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4.
Dig Dis Sci ; 66(4): 945-953, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33655456

RESUMO

Telemedicine involves delivering healthcare and preventative care services to patients without the need for in-person encounters. Traditionally, telemedicine has been used for acute events (e.g., stroke, used to relay essential information to the emergency department) and chronic disease management (e.g., diabetes and chronic kidney disease management). Though the utilization of telemedicine in gastroenterology and hepatology has been modest at best, especially for inflammatory bowel diseases and chronic liver disease management, since the onset of coronavirus disease 2019 (COVID-19) pandemic, utilization of telemedicine in gastroenterology increased by 4000% in the first two weeks, equivalent to the last six years of growth before the pandemic. The Center for Medicare and Medicaid (CMS) relaxed rules for the use of telemedicine with easing restrictions on reimbursements, location, licensing requirements (across state lines), and the need for a prior provider-patient relationship. These changes increased the use of telemedicine in inpatient and outpatient settings for gastroenterology-related referrals. The use of inpatient telephonic or video consults helps provide timely care during the pandemic while conserving personal protective equipment and decreasing provider and patient exposure. Nevertheless, telehealth use comes at the cost of no direct patient contact and lesser reimbursements. The appropriate use of technology and equipment, training of healthcare providers, use of platforms that can be integrated into the electronic health record while protecting the privacy and the flow of information are essential components of telemedicine. Furthermore, encouraging patients to seek medical care remotely with the proper equipment and improving digital literacy without the need for physical examinations is a challenge, further compounded in elderly or hard-of-hearing patients and in patients who are more comfortable with in-person visits. The authors will systematically review and discuss how telemedicine can be integrated into the practice of gastroenterology and hepatology, with emphasis placed on discussing barriers to success and the ways they can be mitigated.


Assuntos
/prevenção & controle , Gastroenterologia , Assistência ao Paciente , Telemedicina , Doença Crônica , Humanos , Doenças Inflamatórias Intestinais/terapia , Hepatopatias/terapia
5.
Orv Hetil ; 162(12): 443-448, 2021 Mar 21.
Artigo em Húngaro | MEDLINE | ID: mdl-33764022

RESUMO

Összefoglaló. Gyulladásos bélbetegségben (IBD) a fájdalomérzés komplex szomatikus és pszichés jelenség. Ez utóbbi komponens pontosabb megértése segíthet a megfelelo kezelési stratégia megállapításában. A szorongásos hangulati zavarok és egyes maladaptív viselkedési minták (dohányzás és alkoholfogyasztás) elofordulási gyakorisága jól dokumentált IBD-ben, a kannabiszhasználat hatása ugyanakkor kevésbé ismert. A szerzok szisztematikus áttekintést végeztek annak megértéséhez, hogy vajon magasabb-e a marihuánahasználat gyakorisága felnott IBD-s betegek között egészséges kontrollpopulációhoz viszonyítva, és ha igen, akkor melyek a szerhasználat legfontosabb jellemzoi. A kutatási periódust szándékosan az elmúlt 7 évre korlátoztuk, ugyanis 2013-tól jelentos változások álltak be a kannabinoidok jogi és orvosi megítélésében az USA-ban. Öt elsodleges és több másodlagos adatbázisban kutattunk elore meghatározott kulcsszavak segítségével 2013 óta teljes szöveggel megjelent, angol nyelvu felnott IBD-s populációt vizsgáló epidemiológiai tanulmányok vonatkozásában. 143 rekord közül 7 cikk felelt meg a beválogatási kritériumoknak. Eredményeink szerint a kannabiszhasználat gyakorisága IBD-ben szenvedo felnott betegek körében valószínuleg magasabb, mint a kontrollpopulációban: a "valaha, bármikor" használók aránya 54-70% között változott (szemben a 46-60% gyakorisággal a kontrollcsoportban), míg az "aktív használók" esetén a gyakoriság 6,8-25% között változott (vs. a kontrollcsoportban tapasztalt 8,6-14%-kal). A prevalenciaadatok széles variabilitása arra utal, hogy a beválogatott epidemiológiai tanulmányok valószínuleg vagy nem voltak megfeleloen tervezve, vagy jelentos heterogenitással bírtak. A pszichés tényezok ellentmondásos mintája azt sugallja, hogy a kannabinoidok egyes esetekben ronthatták, más esetben valószínuleg javították bizonyos prominens tünetek megélését. Javasoljuk ezért, hogy a valós prevalencia megállapítása érdekében a keresztmetszeti vizsgálatok mellé ismételt pszichometriai vizsgálatokon alapuló vizsgálatok is bekerüljenek a további kutatásba. Orv Hetil. 2021; 162(12): 443-448. Summary. Pain perception in inflammatory bowel disease (IBD) is beyond a purely somatic process. In-depth understanding of psychologic elements might enable more effective management in this patient group. Anxiety disorders and certain maladaptive coping strategies like smoking and alcohol consumption are well-documented in IBD, unlike the scarcely researched cannabis use. The authors designed a systematic review, to investigate if the prevalence of cannabis use is higher in IBD that in unselected controls. The research window was intentionally set to cover for the past 7 years, as in 2013 major legislative changes took place in the cannabis decriminalisation process in the United States. 5 primary and several secondary databases were researched with a pre-formulated algorithm registered at PROSPERO for full text epidemiological studies published in English language involving adult IBD patients. Out of 143 records, 7 articles met the in/exclusion criteria. Our results suggest that cannabis use among adult patients with IBD is likely to be higher than in the unselected control population. The proportion of "ever" users varied from 54% to 70% (vs. 46-60% in the control group); and for 'active users', the prevalence ranged between 6.8% to 25% (vs. 8.6-14% in the control group). The wide variability in prevalence data suggests that the selected epidemiological studies were either inappropriately designed or were too heterogeneous (or both). The contradictory pattern of psychological factors suggests that cannabinoids might improve or worsen IBD depending on case by case basis. We therefore opine that in addition to cross-sectional papers, studies based on repeated psychometric analysis are needed to establish the real prevalence and inform cannabinoid prescription and holistic management in inflammatory bowel disease. Orv Hetil. 2021; 162(12): 443-448.


