. Further, prospective studies with a central reading component for histology and endoscopy are needed to validate these findings.

USING A REAL TIME DASHBOARD TO SUPPORT POPULATION HEALTH IN INFLAMMATORY BOWEL DISEASE

Abstract The Phoenix Children’s Hospital (PCH) Inflammatory Bowel Disease (IBD) Clinic provides care for nearly 500 patients. As a group, PCH is part of the ImproveCareNow (ICN) network—a collaboration of over 100 centers worldwide to improve IBD care. Patient care has followed ICN guidelines including a weekly pre-visit planning (PVP) session. PVP is a time intensive process of manual chart review and data gathering for upcoming clinic patients. To improve this process and patient care, our group created a real-time IBD dashboard. OBJECTIVES: The aims of the dashboard were to identify and validate our patient population, improve efficiency by automating data gathering for PVP, and create a visual representation . Secondary aim, was to optimize processes including documentation, order entry and timely follow-up. METHODS: Data is sourced from the Allscripts electronic medical record (EMR). Data retrieval is contingent upon documentation. Our population of patients with IBD was identified based on a charted ICD-10 diagnosis of CD, UC or IC. PCH has a data warehouse of orders, results, Admission-Discharge-Transfer documentation, and flowsheets from the EMR and external data sources. Data is harvested and hosted using Microsoft Power BI for live review at weekly PVP. Once desired data points were hosted, focus was on process improvement (proper documentation, follow-up orders, and patient visits every 200 days). RESULTS: The dashboard hosts patients seen within the last 200 days, provider follow-up order placement, and physician global assessment (PGA) since January 2021. The percent of patients with follow-up orders placed was 61% in 2021. With dashboard enhancements and data visibility, this improved to 99% as of October 17, 2022. Physician global assessment (PGA) was recorded in 81% of encounters in 2021. Our most recent documentation rate is 92% on October 17, 2022. Our group had seen 82% of patients within the 200 days in 2021. Currently we have seen 89% of patients within 200 days as of October 17, 2022 (of these 91% of patients with active disease have been seen). We have instituted a work-flow process with schedulers to ensure patients are contacted and scheduled and not transitioned or moved. Figure 1 Historical Data from 1/2021-10/2021 Figure 2 Current Data as of 10/17/2022 CONCLUSIONS: With time, the IBD dashboard has proven to be a powerful tool in improving process measures. Our hope is these improvements will lend themselves to improved patient outcomes. With the ability to view data in real time in an automated fashion, staff hours have been saved and reallocated to other patient care needs. With continuous review of the data and introduction of accountability, we continue to see improvement. We now have the capacity to add additional metrics to the dashboard and our this can be viewed as a proof of concept for use in other specialties and chronic disease states.

IBD barriers across the continents: a continent-specific analysis - Australasia.

Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous shared issues of IBD care between Australia and New Zealand, whereas Papua New Guinea has its' own unique set of circumstances. This review looks to explore some of the barriers to IBD care across the continent from the perspective of local IBD healthcare professionals. Barriers to IBD care that are explored include access to IBD multidisciplinary teams, provision of nutritional-based therapies, the prevalence and engagement of IBD-associated mental health disorders, access to medicine, access to endoscopy, rural barriers to care, Indigenous IBD care and paediatric issues. We look to highlight areas where improvements to IBD care across Australasia could be made as well as address research needs.

Barriers to optimizing inflammatory bowel disease care in the United States.

Significant progress in the management and modification of inflammatory bowel disease (IBD) has been made; however, significant barriers to the optimization of IBD care in the United States still exist. The majority of these barriers are constructed by insurance carriers and the integration of market pressures into healthcare decision-making. In this review, we highlight the barriers to IBD care optimization within the context of the US insurance system and review current and proposed solutions.

Barriers in inflammatory bowel disease care in Central and Eastern Europe: a region-specific analysis.

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated diseases with a high incidence and prevalence in Europe. Since these are diseases with associated disability, they require complex management and the availability of high-quality healthcare resources. We focused on the analysis of IBD care in selected countries of Central and Eastern Europe (Croatia, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia) targeting the availability and reimbursement of diagnostic and therapeutic modalities, the role of IBD centers and also education and research in IBD. As part of the analysis, we created a questionnaire of 73 statements organized in three topics: (1) diagnostics, follow-up and screening, (2) medications and (3) IBD centers. The questionnaire was filled out by co-authoring IBD experts from individual countries, and then the answers and comments on the questionnaire were analyzed. We identified that despite the financial burden, which still partially persists in the region, the availability of some of the cost-saving tools (calprotectin test, therapeutic drug monitoring) differs among countries, mainly due to variable reimbursement from country to country. In most participating countries, there also remains a lack of dedicated dietary and psychological counseling, which is often replaced by recommendations offered by gastroenterologists. However, there is adequate availability of most of the currently recommended diagnostic methods and therapies in each participating country, as well as the implementation of established IBD centers in the region.

