Influence Of Inflammatory Bowel Disease Research Articles

Retrospective comparison of different treatments for ESGD and EGGD and the influence of inflammatory bowel disease

Retrospective comparison of different treatments for <scp>ESGD</scp> and <scp>EGGD</scp> and the influence of inflammatory bowel disease

A123 THE EFFECTS OF INFLAMMATORY BOWEL DISEASE ON THE MANAGEMENT AND OUTCOMES OF COMPLEX POLYPS IN PATIENTS UNDERGOING SURVEILLANCE COLONOSCOPY: A RETROSPECTIVE COHORT STUDY

Abstract Background The influence of inflammatory bowel disease (IBD) on the outcomes of complex polyps remains an area of uncertainty. Aims To investigate the impact of IBD on the management and outcomes of complex polyps during surveillance colonoscopy. Methods This retrospective cohort study utilized a prospectively collected database, involving patients who underwent surveillance colonoscopy for colorectal cancer or IBD surveillance who were identified to have complex polyps between February 2019 and December 2020 in Southwestern Ontario. Patient demographics, disease characteristics, medication history, polyp description and management were analyzed. The data were summarized in median and interquartile range for continuous variable and frequency and percentage for categorical variables. Characteristics between IBD and non-IBD were compared using the Wilcoxon rank sum test and Fisher’s exact test, as appropriate. Results 383 patients were included in the study, of which 27 individuals had IBD (5 Crohn's disease, 13 ulcerative colitis, and 9 indeterminate colitis). Patients with IBD were generally younger than their non-IBD counterparts (median age 61 vs 67 respectively). No significant differences were identified in terms of rates of complete polyp removal (17.70 % vs 22.22 %, pampersand:003C0.602), residual polyps after resection (76.97% vs 70.37%, pampersand:003C0.476), repeat removal attempts (84.27% vs 74.07%, pampersand:003C0.179), or surgical intervention (88.76% vs 88.89%, pampersand:003C0.99). A higher proportion of IBD patients were managed by gastroenterologists vs other endoscopists (81.48% vs. 40.17%, p ampersand:003C 0.001). No significant differences in complex polyp characteristics were observed, except in difficult locations of complex polyps were more common in the non-IBD cohort (55.34% vs 25.93%, pampersand:003C0.004). Conclusions In this retrospective cohort study, IBD does not appear to influence the management or outcome of complex polyps. Larger studies are required given the small IBD cohort size in this study. Funding Agencies None

Management of psoriatic arthritis: a consensus opinion by expert rheumatologists.

Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease involving several articular and extra-articular structures. Despite the important progresses recently made in all of the aspects of this disease, its management is still burdened by unresolved issues. The aim of this exercise was to provide a set of statements that may be helpful for the management of PsA. A group of 38 Italian rheumatologists with recognized expertise in PsA selected and addressed the following four topics: "early PsA," "axial-PsA," "extra-articular manifestations and comorbidities," "therapeutic goals." Relevant articles from the literature (2016-2022) were selected by the experts based on a PubMed search. A number of statements for each topic were elaborated. Ninety-four articles were selected and evaluated, 68 out of the 1,114 yielded by the literature search and 26 added by the Authors. Each of the four topic was subdivided in themes as follows: transition from psoriasis to PsA, imaging vs. CASPAR criteria in early diagnosis, early treatment for "early PsA"; axial-PsA vs. axialspondyloarthritis, diagnosis, clinical evaluation, treatment, standard radiography vs. magnetic resonance imaging for "axial PsA"; influence of inflammatory bowel disease on the therapeutic choice, cardiovascular comorbidity, bone damage, risk of infection for "comorbidities and extra-articular manifestations"; target and tools, treat-to-target strategy, role of imaging for "therapeutic goals." The final document consisted of 49 statements. The final product of this exercise is a set of statements concerning the main issues of PsA management offering an expert opinion for some unmet needs of this complex disease.

