A comparison of intravenous methylprednisolone and hydrocortisone for the treatment of acute inflammatory bowel disease.

BACKGROUND AND AIM: Despite widespread recommendations and use of intravenous corticosteroids (IVCS) for the treatment of acute flares of ulcerative colitis and Crohn's disease, limited evidence exists comparing outcomes of the two most common regimens, intravenous methylprednisolone (IVMP) and intravenous hydrocortisone (IVHC). IVHC has stronger mineralocorticoid effects compared with IVMP and may cause higher rates of hypokalemia. We aimed to determine differences in clinical outcomes including requirement for inpatient rescue therapy, bowel resection, and rates of hypokalemia. METHODS: We conducted a multicenter cohort study of all adult patients admitted with an acute flare of inflammatory bowel disease (IBD) to the three tertiary hospitals in Auckland, New Zealand, where the protocol at each institution is either IVMP 60 mg daily or IVHC 100 mg four times daily. All patients requiring IVCS between 20 June 2016 and 30 June 2018 were included. The IVCS protocol was then changed at one hospital, where further data were collected for a further 12 months from 30 January 2019 until 30 December 2019. RESULTS: There were 359 patients, including 129 (35.9%) patients receiving IVMP and 230 (64.1%) patients receiving IVHC. IVMP treatment was associated with a greater requirement for rescue therapy than IVHC (36.4% vs 19.6%, P = 0.001; odds ratio [OR] = 2.79; 95% confidence interval [CI], 1.64-4.75, P < 0.001), but also reduced rates of hypokalemia (55.8% vs 67.0%, P = 0.04; OR = 0.49; 95% CI, 0.30-0.81, P = 0.005). There was no difference between treatment groups for the median length of admission (5 days, interquartile range [IQR] 3-8), median duration of IVCS treatment (3 days, IQR 2-5), or bowel resection within 30 days of admission (12.4% vs 11.7%; OR = 1.04). CONCLUSION: For the treatment of an acute flare of IBD, treatment with IVMP results in significantly more requirement for inpatient rescue biologic or cyclosporin. In addition, it causes statistically significant less hypokalemia than IVHC, although in practice differences are negligible.

How do hospitals help patients prepare for and participate in outpatient clinics?

BACKGROUND: Patients attending general medicine outpatient clinics (GM OPC) at hospital face multiple healthcare demands in an environment that has evolved with the clinician at its centre. The ideas, knowledge and understanding that patients bring to their clinic appointments are not well studied in the New Zealand setting. AIMS: To assess how hospitals prepare patients for their outpatient appointments and encourage people to participate actively in their own care. METHODS: A prospective survey of 50 patients attending follow-up GM OPC was performed. Participants' understanding of the purpose of their appointment and knowledge of their prescription medications was explored using a nine-item questionnaire. Patient-directed hospital communication was then analysed to assess the information supplied to patients. RESULTS: Two-thirds (66%) of participants attending follow-up GM OPC recalled being informed of an appointment at the time of leaving hospital; only half (54%) felt they had been informed of the purpose of these appointments. Patient-directed communication was not completed in half (50%) of the analysed discharge letters. One-third (36%) of participants did not have specific questions for their clinic visits. CONCLUSIONS: Limited information and support is provided to patients attending follow-up GM OPC and is not tailored to individuals' health literacy. This practice assumes patients have comparable health literacy to clinicians, which may have downstream impacts on the usefulness of the clinic experience. The information that health users bring to clinic may be improved by increasing pre-clinic user engagement and deploying patient-centred tools within the healthcare environment.

Artificial intelligence improves adenoma detection rate during colonoscopy.

BACKGROUND: Artificial intelligence-assisted colonoscopy (AIAC) has gained attention as a tool to assist with polyp detection during colonoscopy. Uncertainty remains as to the clinical benefit, given limited publications using different modules. METHOD: A single-centre retrospective study was performed at Waitemata Endoscopy, a private endoscopy centre in Auckland, New Zealand. An Olympus Endo-AID module was utilised for the first time by 13 experienced endoscopists. Outcomes from AIAC between 10 March 2021 to 23 April 2021 were compared to a subsequent non-AI conventional colonoscopy (CC) control group from 27/4/21 to 20/6/21. RESULTS: A total of 213 AIACs were compared with 213 CCs. Baseline patient age, gender, indication for procedure, bowel preparation scores and specialty of proceduralist (gastroenterologist or surgeon) were well matched (p>0.05). The withdrawal time was significantly longer in the AIAC group compared to CC controls (15 vs 13 minutes; p<0.001). The adenoma detection rate (ADR) was significantly higher in the AIAC group compared to CC group (47.9% vs 38.5%; odds ratio 1.59; 95% CI [1.05-2.41]; p=0.03). The overall polyp detection rate (PDR) was similar between groups (70% vs 70%; p=0.79). Analysis by polyp size, location and other histology was not significant between groups. CONCLUSION: AI-assisted colonoscopy significantly improved ADR compared with conventional colonoscopy. Further research is required to understand its utility and impact on long-term clinical outcomes.

Clostridium difficile infections in patients with inflammatory bowel disease.

Case report of a 23-year-old male presenting with a severe flare of Crohn's disease, exacerbated by community-acquired infection with Clostridium difficile. This case outlines the association between C. difficile infection and inflammatory bowel disease, as both a mimic and a precipitant of flares. The discussion concerns the latest literature consensus on assessment and management of Clostridium difficile infection in patients with inflammatory bowel disease.