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1.
Harefuah ; 159(11): 815-819, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210852

RESUMO

INTRODUCTION: nflammatory bowel diseases (IBD) which include Crohn's disease and ulcerative colitis cause chronic remitting inflammation of the gastrointestinal tract with the potential of bowel wall injury which can lead to disability. AIMS: This study aimed to evaluate the degree of disability among IBD patients in Israel using validated scales and to identify factors that are associated with disability. Furthermore, the study aimed to examine the association between disability and quality of life (QoL) among patients. METHODS: The study population included 96 patients who attended a dedicated IBD clinic, (71 patients (pts) with Crohn's disease (CD), 22 pts with ulcerative colitis (UC) and 3 pts with IBD-undefined (IBD-U)). The participants completed a 5-part questionnaire which included demographic parameters, a validated QoL measure (inflammatory bowel disease questionnaire (IBDQ), two validated disability scales (the work and social adjustment scale (WSAS) and the World Health Organization Disability Assessment Schedule V.2.0 (WHODAS2.0), employment status, and a disease activity measure (the Manitoba IBD index (MIBDI). RESULTS: Major disability was found among 20% of the participants (as defined by a WSAS score ≥17). Major disability was significantly associated with lower QoL (p<0.001) and with recognition of disability from the National Insurance Institute of Israel ("Hamosad Lebituach Leumi") (p=0.005). Significant association was found between WHODAS2.0 and low QoL (r=-0.763,p<0.001). There were no significant differences in rates of major disability among patients with CD vs. those with UC. CONCLUSIONS: Approximately one fifth of IBD patients in Israel have major disability, which in turn, is associated with a decreased quality of life and recognition of disability from the National Insurance Institute of Israel. There were no significant differences in rates of disability between patients with CD vs. those with UC.


Assuntos
Colite Ulcerativa , Doenças Inflamatórias Intestinais , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Estudos Transversais , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Israel/epidemiologia , Qualidade de Vida , Índice de Gravidade de Doença
2.
J Immunol Res ; 2020: 2847316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062719

RESUMO

Objectives: The COVID-19 epidemic triggered by coronavirus SARS-CoV-2 is rapidly spreading around the globe. This study is aimed at finding out the suspected or confirmed SARS-CoV-2 infection in patients with inflammatory bowel disease (IBD) in Hubei province, China. We also investigated symptoms, medications, life quality, and psychological issues of IBD patients under the ongoing pandemic. Methods: We conducted a self-reported questionnaire survey via an online survey platform. SARS-CoV-2 infection-related data was collected from IBD patients. The status quo of medications and symptoms of the subjects were investigated. Life quality, depression, and anxiety were measured by clinical questionnaires and rated on scoring systems. Results: A total of 204 IBD patients from Hubei province were included in this study. No suspected or confirmed SARS-CoV-2 infection case was found in this study. As a result of city shutdown, two-thirds of the patients (138/204) in our series reported difficulty in accessing medicines and nearly half of them (73/138) had to discontinue medications. Apart from gastrointestinal symptoms, systemic symptoms were common while respiratory symptoms were rare in the cohort. Though their quality of life was not significantly lowered, depression and anxiety were problems that seriously affected them during the COVID-19 epidemic. Conclusions: Inaccessibility to medications is a serious problem for IBD patients after city shutdown. Efforts have to be made to address the problems of drug withdrawal and psychological issues that IBD patients suffer from during the COVID-19 outbreak.


Assuntos
Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Ansiedade/psicologia , Betacoronavirus/efeitos dos fármacos , China/epidemiologia , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/patologia , Masculino , Pandemias , Qualidade de Vida/psicologia , Inquéritos e Questionários
5.
Inflamm Bowel Dis ; 26(11): e134-e136, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-33029612
6.
J Med Internet Res ; 22(11): e19574, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33006945

RESUMO

BACKGROUND: After the COVID-19 outbreak, the Italian Government stopped most regular health care activity. As a result, patients with inflammatory bowel disease (IBD) had limited access to outpatient clinics and hospitals. OBJECTIVE: This study aimed to analyze the perception of the COVID-19 emergency among patients with IBD during the early weeks of the lockdown. METHODS: We invited adult patients with IBD from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) by email to answer an ad hoc anonymous survey about COVID-19. We also collected data on demographic and disease characteristics. RESULTS: In total, 167 patients with IBD from Padua and 83 patients from Salerno answered the survey (age: mean 39.7 years, SD 13.9 years; female: n=116, 46.4%). We found that patients with IBD were particularly worried about the COVID-19 pandemic (enough: 77/250, 30.8%; much/very much: 140/250, 56.0%), as they felt more vulnerable to COVID-19 due to their condition (enough: 70/250, 28.0%; much/very much: 109/250, 43.6%). Patients with IBD from the red zone of Veneto were more worried than patients from Campania (P=.001), and men felt more susceptible to the virus than women (P=.05). Additionally, remote medicine was appreciated more by younger patients than older patients (P=.04). CONCLUSIONS: The results of our survey demonstrate that the lockdown had a significant impact on the psychological aspects of patients with IBD and suggest the need for increasing communication with patients with IBD (eg, through telemedicine) to ensure patients receive adequate health care, correct information, and proper psychological support.