Influence of Inflammatory Bowel Disease on Patients Undergoing Primary Total Joint Arthroplasty: A Systematic Review and Meta-analysis of Cohort Studies

Background: Inflammatory bowel disease (IBD) is recognized as a global disease. Although IBD is commonly diagnosed in the young male population, it also occurs in patients aged &gt;60 years. With the advent of an aging society, it is expected that an increasing number of patients with IBD will undergo total joint arthroplasty (TJA). Purpose: To assess the impact of IBD on the risk of complications and revision as well as the length of stay (LOS) and treatment costs after TJA. Study Design: Systematic review; Level of evidence, 4. Methods: Utilizing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles were searched in the PubMed/MEDLINE, Embase, and Cochrane Library databases from the date of inception to August 31, 2022, using the following search terms: (1) “Inflammatory Bowel Diseases”[MeSH] and (2) “Arthroplasty, Replacement”[MeSH]. The study quality was scored according to the Newcastle-Ottawa Scale. A fixed-effects or random-effects model was used to calculate odds ratios or mean differences with 95% confidence intervals. Results: Of 232 studies initially retrieved, 8 retrospective cohort studies consisting of 33,758 patients with IBD and 386,238 patients without IBD were included. Patients with IBD had a higher incidence of complications ( P &lt; .05), readmission and revision ( P &lt; .05), experienced a longer LOS ( P &lt; .01), and paid higher treatment costs after TJA compared with patients without IBD . Conclusion: The results of our review demonstrated that IBD increased the risk of postoperative complications, prolonged the LOS, and increased treatment costs.

Perceptions of shared decision making in gastroenterology and inflammatory bowel disease: A qualitative analysis

ObjectiveShared decision-making (SDM) is the partnership and discussion between clinicians and patients to make an appropriate decision based on scientific evidence and patient preferences. Many benefits are associated with SDM; however, little is known about its awareness or use by inflammatory bowel disease (IBD) clinicians in gastroenterology departments across Israel. This study aims to identify barriers and facilitators in implementing SDM as standard practice to achieve optimal disease management and personalized care for patients with IBD. MethodsSixteen semi-structured interviews were conducted with IBD clinicians across Israel to identify the barriers and facilitators for SDM use. An interview guide was developed, based on the systematic approach of the Theoretical Domain Framework (TDF). Interview transcripts were coded into theoretical domains to identify factors that may impact SDM. ResultsSixteen gastroenterologists from nine different hospitals were interviewed. Common TDF domains that presented as barriers were: knowledge, skills, social/professional role and identity, environmental context and resources, and reinforcement. Most participants had never heard the precise term “shared decision making” and lacked formal training on SDM. ConclusionThis study identified key barriers and facilitators to SDM in IBD clinics across Israel. Main barriers of SDM include limited or nonexistent training; clinicians were unaware of SDM guidelines or techniques. The main facilitators of SDM were clinicians’ social and professional role and identity and their beliefs about the influence of IBD and/or CD. Practice ImplicationsThese influencing factors and TDF domains identified provide a basis for developing future interventions to improve the implementation of SDM within IBD management.

Inflammatory bowel disease is associated with increased complications after total knee arthroplasty

BackgroundFew studies investigate the influence of inflammatory bowel disease (IBD) on complications following total knee arthroplasty (TKA). Therefore, we compared complications and readmissions frequencies after TKA in patients with Crohn’s disease (CD) and ulcerative colitis (UC) to patients without IBD. MethodsA large administrative claims database was used to identify patients who underwent primary TKAs from 2010 to 2019 and had a diagnosis of IBD before TKA. Patients were stratified into two groups: those with CD (n = 8,369) and those with UC (n = 11,347). These patients were compared a control of 1.3 million patients without an IBD diagnosis. Chi-square and unadjusted odds ratios (OR) with 95% confidence intervals (CI) were used to compare complication frequencies. Multivariable logistic regression was used to evaluate independent risk factors for 90-day complications. ResultsCompared to patients without IBD, patients with IBD were associated with higher unadjusted 90-day odds for Clostridium difficile infection (CDI) (CD: OR 2.81 [95% CI 2.17 to 3.63]; p < 0.001; UC: OR 3.01 [95% CI 2.43 to 3.72]; p < 0.001) and two-year periprosthetic joint infection (CD: OR 1.34 [95% CI 1.18 to 1.52]; p < 0.001; UC: OR 1.26 [95% CI 1.13 to 1.41]; p < 0.001). After controlling for risk factors like obesity, tobacco use, and diabetes, both types of IBD were associated with higher 90-day odds for CDI and PJI (p < 0.001 for all). ConclusionIBD is associated with higher 90-day postoperative CDI and PJI compared with patients without IBD. Providers should consider discussing these risks with patients who have a diagnosis of IBD.

