Food avoidance in patients with inflammatory bowel disease: What, when and who?

BACKGROUND & AIMS: Patients with inflammatory bowel diseases avoid a variety of foods. However, it remains unclear how this behavior varies across patients. This cross-sectional study investigated how the food avoidance pattern in inflammatory bowel disease varies according to disease's activity, disease's subtype, Crohn's location, and prior history of bowel resection, strictures, and fistulae. METHODS: Outpatients with Crohn's disease (n = 173) and ulcerative colitis (n = 72) reported which food they avoid when they perceive they are in remission or in active disease using a list of 82 food items classified in 10 categories. Medical charts were reviewed for patients' characteristics. Linear regression analyses were used to compare food exclusion rates between patients' subgroups and food categories. RESULTS: During remission, food exclusion rates varied from 1 to 39%. Most avoided foods were those with capsaicin, meat alternatives, and raw vegetables. Overall, food exclusion rates were 38% higher in Crohn's disease than ulcerative colitis (P < 0.001), and 50% higher in stricturing than non-stricturing Crohn's disease (P < 0.001). During active disease, food exclusion rates were 69% higher than in remission (P < 0.001). Similar differences between subgroups were again observed during active disease though less noticeable than in remission. No association was found with other disease characteristics. Avoided foods were very similar across patients except for alcoholic beverages and foods rich in dietary fibers/residue, which were avoided more specifically during active disease and in Crohn's disease, respectively. CONCLUSIONS: Food avoidance is common among patients with inflammatory bowel diseases, and most particularly in those with stricturing Crohn's disease. Specificities in avoidance pattern suggest that the clinical response to dietary restrictions may differ according to the disease's characteristics.

Patients With Inflammatory Bowel Disease Are Unaware of the Impact of Smoking on Their Disease.

BACKGOUND: Tobacco is one of the most significant risk factors for inflammatory bowel disease (IBD). GOALS: The main objective was to assess the knowledge of patients with IBD regarding the effects of tobacco on their disease. Secondary objectives were to determine the source of their knowledge, the influence of their knowledge on their intent to quit smoking, and the association between patients' characteristics and their knowledge. STUDY: Patients with IBD completed a self-administered questionnaire on demographic data, severity of disease, and effects of tobacco on their disease. RESULTS: In total 259 patients [182 with Crohn's disease, 77 with ulcerative colitis (UC)] participated. The prevalence of current smokers, exsmokers, and nonsmokers was 19.6%, 40.2%, and 40.2%, respectively. Patients with Crohn's disease were more aware of the effects of tobacco on their disease compared with those with UC (57.7% vs. 13.0%, P<0.0001). In informed patients, the main source of information was the gastroenterologist (56.9%). The intent to quit smoking was superior in informed patients compared with those uninformed (78.6% vs. 47.8%, P=0.046). Older patients (odds ratio=0.97, P=0.01) and patients with UC (odds ratio=0.11, P<0.0001) were less likely to be informed. CONCLUSIONS: Only half of patients with IBD are aware of the risks of smoking associated with their disease, whereas their intent to quit smoking is directly related to their awareness. In the scope of IBD's treatment, management of smoking cessation should be undertaken in all smokers.

Vertebral osteomyelitis: an under-recognized infectious complication in patients on home parenteral nutrition.

BACKGROUND: Patients on home parenteral nutrition (HPN) are at high risk of central venous catheter sepsis (CVCS). CVCS can be associated with distant bacterial seeding. However, few cases of vertebral osteomyelitis (VO) related to HPN have been reported. For this reason, we made the hypothesis that the incidence of VO in patients on HPN is probably higher than what is reported. The goal of this study was to evaluate the incidence of infectious complications, and more specifically, the incidence of VO in patients on HPN. METHODS: A retrospective study of all patients receiving HPN from 2001 to 2006 was conducted. Patients who received HPN for < 1 month were excluded. Infectious complications and, more specifically, cases of VO were searched. RESULTS: Thirty-one patients received HPN and were included in the analysis. Forty-four infectious complications occurred (1.302/1,000 CVC-days). The most frequent infectious complication was urinary tract infection (25 cases; 0.740/1,000 CVC-days). Seven CVCS occurred in five different patients (0.207/1,000 CVC-days). In patients with CVCS, 42.9% (three cases) developed a secondary VO. No predictive factors for the development of VO could be identified in univariate analysis. CONCLUSION: We report a very low rate of infectious complications and an even lower rate of CVCS in patients on HPN. However, we report that 42.9% of our cases of CVCS developed a secondary VO. Consequently, VO must be part of the differential diagnosis among patients with HPN who complain of back pain.

Coeliac disease.

Increased awareness of non-classical presentations and more reliable screening tests have led to higher detection rates for coeliac disease in elderly adults. Clinical presentations are influenced largely by the long-standing course of the subclinical disease before diagnosis. In the majority of elderly patients, weight loss, diarrhoea and iron deficiency anaemia are present. With a delay in diagnosis, there are increased risks of associated autoimmune diseases, of neoplasms (mostly small bowel lymphoma) and of metabolic bone diseases. Thyroid disease is the most common autoimmune disease. Lymphoma may be the initial presentation or may complicate the clinical course of well established coeliac disease. Osteopenia is very common at presentation, can be clinically severe and require specific therapy in addition to the gluten-free diet. The high risk of complications in elderly patients with coeliac disease warrants a systematic approach in their investigation and management.