BACKGROUND AND AIMS: Quality metrics were established to develop standards to help assess quality of care, yet variation in inflammatory bowel disease (IBD) clinical practice exists. We performed a systematic review to assess the overall quality of evidence cited in formulating IBD quality metrics. METHODS: A systematic search was performed on PubMed, MEDLINE, and EMBASE. All major national and international IBD societies were included. Quality metrics were assessed for evidence quality and categorized as category A (guideline based), category B (primarily retrospective and observational studies) or category C (expert opinion). Quality metrics were examined for the type of metric, the quality, measurability, review, existing conflicts of interest (COI), and patient participation of the metric. Statistical analysis was conducted in R. RESULTS: A total of 143 distinct, and an aggregate total of 217 quality metrics were included and analyzed. 68%, 3.2%, and 28.6% of IBD quality metrics were based on low, moderate, and high quality of evidence, respectively. The proportion of high quality evidence across societies was significantly different (P <0.01). Five organizations included patients in quality metric development, three reported external review, not all reported measurable outcomes or stated the presence of a COI. Finally, 43% of quality metrics were published more than 5 years ago. CONCLUSIONS: Quality metrics are important to standardize practice. As more than two-thirds of the quality metrics in IBD are based on low quality evidence, further studies are needed to improve the overall quality of evidence supporting the development of quality measures.
Intestinal angioedema is the dilatation or thickening, or both, of a segment of bowel. It is a diagnostic phenomenon that manifests itself clinically as acute abdominal pain, diarrhea, and emesis. Generally, this condition occurs in tandem with angioedema of the face and tongue and/or in association with the use of an angiotensin-converting enzyme inhibitor (ACE-I). We present a rare case of a 63-year-old woman who developed isolated intestinal angioedema due to the ingestion of a food allergen.
Amongst other indications, cyclosporine therapy has emerged as a novel agent for the management of severe refractory ulcerative colitis (UC). In the historic population of patients receiving cyclosporine therapy-namely solid organ transplant patients-renal toxicity has proven to be a significant mitigating side effect limiting the therapeutic window. However, dose-limiting sequelae amongst patients receiving cyclosporine for inflammatory bowel disease (IBD) have not been as significant. As a result, the fear of renal toxicity as an adverse effect is less of a concern in IBD patients. The goal of this manuscript is to emphasize the need for future research to explore optimal drug dosing and extended use of cyclosporine therapy in the treatment of IBD-given its pathophysiology, efficacy, and safety profile in patients with IBD.