The Impact of Steroids and Inflammatory Bowel Disease in Colectomies in the Era of Enhanced Recovery.

Enhanced recovery after surgery protocols are commonly used, but their utility in patients with inflammatory bowel disease and steroid use is poorly studied. We sought to examine influence of inflammatory bowel disease (IBD) and steroid use on hospital length of stay (LOS) and operative duration in patients undergoing colectomies in the era of ERAS. We performed retrospective review of our institutional National Surgical Quality Improvement Program (NSQIP) registry (2016-2018) for colectomies. We performed 2 distinct analyses to examine influence of steroids and IBD on LOS and operative duration. Multivariable linear regression was used to predict outcomes after adjusting for relevant perioperative features. There were 366 patients in the cohort; 17.8% were on steroids and 16.4% had IBD. Patients using steroids had longer LOS (6 vs 4 days, P < .0001). IBD patients had a longer LOS (7 vs 5 days, P < .0001) and longer operative duration (383 min vs 335.5 minute, P = .01) compared to non-IBD patients. On multivariable analysis, steroid use was not associated with increased LOS or operative duration. Inflammatory bowel disease was associated with an increased hospital LOS and operative duration. Patients on steroids had longer LOS when compared to patients not on steroids. Inflammatory bowel disease regardless of steroid use was found to be a significant risk factor for both increased LOS and operative duration. A closer look at preoperative physiology may help to tailor ERAS protocols in patients with inflammatory conditions.

A Systematic Analysis of the Available Human Clinical Studies of Dental Implant Failure in Patients with Inflammatory Bowel Disease

Background and objectives: The aim was to evaluate the current literature on the influence of inflammatory bowel disease (ulcerative colitis/Crohn’s disease) in dental implant osseointegration in human clinical studies. Materials and methods: This review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. PubMed, Scopus, and Web of Science databases were electronic screened to find relevant articles published until October 2021. The inclusion criteria consisted of human clinical studies that reported the use of dental implant in patients diagnosed with inflammatory bowel disease. Risk of bias was assessed according to The Strengthening the Reporting of Observational studies in Epidemiology criteria. Results: A total of 786 studies were identified from databases. Of these, six studies were included in the review and reported the use of implants in patients with Crohn’s disease. No articles were available for ulcerative colitis. Included articles indicated that Crohn’s disease may determine early and late implant failure. Besides Crohn’s disease, several patients presented associated risk factors and systemic disease that determined implant failure. Conclusions: The presence of clinical studies on the influence of IBD in implant therapy is low. When recommending an implant therapy to IBD patients, the multidisciplinary team should be aware of side effects and a close collaboration between members of this team is necessary. More data are needed to sustain the effect of IBD on implant therapy.

Inflammatory Bowel Disease in the COVID-19 Pandemic: the Patients' Perspective.

BackgroundThe coronavirus disease 2019 [COVID-19] pandemic is affecting lives worldwide. The influence of inflammatory bowel disease [IBD] medication and IBD itself on COVID-19 is controversial. Additionally, IBD-focused guidance is scarce.ObjectiveOur aims were to determine COVID-19 prevalence/exposure, perception and information sources, medication compliance, patient behaviour and physician contact among patients with IBD compared with non-IBD controls.MethodsA cross-sectional anonymous survey of patients with IBD [N = 415] at one university IBD clinic and one gastroenterology practice, matched 4:1 with control participants [N = 116], was performed.ResultsPatients with IBD had a high fear of infection. This was more pronounced in patients taking immunosuppressants and it extended to hospitals, private practices and public places, such as supermarkets. IBD patients reported leaving their homes less frequently than their peers without IBD. A total of 90% of patients with IBD reported washing their hands more frequently. Patients taking immunosuppressants were concerned about interactions between medication and COVID-19, whereas patients taking 5-aminosalicylates were not. Nonetheless, 96.4% of patients adhered to continuing their medication. Patients sought guidance primarily from television and internet news sites. Video consultations were found to be a suitable solution for a subset of patients who are young, have a high level of fear and leave their home less frequently than their peers, whereas overall acceptance of video consultations was limited.ConclusionPatients with IBD are significantly more affected by the COVID-19 pandemic than their non-IBD peers, but they continue to adhere to their medication regimens. IBD-focused COVID-19 information should be actively conveyed.