Assuntos
Doenças Inflamatórias Intestinais , Uso da Maconha , Humanos , Doenças Inflamatórias Intestinais/terapia , Uso da Maconha/epidemiologia
6.
Medicine (Baltimore) ; 100(7): e24729, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607817

RESUMO

ABSTRACT: The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010-2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09-1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92-0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02-1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19-4.69 P < .001).Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.


Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Demografia/tendências , Doenças Inflamatórias Intestinais/epidemiologia , Urbanização/tendências , Adulto , Estudos de Casos e Controles , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Colômbia/epidemiologia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Gerenciamento de Dados , Bases de Dados Factuais , Meio Ambiente , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Fatores de Risco
7.
Intern Med J ; 51(2): 284-287, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33631857

RESUMO

The COVID-19 pandemic has demanded a rapid adaptation in healthcare provision, including patients with inflammatory bowel disease (IBD). This viewpoint discusses some of the unique challenges in managing comorbid IBD and COVID-10 experienced by our team at The Royal Melbourne Hospital, which was at the epicentre of the COVID-19 'second-wave' surge in Melbourne.


Assuntos
/complicações , Assistência à Saúde , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapia , Austrália , Humanos , Pandemias
8.
Angiology ; 72(4): 303-314, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33601945

RESUMO

Atherosclerosis and inflammatory bowel disease (IBD) are often regarded as 2 distinct entities. The commonest manifestation of atherosclerosis is ischemic heart disease (IHD), and an association between IHD and IBD has been reported. Atherosclerosis and IBD share common pathophysiological mechanisms in terms of their genetics, immunology, and contributing environmental factors. Factors associated with atherosclerosis are implicated in the development of IBD and vice versa. Therefore, treatments targeting the common pathophysiology pathways may be effective in both conditions. The current review considers the pathophysiological pathways that are shared between the 2 conditions and discusses the implications for treatment and research.


Assuntos
Imunidade Adaptativa , Aterosclerose/etiologia , Imunidade Inata , Doenças Inflamatórias Intestinais/etiologia , Estilo de Vida , Polimorfismo de Nucleotídeo Único , Animais , Aterosclerose/genética , Aterosclerose/imunologia , Aterosclerose/terapia , Microbioma Gastrointestinal , Predisposição Genética para Doença , Humanos , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/terapia , Fenótipo , Polimorfismo Genético , Medição de Risco , Fatores de Risco , Vitamina D/imunologia
10.
J Med Internet Res ; 23(1): e20629, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33399540

RESUMO

BACKGROUND: The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies. OBJECTIVE: The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn's & Colitis Foundation web-based platform in China. METHODS: Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed. RESULTS: In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US $11,668.68 ($7944.44) and US $74.90 ($253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50%. However, the income of 85.5% (2565/3000) of the patients was less than ¥10,000 (US $1445) per month. Approximately 96.5% (2894/3000) of the patients were covered by health insurance, but only 24.7% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0% (2954/3000) of the patients worried about their financial situation. Thus, 79.7% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7%) had no primary care provider, and 52.2% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income (P=.001) and higher transportation (P=.004) and accommodation costs (P=.001) were significantly associated with the increased number of emergency visits of the patients. CONCLUSIONS: Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs.


Assuntos
Colite Ulcerativa/economia , Colite Ulcerativa/terapia , Doença de Crohn/economia , Doença de Crohn/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/terapia , Telemedicina/métodos , Adolescente , Adulto , Idoso , China , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
12.
Lancet Gastroenterol Hepatol ; 6(3): 218-224, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33508241

RESUMO

SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD. Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.


Assuntos
/farmacologia , Doenças Inflamatórias Intestinais , /epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Gastroenterologia/métodos , Gastroenterologia/tendências , Humanos , Hospedeiro Imunocomprometido , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/terapia , Sociedades Médicas , Reino Unido , Vacinação/métodos
14.
Rev Esp Enferm Dig ; 113(2): 153-154, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33467860

RESUMO

The COVID-19 pandemic has forced major changes in the care of patients with inflammatory bowel disease (IBD). The articles by El Hajra et al. and Fernández Álvarez el al. show the modifications in patient management that were performed during the state of alarm in Spain.