Assuntos
Infecções por Coronavirus/epidemiologia , Doenças Inflamatórias Intestinais/psicologia , Pacientes Ambulatoriais/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Inquéritos e Questionários , Telemedicina , Adulto , Ansiedade/epidemiologia , Estudos Transversais , Assistência à Saúde , Surtos de Doenças , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Itália/epidemiologia , Masculino
7.
Medicine (Baltimore) ; 99(44): e22897, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126343

RESUMO

Inflammatory bowel disease (IBD) in Asia has become increasingly prevalent. As a treatment of IBD, many immunomodulators and biological agents were introduced and shown to be effective in inducing and maintaining remission. However, many cases with treatment failure were reported. To overcome the failure, combination therapy of immunomodulatory and biologics have emerged, showing better outcomes by optimizing biologic pharmacokinetics and minimizing immunogenicity. Adversely, rates of tuberculosis (TB) have been increased as a result. The aim of this study is to compare the risk of TB according to the therapy using large population data.We used data from the South Korean Health Insurance and Review Agency over the period 2008-2016 and calculated the hazard ratio (HR) for TB in IBD. We compared the risk of TB according to the medication: infliximab only, azathioprine only (AZA), combination of azathioprine and infliximab (CAI), azathioprine monotherapy and infliximab monotherapy (AIM), and azathioprine and infliximab whether simultaneously or separately (AISS).In IBD patients, a total of 249 patients were identified as active TB. After one-to-one matching with age, sex and disease duration, the risks of TB were significantly higher in AZA group (HR, 2.06; 95% CI, 1.35-3.12, P < .001), AIM group (HR, 3.26; 95% CI, 1.18-9.05, P = .02), AISS group (HR, 3.50; 95% CI, 1.92-6.37, P < .001), and CAI group (HR, 5.67; 95% CI, 2.42-10.21, P < .001), and the HR increased gradually in this order. In UC patients, the results were in similar pattern, but this pattern was not observed in CD patients in our study.Our study shows that Korean IBD patients are at risk of TB, and the risk increases with usage of IBD medication; moreover, the risk is the highest if combination therapy is used. These results highlight the importance of screening for TB in IBD patients, especially in combination therapy.


Assuntos
Azatioprina/uso terapêutico , Quimioterapia Combinada/métodos , Infliximab/uso terapêutico , Tuberculose , Imunidade Adaptativa/efeitos dos fármacos , Produtos Biológicos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/imunologia , Quimioterapia de Manutenção/efeitos adversos , Quimioterapia de Manutenção/métodos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
10.
Inflamm Bowel Dis ; 26(11): 1779-1785, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-32879978
17.
Clin Gastroenterol Hepatol ; 18(12): 2689-2700, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32777550

RESUMO

BACKGROUND & AIMS: Data on the clinical characteristics of patients with inflammatory bowel diseases (IBDs) with coronavirus disease 2019 (COVID-19) are scarce. The aim of our systematic review was to investigate symptoms and diagnostic-therapeutic management of IBD patients with COVID-19. METHODS: We searched PubMed, Embase, Web of Science, and MedRxiv up to July 29, 2020, to identify all studies reporting clinical information on adult and pediatric IBD patients with confirmed COVID-19. RESULTS: Twenty-three studies met our inclusion criteria, including 243,760 IBD patients. COVID-19 was diagnosed in 1028 patients (509 with Crohn's disease [49.5%], 428 with ulcerative colitis [41.6%], 49 with indeterminate colitis [4.8%], and 42 with missing data [4.1%]), accounting for a cumulative prevalence of 0.4%. Viral infection occurred more frequently in males than in females (56.5% vs 39.7%), and the mean age ranged from 14 to 85 years. The most common symptoms were fever (48.3%), cough (46.5%), and diarrhea (20.5%), and a COVID-19 diagnosis was achieved mainly through polymerase chain reaction analysis of nasopharyngeal swabs (94.4%) and chest computed tomography scans (38.9%). Hydroxychloroquine (23.9%), lopinavir/ritonavir (8.2%), steroids (3.2%), and antibiotics (3.1%) were the most used drugs. Overall, approximately a third of patients were hospitalized (30.6%), and 11.4% of them required admission to the intensive care unit. In total, 29 COVID-19-related deaths were reported (3.8%), and increasing age and the presence of comorbidities were recognized as risk factors for COVID-19 and negative outcomes. CONCLUSIONS: Diarrhea occurs more frequently in IBD patients with COVID-19 than in the non-IBD population. Further studies are needed to define the optimal diagnostic-therapeutic approach in IBD patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Doenças Inflamatórias Intestinais/epidemiologia , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/epidemiologia , Comorbidade , Saúde Global , Humanos , Doenças Inflamatórias Intestinais/terapia , Prevalência
18.
Lancet Gastroenterol Hepatol ; 5(11): 986-995, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32818437