P247 Sex-related differences in clinical diagnosis of inflammatory bowel disease

Abstract Background There is a lack of knowledge of the differences between women and men in clinical behaviour at the onset of inflammatory bowel disease (IBD). We hypothesise a potential diagnostic delay in women in IBD. The aims of this study were: (1) to evaluate the differences in diagnostic effort between women and men with IBD and (2) to assess the sex differences in IBD diagnosis and its impact on the gender roles, the quality of life and the emotional sphere. Methods We performed a prospective multicentre observational study in adults with a new diagnosis of IBD. The diagnostic process of IBD was reconstructed with semistructured interviews and electronic clinical records. Time to diagnostic resolution after the onset of symptoms and misdiagnosis of IBD in the different levels of the healthcare system were analysed. Patient delay was defined as the period from symptom recognition to first medical consultation. An additional interview was conducted to assess differences between women and men in the influence of IBD in gender roles (directed questions), quality of life (IBDQ-32), anxiety and depression (Hospital Anxiety and Depression Scale) and stress (Disease-Related Stress Appreciation Scale). Results 121 patients were included (44.6% CD, 53.7% UC, 1.7% IBD-U), (43.8% women 56.2% men) (median age 43 years, 29.5–55). Time to diagnostic resolution was higher in women compared with men, 214 days (93–452) vs. 90 days (40–183) p = 0.001. These differences were more evident in CD 326 days (94–627) / 67 days (28–182) p = 0.007, than in CU 174 days (92–350) / 92 days (47–184) p = 0.078. There were no significant sex differences in patient delay. Misdiagnosis of IBD was found to be 71.7% for women and 48.5% for men (p = 0.010). Data from Table 1 and Table 2 show the sex differences in the ‘influence’ of IBD in a sample of gender roles evaluated, the quality of life and the emotional sphere. Conclusion Our results demonstrate that women with IBD show a higher diagnostic delay and misdiagnosis compared with men. This delay is more evident in CD. Moreover, there is a higher impact of IBD diagnosis in women on the gender roles, the quality of life and the emotional sphere.

The Influence of Inflammatory Bowel Disease on the Outcome of Patients With Acute Stroke

Introduction: Data suggests that inflammatory bowel disease (IBD) may be associated w/ a small increased risk of stroke. However, it's not known how the copresence of IBD affects outcomes after ischemic stroke. We sought to assess the relationship between IBD & outcomes after stroke, as measured by discharge disposition, death & length of stay(LOS). Methods: Using claims data from the Healthcare Cost and Utilization Project (HCUP), we identified a cohort of patients hospitalized with a primary diagnosis of stroke from 2010-2014. HCUP includes the largest collection of all-payer, encounter-level hospital care data in the US w/ data from >7 million hospital stays each year. The predictor variable was the presence of IBD & the independent variables were discharge disposition (to home versus rehab or skilled nursing facility), death, & LOS. Logistic regression was used to analyze the association between IBD & both discharge disposition & death. Linear regression was used to analyze the association between IBD & length of stay. All regression models were adjusted for patient demographics & factors that could serve as potential confounders. Results: We identified a weighted sample of 156,456 hospitalizations for ischemic stroke. 0.5% (N=782) of the cohort carried a secondary diagnosis code of IBD, of which 47% had Crohn's disease and 53% had ulcerative colitis. Baseline demographics are in Table 1; there was a statistically significant difference between those w/ & w/o concurrent IBD, w/ regards to age (69.9 vs 72, p value 0.005), # of chronic conditions (8.9 vs 7.8, p value <0.001), & race (84.4% white vs 74.6% white, p value <0.001). The 3 outcomes of interest weren't different between the 2 groups (Table 2). When controlling for all baseline demographics, IBD wasn't associated w/ worse discharge disposition, w/ a relative risk reduction of 0.85 (95% CI 0.67-1.07) for those discharge to a facility compared to those discharged to home. When examining death as an outcome, the presence of IBD was associated with an odds ratio of 1.04 (95% CI 0.67-1.56). The presence of IBD wasn't associated w/ a significant decrease in LOS (p-value 0.88). In sub-group analysis, there were no differences between patients w/CD vs UC w/ regards to outcomes. Conclusion: The presence of IBD wasn't associated w/ worse discharge disposition, increase death, or increased LOS for individuals admitted w/ a stroke, in a nationally representative patient population.741_A Figure 1. Demographics741_B Figure 2. Outcomes