Risk factors for incomplete telehealth appointments among patients with inflammatory bowel disease.

The COVID-19 pandemic led to the urgent implementation of telehealth visits in inflammatory bowel disease (IBD) care; however, data assessing feasibility remain limited. We looked to determine the completion rate of telehealth appointments for adults with IBD, as well as to evaluate demographic, clinical, and social predictors of incomplete appointments. We conducted a retrospective analysis of all patients with IBD who had at least one scheduled telehealth visit at the NYU IBD Center between 1 March 2020 and 31 August 2021, with only the first scheduled telehealth appointment considered. Medical records were parsed for relevant covariables, and multivariable logistic regression was used to estimate the adjusted association between demographic factors and an incomplete telehealth appointment. From 1 March 2020 to 31 August 2021, there were 2508 patients with IBD who had at least one telehealth appointment, with 1088 (43%) having Crohn's disease (CD), 1037 (41%) having ulcerative colitis (UC), and 383 (15%) having indeterminate colitis. Of the initial telehealth visits, 519 (21%) were not completed, including 435 (20%) among patients <60 years as compared to 84 (23%) among patients ⩾60 years (p = 0.22). After adjustment, patients with CD had higher odds of an incomplete appointment as compared to patients with UC [adjusted odds ratio (adjOR): 1.37, 95% confidence interval (CI): 1.10-1.69], as did females (adjOR: 1.26, 95% CI: 1.04-1.54), and patients who had a non-first-degree relative listed as an emergency contact (adjOR: 1.69, 95% CI: 1.16-2.44). While age ⩾60 years was not associated with appointment completion status, we did find that age >80 years was an independent predictor of missed telehealth appointments (adjOR: 2.92, 95% CI: 1.12-7.63) when compared to individuals aged 60-70 years. Patients with CD, females, and those with less social support were at higher risk for missed telehealth appointments, as were adults >80 years. Engaging older adults via telehealth, particularly those aged 60-80 years, may therefore provide an additional venue to complement in-person care.

Characteristics and Treatment Outcomes of Transition among Patients with Inflammatory Bowel Disease.

This study aimed to assess disease characteristics and outcomes of transition in patient care among adolescent patients with inflammatory bowel disease (IBD). Data from patients younger than 18 years who were diagnosed with IBD (Crohn's disease, ulcerative colitis, or intestinal Behçet's disease) were investigated. We categorized the patients into two groups: transition IBD group (Group A, diagnosed in pediatric care followed by transfer to/attendance in adult IBD care) and non-transition group (Group B, diagnosed and followed up in pediatric care or adult IBD care without transfer). Data from a total of 242 patients [Group A (n=29, 12.0%), Group B (n=213, 88.0%)] were analyzed. A significantly higher number of patients was diagnosed at an earlier age in Group A than in Group B (p<0.001). Group A patients had more severe disease in terms of number of disease flare ups (p=0.011) and frequency of bowel-related complications (p<0.001). Multiple linear regression analysis showed that Group B patients had more medical non-compliance than Group A patients (β=2.31, p=0.018). After transition, IBD-related admission frequency, emergency admission frequency, disease flare frequency, and medical non-compliance were significantly improved. The transition IBD group had more severe disease. Medical non-compliance was lower in the transition IBD group. Clinical outcomes improved after transition.

Inflammatory bowel disease in Saudi Arabia: a review article

Inflammatory Bowel Disease (IBD) encompasses chronic intestinal disorders, like ulcerative colitis (UC) and Crohn&amp;apos;s disease, causing gastrointestinal (GI) tract inflammation. Saudi Arabia, particularly among pediatric populations, has seen an increasing prevalence of IBD. Clinical symptoms, including abdominal pain, diarrhea, weight loss, and rectal bleeding, significantly impact patients&amp;apos; lives, requiring lifelong medical care, especially for children. The study highlights the growing burden of IBD in Saudi Arabia due to insufficient epidemiological data and rising disease incidence. Early IBD diagnosis is crucial for successful management and improved outcomes. Effective treatments for mild to moderate UC, such as 5-aminosalicylic acid-based drugs like mesalazine and sulfasalazine, show promising results. However, patients may experience ongoing GI symptoms even after successful treatment, underscoring the need for comprehensive care. Frequent remissions and relapses pose a challenge, necessitating continuous monitoring and appropriate medical intervention. Untreated symptoms can negatively impact patients&amp;apos; well-being and increase healthcare expenditures. Hence, exploring better approaches for long-term symptom control and mucosal repair is essential. In severe cases, surgical interventions like total colectomy become necessary, but the focus should be on optimizing medical therapies to reduce the need for drastic measures. In conclusion, early detection, accurate diagnosis, and proper management of IBD in Saudi Arabia are vital. Collaborative efforts among healthcare professionals, researchers, and policymakers are required to gather comprehensive epidemiological data and develop targeted strategies for improving IBD care. Addressing these challenges and opportunities can enhance the quality of life for IBD patients in Saudi Arabia and potentially alleviate the burden on the healthcare system.