Assuntos
Doenças Inflamatórias Intestinais , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Pandemias , Espanha/epidemiologia
15.
Viruses ; 13(1)2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33451106

RESUMO

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a multifactorial disease in which dietary, genetic, immunological, and microbial factors are at play. The role of enteric viruses in IBD remains only partially explored. To date, epidemiological studies have not fully described the role of enteric viruses in inflammatory flare-ups, especially that of human noroviruses and rotaviruses, which are the main causative agents of viral gastroenteritis. Genome-wide association studies have demonstrated the association between IBD, polymorphisms of the FUT2 and FUT3 genes (which drive the synthesis of histo-blood group antigens), and ligands for norovirus and rotavirus in the intestine. The role of autophagy in defensin-deficient Paneth cells and the perturbations of cytokine secretion in T-helper 1 and T-helper 17 inflammatory pathways following enteric virus infections have been demonstrated as well. Enteric virus interactions with commensal bacteria could play a significant role in the modulation of enteric virus infections in IBD. Based on the currently incomplete knowledge of the complex phenomena underlying IBD pathogenesis, future studies using multi-sampling and data integration combined with new techniques such as human intestinal enteroids could help to decipher the role of enteric viruses in IBD.


Assuntos
Suscetibilidade a Doenças , Infecções por Enterovirus/complicações , Infecções por Enterovirus/virologia , Enterovirus/fisiologia , Interações Hospedeiro-Patógeno , Doenças Inflamatórias Intestinais/etiologia , Animais , Autofagia , Biomarcadores , Antígenos de Grupos Sanguíneos/genética , Antígenos de Grupos Sanguíneos/imunologia , Gerenciamento Clínico , Infecções por Enterovirus/epidemiologia , Microbioma Gastrointestinal , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Interações Microbianas , Transdução de Sinais
16.
Rev Esp Enferm Dig ; 113(2): 92-97, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33371692

RESUMO

INTRODUCTION AND OBJECTIVES: the SARS-COV-2 pandemic has forced a substantial change in the care of patients with digestive pathologies, especially for inflammatory bowel disease (IBD) patients taking immunosuppessive medications. In this regard, some national and international guidelines have indicated the standards to be taken into account. However, few studies have evaluated how patients have dealt with this infection. Therefore, this study was performed with the aim to determine how the SARS-COV-2 pandemic has affected our IBD patients. MATERIAL AND METHODS: an online survey was performed among the members (295) of the Association of Crohn's Disease and Ulcerative Colitis (ACCU), which consisted of 19 questions. Finally, it was completed by 168 patients. RESULTS: fifty-eight per cent of cases were female, 63.7 % had Crohn's disease (CD) and 53 % received biologic therapy. Five per cent were infected by SARS-CoV-2 and were male. The main concern of the patients was the fear of acquiring the infection (80.9 %). More than 90 % continued their treatments and half of the patients worked from home during the pandemic period. CONCLUSIONS: the perspective of the patients is necessary to achieve an adequate management and evolution of the disease. More studies are needed to assess the impact that exceptional situations, such as the COVID-19 pandemic, may have on IBD patients in order to improve adherence and control of the disease.


Assuntos
Doenças Inflamatórias Intestinais/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Grupos de Autoajuda , Adulto Jovem
17.
Rev Esp Enferm Dig ; 113(2): 98-102, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33342217

RESUMO

INTRODUCTION: COVID-19 has altered the usual practice of medicine and the state of emergency declared in Spain on March 14th has considerably changed the activity of inflammatory bowel disease (IBD) units. The aim of this study was to evaluate the consequences of COVID-19 on the IBD Unit's activity and provide information on restructuring with available resources. METHODS: an observational study was performed in a referral hospital in Madrid (Spain). Type of appointment, loss of follow-up, hospital admission, treatment changes, endoscopic activity, surgeries and blood tests were evaluated between March 15th and May 15th, 2020. This data was compared with the usual activity a year before. RESULTS: among the 510 patients included, 476 (93.33 %) received had a remote consultation, representing an increase of 92.38 % compared with the previous year (0.95 %). There was a loss of follow-up in 26 patients (5.1 %) vs 15 (3.58 %) the previous year. A total of 60 (35.09 %) blood tests, 64 (76.19 %) endoscopies and all scheduled surgeries were suspended. Besides, 484 (94.9 %) patients remained adherent vs 417/419 (99.5 %) in the pre-pandemic period and 48 (9.41 %) reported symptoms of an IBD flare. Thirty-nine (7.6 %) patients developed symptoms suggestive of COVID-19. CONCLUSION: a large number of tests and on-site outpatient visit consultations were suspended. However, a rapid adaptation to telemedicine allowed these patients to be closely followed up. Although it was possible to maintain therapeutic compliance, with a loss to follow-up slightly higher than the previous year, suspensions and delays of tests could have significant negative consequences in the long term.


Assuntos
Doenças Inflamatórias Intestinais/terapia , Adulto , Assistência à Saúde , Feminino , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia
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