P246. Influence of inflammatory bowel disease on work-related outcomes and activity impairment and its relation with health-related quality of life

P246. Influence of inflammatory bowel disease on work-related outcomes and activity impairment and its relation with health-related quality of life

Survival of Colorectal Cancer in Patients With or Without Inflammatory Bowel Disease: A Meta-Analysis.

Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer (CRC), but little is known about the influence of IBD on CRC prognosis. The aim of this study was to perform a meta-analysis to compare survival in CRC patients with IBD (IBD-CRC) and without IBD. An electronic search was conducted via PubMed, Embase, and the Cochrane Library to identify eligible trials until July 2015. We pooled the hazard ratios (HRs) and their 95% confidence intervals (CIs) to quantitatively assess the survival of CRC in patients with or without IBD. In addition, clinicopathological parameters of IBD-CRC versus non-IBD CRC were evaluated. Twelve studies containing a total of 3472 IBD-CRC patients were eligible according to our selection criteria. Our analysis indicated that CRC patients with IBD had shorter overall survival than those without IBD (HR 1.24, 95% CI 1.19-1.29). IBD-CRC showed a propensity to develop in proximal colon [odds ratio (OR) 2.52, 95% CI 1.35-4.72] and correlated with worse differentiation of tumor (OR 1.59, 95% CI 1.26-1.99) compared to non-IBD CRC. Meta-regression analysis showed that sample size (P = 0.002) could explain 99.01% inter-study heterogeneity. This meta-analysis found poorer overall survival in CRC patients with IBD than CRC patients without IBD, and further prospective research to confirm these findings is warranted.

M1151 Influence of Inflammatory Bowel Disease On Pregnancy

Objective: evaluate the influence of inflammatory bowel disease (IBD) on pregnancy evolution and fetal alterations. Method: the protocols of patients with Crohn's disease (CD) and ulcerative colitis (UC), from 1984 and 2006, in fertile age, followed at the ambulatory of IBD, were reviewed. Patients were interviewed by the research medical doctor, to complete some issues not found in their protocols. Patients with others colitis, incomplete investigation, not in fertile age or without cognitive capacity were excluded from this study. Obstetric history before and after the beginning of symptoms related to IBD, clinical conditions of patients, drugs administered during pregnancy period, preterm delivery, low birth weight, stillbirth, congenital anomalies, spontaneous miscarriage, vaginal and cesarean delivery were investigated. Results: 416 pregnancies in 163 patients before the diagnosis of IBD and 140 pregnancies in 104 patients with IBD were evaluated (UC in 63 pregnancies and CD in 77 pregnancies). IBD was associated with increased preterm delivery (x2=6.7205, p=0.009). There was no statistical difference in low birth weight (x2=0.413 / p=0.5204), congenital anomalies (Fisher test: p=0.6447), stillbirth (Fisher: p=0.2245), spontaneous miscarriage (x2= 4.884, p=0.27), vaginal and cesarean delivery (x2= 1.7959, p=0.1802). There were 63 pregnancies in UC patients, with active disease in 28 and inactive in 35 pregnancies. There were 77 pregnancies in CD patients, with active disease in 57 and inactive in 20 patients. There was no difference between the groups of pregnancies in UC and CD, related to preterm delivery, low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage (p > 0.0649). There was statistical difference in active and inactive disease groups in CD, related to preterm delivery and low birth weight (p < 0.0365). Distribution of alterations in fetus and activity of UC and CD is shown on table 1. Conclusions: preterm delivery rates were higher in pregnancies of CD patients, even with inactive disease during pregnancy. There was no influence of IBD on low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage. Table 1. Distribution of alterations in fetus and activity of UC and CD.