IBD barriers across the continents: a continent-specific analysis: Latin America.

Latin America (LATAM) is a large region comprising 47 countries and territories. Each one carries a different cultural and historical background, diverse political systems, and a particular approach to healthcare management. There is a lack of high-quality data on the epidemiology of inflammatory bowel diseases (IBD) in this region, including broad and detailed information about the penetration of biological and advanced therapies as treatment strategies. From an IBD perspective, patients experience, in general, fragmentations and inequities in the healthcare systems, with different and usually delayed access to qualified health services. This review explores the barriers to accessing IBD care throughout LATAM. The authors compiled data from multiple sources, such as studies focusing on epidemiology, biological penetration, and surgical rates. In addition, overall access to IBD treatments was assessed through a questionnaire distributed to physicians in LATAM via email and direct messaging to capture local perspectives.

Latin America consensus statement inflammatory bowel disease: importance of timely access to diagnosis and treatment.

Inflammatory bowel diseases (IBDs) are chronic conditions that negatively interferes with the quality of life of the patients, on a physical, emotional, and social level. Its symptoms can vary including diarrhea, bleeding, abdominal pain, fever, and weight loss, depending on the type and location and severity of the disease. Despite evolving treatment, they do not always achieve control of the symptoms, so between 23% and 45% of people with idiopathic chronic ulcerative colitis, and up to 75% of those with Crohn's disease, eventually, will need surgery. The increase in its incidence in Latin America has promoted a renewed interest on the part of the medical and scientific community in standardizing and unifying criteria for the proper diagnosis and management of the disease, which is part of the current discussions of various events; however, this interest has not yet been reflected in policies and initiatives by governments to address the disease. We decided to develop a consensus meeting in order to elucidate the actual situation of IBD care in our region. The methodology employed to build the consensus document derived from a review of literature, evidence, and policies on IBD, followed by a process of validation and feedback with a group of 10 experts in the field. Nine experts from different countries in Latin America were reunited in web meetings on 2 days and voted on topics derived from the consensus document. A full agreement with 100% approval was needed, so topics were discussed to reach the consensus otherwise were removed. There is still a lack of information about IBD in Latin America, therefore IBD continues to be an 'invisible' disease and is little recognized by decision-makers. This document describes the current situation of IBDs in the Latin American region, highlighting the main barriers and challenges in timely access to diagnosis and treatment, in order to demonstrate the need to promote the development and implementation of policies, in order to improve the quality of care of patients with IBD.

The inflammatory bowel disease care manager: Italian state of the art.

In the inflammatory bowel disease (IBD) multidisciplinary team, a key figure is the IBD care manager, usually an independent practice nurse, responsible for evidence-based assessment, care planning, treatment evaluation, and provision of practical information, health education, and emotional support to patients. The objective of this study was to evaluate the profile of this figure in Italy. A team of experienced nurses created a questionnaire based on the Second N-ECCO declaration, which was administered to nurses who worked in an IBD unit for a period of at least 3 years. A definition of IBD care manager was provided to every participant. The questionnaire consisted of 3 sections: behavioral, knowledge and managerial skills that an IBD care manager should exhibit. Results were studied in relation to the benefits for the patient, organizational advantages, clinical advantages and Italian state of the art. Fifty-five nurses participated in the study, from 28 Italian centers. In the evaluation of behavioral skills of IBD care managers, "management and support of the pregnant patient" was the lowest scored item, while "patient privacy" obtained higher scores. In the evaluation of knowledge, "knowledge of intimacy and sexuality" obtained the lowest scores, while "knowledge of psychophysical and social impact of the disease" obtained a higher score. In managerial skills "management of pain" obtained the lowest scores. Our study confirmed that IBD care managers are invaluable nursing figures within the multidisciplinary team that cares for IBD patients, providing benefits to both patients' clinics and management.

Intestinal Ultrasound in Inflammatory Bowel Disease: A Novel and Increasingly Important Tool.

New and efficacious medical therapies have become available that have greatly enhanced clinicians' ability to manage inflammatory bowel diseases (IBDs). IBD activity should be assessed regularly in scheduled examinations as the part of a treat-to-target strategy for IBD care. The gold-standard approach to investigating IBD is colonoscopy, but this is an invasive procedure. Intestinal ultrasound (IUS) has played a crucial role in recent years regarding the assessment of IBD activity because it is noninvasive, safe, reproducible, and inexpensive. IUS findings could inform changes in therapeutic interventions for IBDs; this would necessitate fewer endoscopies and enable faster decision-making processes. Furthermore, patients are accepting and tolerant of IUS examinations. This review outlines the current evidence and gives indication regarding the use of IUS in the management of IBDs.