RESUMO

BACKGROUND: Use of antibiotics in early life has been linked with childhood inflammatory bowel disease (IBD), but data for adults are mixed, and based on smaller investigations that did not compare risk among siblings with shared genetic or environmental risk factors. We aimed to investigate the association between antibiotic therapy and IBD in a large, population-based study. METHODS: In this prospective case-control study, we identified people living in Sweden aged 16 years or older, with a diagnosis of IBD based on histology and at least one diagnosis code for IBD or its subtypes (ulcerative colitis and Crohn's disease). We identified consecutive patients with incident IBD from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, cross-referenced with the Swedish Patient Register and the Prescribed Drug Register. We accrued data for cumulative antibiotic dispensations until 1 year before time of matching for patients and up to five general population controls per patient (matched on the basis of age, sex, county, and calendar year). We also included unaffected full siblings as a secondary control group. Conditional logistic regression was used to estimate multivariable-adjusted odds ratios (aORs) and 95% CIs for diagnosis of incident IBD. FINDINGS: We identified 23 982 new patients with IBD (15 951 ulcerative colitis, 7898 Crohn's disease, 133 unclassified IBD) diagnosed between Jan 1, 2007, and Dec 31, 2016. 117 827 matched controls and 28 732 siblings were also identified. After adjusting for several risk factors, aOR in patients who had used antibiotics versus those who had never used antibiotics was 1·88 (95% CI 1·79-1·98) for diagnosis of incident IBD, 1·74 (1·64-1·85) for ulcerative colitis, and 2·27 (2·06-2·49) for Crohn's disease. aOR was higher in patients who had received one antibiotic dispensation (1·11, 1·07-1·15), two antibiotic dispensations (1·38, 1·32-1·44), and three or more antibiotic dispensations (1·55, 1·49-1·61) than patients who had none. Increased risk was noted for ulcerative colitis (aOR with three or more antibiotic dispensations 1·47, 95% CI 1·40-1·54) and Crohn's disease (1·64, 1·53-1·76) with higher estimates corresponding to broad-spectrum antibiotics. Similar but attenuated results were observed when siblings were used as the reference group, with an aOR of 1·35 (95% CI 1·28-1·43) for patients who had received three or more dispensations, compared with general population controls. INTERPRETATION: Higher cumulative exposure to systemic antibiotic therapy, particularly treatments with greater spectrum of microbial coverage, may be associated with a greater risk of new-onset IBD and its subtypes. The association between antimicrobial treatment and IBD did not appear to differ when predisposed siblings were used as the reference controls. Our findings, if substantiated by longer-term prospective studies in humans or mechanistic preclinical investigations, suggest the need to further emphasise antibiotic stewardship to prevent the rise in dysbiosis-related chronic diseases, including IBD. FUNDING: National Institutes of Health. Crohn's and Colitis Foundation.


Assuntos
Antibacterianos , Disbiose , Doenças Inflamatórias Intestinais , Adolescente , Adulto , Idade de Início , Antibacterianos/classificação , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Biópsia/estatística & dados numéricos , Estudos de Casos e Controles , Sistemas de Informação em Farmácia Clínica/estatística & dados numéricos , Disbiose/induzido quimicamente , Disbiose/prevenção & controle , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/patologia , Masculino , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Irmãos , Suécia/epidemiologia
20.
Indian J Gastroenterol ; 39(3): 220-231, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32783168

RESUMO

The world is witnessing a serious public health threat in the wake of the third corona virus pandemic, a novel corona virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Corona Virus Disease-19 (COVID-19) is not limited to the respiratory system but has widespread involvement including the gastrointestinal (GI) tract and liver, with evidence of prolonged fecal shedding and feco-oral transmission. This finding has stirred up a hornet's nest of not only a newer modality of the spread of the virus but also a risk of the unpredictable duration of the infective potential of the shedders. We reviewed the literature on fecal shedding and possible implications on prevention and surveillance strategies. The pandemic is changing the management of underlying chronic diseases such as inflammatory bowel disease (IBD) and other diseases. Moreover, for the gastroenterologist, doing endoscopic procedures in this COVID-19 era poses a high risk of contamination, as it is an aerosol-generating procedure. There is a daily influx of data on this disease, and multiple societies are coming up with various recommendations. We provide a comprehensive review of all the reported GI manifestations of COVID-19 infection and the side effects of confounding drugs. We have summarized the management recommendations for diseases such as IBD with COVID-19 and nutritional recommendations and provided a concise review of the endoscopy guidelines by the various societies. This review provides a comprehensive account and a lucid guide covering various aspects of gastroenterology practice during this COVID-19 pandemic.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia Gastrointestinal , Fezes/virologia , Gastroenterologia , Doenças Inflamatórias Intestinais , Pandemias , Pneumonia Viral , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Gerenciamento Clínico , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Gastroenterologia/métodos , Gastroenterologia/tendências , Trato Gastrointestinal/virologia , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
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