M1152 Influence of Smoking Habits On the Mid-Term Clinical Outcome of New-Onset Crohn's Disease

Objective: evaluate the influence of inflammatory bowel disease (IBD) on pregnancy evolution and fetal alterations. Method: the protocols of patients with Crohn's disease (CD) and ulcerative colitis (UC), from 1984 and 2006, in fertile age, followed at the ambulatory of IBD, were reviewed. Patients were interviewed by the research medical doctor, to complete some issues not found in their protocols. Patients with others colitis, incomplete investigation, not in fertile age or without cognitive capacity were excluded from this study. Obstetric history before and after the beginning of symptoms related to IBD, clinical conditions of patients, drugs administered during pregnancy period, preterm delivery, low birth weight, stillbirth, congenital anomalies, spontaneous miscarriage, vaginal and cesarean delivery were investigated. Results: 416 pregnancies in 163 patients before the diagnosis of IBD and 140 pregnancies in 104 patients with IBD were evaluated (UC in 63 pregnancies and CD in 77 pregnancies). IBD was associated with increased preterm delivery (x2=6.7205, p=0.009). There was no statistical difference in low birth weight (x2=0.413 / p=0.5204), congenital anomalies (Fisher test: p=0.6447), stillbirth (Fisher: p=0.2245), spontaneous miscarriage (x2= 4.884, p=0.27), vaginal and cesarean delivery (x2= 1.7959, p=0.1802). There were 63 pregnancies in UC patients, with active disease in 28 and inactive in 35 pregnancies. There were 77 pregnancies in CD patients, with active disease in 57 and inactive in 20 patients. There was no difference between the groups of pregnancies in UC and CD, related to preterm delivery, low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage (p > 0.0649). There was statistical difference in active and inactive disease groups in CD, related to preterm delivery and low birth weight (p < 0.0365). Distribution of alterations in fetus and activity of UC and CD is shown on table 1. Conclusions: preterm delivery rates were higher in pregnancies of CD patients, even with inactive disease during pregnancy. There was no influence of IBD on low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage. Table 1. Distribution of alterations in fetus and activity of UC and CD.

A meta-analysis on the influence of inflammatory bowel disease on pregnancy

A meta-analysis on the influence of inflammatory bowel disease on pregnancy

Survival in Danish patients with breast cancer and inflammatory bowel disease: A nationwide cohort study

Incidences of inflammatory bowel disease (IBD) and of breast cancer have increased over the last decades. The influence of IBD on breast cancer prognosis, however, is unknown. We therefore examined the impact of IBD on treatment receipt and survival in breast cancer patients. Information on breast cancer patients (stage and treatment) diagnosed between 1980 and 2004 was sourced from the Danish Cancer Registry. Data on IBD and potential confounders were extracted from the Danish National Registry of Patients covering all Danish hospitals. Cox regression was used to compute mortality rate ratios (MRRs) among breast cancer patients with IBD, compared to their non-IBD counterparts, adjusting for age, stage, comorbidity measured by the Charlson Index, and calendar year. We identified 71,148 breast cancer cases; 67 also had Crohn's disease (CD) and 216 had ulcerative colitis (UC). Patients with CD had more advanced stage and received radiotherapy less, and chemotherapy more, frequently than patients without IBD. In the adjusted analyses there was no substantial survival difference in breast cancer patients with and without IBD (MRR(CD) = 1.22; 95% confidence interval [CI] = 0.85-1.75; MRR(UC) = 1.09; 95% CI = 0.86-1.38). In a stratified analysis, chemotherapy was associated with poorer survival in patients with CD (MRR(CD) = 1.93; 95% CI = 1.00-3.72). Breast cancer patients with UC receive the same treatment and have similar survival to breast cancer without IBD. In contrast, breast cancer patients with CD are treated with radiotherapy less often. Survival of breast cancer in patients with CD treated with chemotherapy is poorer compared to survival in patients without IBD.

Synchronous colectomy and caesarean section for fulminant ulcerative colitis: case report and review of the literature

Ulcerative colitis (UC) affects women of all ages, with a peak incidence in the third and fourth decades, at the prime of their reproductive years [Baiocco PJ, Korelitz BI (1984) The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol 6(3):211-216]. We describe a case of fulminating UC at 28 weeks' gestation treated by combined emergency subtotal colectomy and caesarean section with excellent foetal and maternal outcome. A treatment algorithm is suggested, and the literature surrounding inflammatory bowel disease in pregnancy is reviewed.

Work losses related to inflammatory bowel disease in Canada: results from a National Population Health Survey.

Few studies have assessed the influence of inflammatory bowel disease (IBD) on work loss or estimated the costs related to work loss. Our analysis reports the employment effects related to IBD as based on the 1998 sample of the Canadian National Population Health Survey (NPHS). Our predictive analysis adapts the theory of labor supply to a health context. Respondents between the ages of 20 and 64 who reported that they had been diagnosed by a health professional to have "a bowel disorder such as Crohn's disease or colitis" were distinguished from the other respondents. A logistic regression model was used to estimate the OR for labor force nonparticipation and variables predictive of it in the case of IBD. For those people in the labor force, the Cox proportional hazard model was used to determine whether having IBD and similar bowel disorders had an effect on the number of months of continuous employment. Of the IBD patients 28.9% reported labor force nonparticipation, which was a greater proportion than the non-IBD respondents (18.5% nonparticipation). The OR was 1.20 (95% CI = 1.19-1.21) for nonparticipation of IBD patients versus non-IBD patients controlling for potentially confounding factors. We estimated the excess nonparticipation attributable to IBD and similar bowel disorders in Canada to be 2.9%. Based on this, the indirect cost of nonparticipation attributable to IBD in 1998 was >$104.2 million Canadian dollars. According to the second regression using the Cox proportional hazard model, IBD and similar bowel disorders were not significantly related to the number of months worked until a break in employment was reported. Thus, there was no excess work loss among those who were employed that was associated with IBD. By using directly observed data in our analysis, this method of estimation can predict the overall burden of IBD and similar bowel disorders, controlling for the effect of other potentially influential characteristics.

Work losses related to inflammatory bowel disease in Canada: results from a national population health survey

Objective Few studies have assessed the influence of inflammatory bowel disease (IBD) on work loss or estimated the costs related to work loss. Our analysis reports the employment effects related to IBD as based on the 1998 sample of the Canadian National Population Health Survey (NPHS). Methods Our predictive analysis adapts the theory of labor supply to a health context. Respondents between the ages of 20 and 64 who reported that they had been diagnosed by a health professional to have “a bowel disorder such as Crohn’s disease or colitis” were distinguished from the other respondents. A logistic regression model was used to estimate the OR for labor force nonparticipation and variables predictive of it in the case of IBD. For those people in the labor force, the Cox proportional hazard model was used to determine whether having IBD and similar bowel disorders had an effect on the number of months of continuous employment. Results Of the IBD patients 28.9% reported labor force nonparticipation, which was a greater proportion than the non-IBD respondents (18.5% nonparticipation). The OR was 1.20 (95% CI = 1.19–1.21) for nonparticipation of IBD patients versus non-IBD patients controlling for potentially confounding factors. We estimated the excess nonparticipation attributable to IBD and similar bowel disorders in Canada to be 2.9%. Based on this, the indirect cost of nonparticipation attributable to IBD in 1998 was >$104.2 million Canadian dollars. According to the second regression using the Cox proportional hazard model, IBD and similar bowel disorders were not significantly related to the number of months worked until a break in employment was reported. Thus, there was no excess work loss among those who were employed that was associated with IBD. Conclusions By using directly observed data in our analysis, this method of estimation can predict the overall burden of IBD and similar bowel disorders, controlling for the effect of other potentially influential characteristics.