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Talar-Wojnarowska R, Caban M, Jastrzębska M, Woźniak M, Strigáč A, Małecka-Wojciesko E. Inflammatory Bowel Diseases in the Elderly: A Focus on Disease Characteristics and Biological Therapy Patterns. J Clin Med 2024; 13:2767. [PMID: 38792308 PMCID: PMC11122211 DOI: 10.3390/jcm13102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The incidence of inflammatory bowel diseases (IBDs) in elderly patients is constantly increasing. It results from the combination of an aging population with compounding prevalence of IBD, as well as the growing burden of elderly-onset IBD. The clinical characteristics of elderly patients differ from young subjects with IBD due to the multimorbidity or polypharmacy, affecting the choice of adequate therapeutic options. The aim of this study was to determine the clinical aspects and biological therapy safety in elderly Polish IBD patients. Methods: We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD patients treated with a biological therapy in two referral centers within the National Drug Program in Poland. Results: Out of the entire group of 366 studied patients, 51 (13.9%) were aged over 60-32 with ulcerative colitis (UC) and 19 with Crohn's disease (CD). The disease location was predominantly ileocolonic (57.89%) in patients with CD and pancolitis for patients with UC (56.25%). Most of the elderly IBD subjects were characterized by significant comorbidities, with Charlson Comorbidity Index (CCI) ≥ 1 in 66.67% patients. The probability of stopping biological therapy due to adverse events had the tendency to be higher in the CCI ≥ 1 group (20.58% vs. 5.88% in CCI = 0; p = 0.087). The main reasons for the therapy discontinuation included hypersensitivity reactions and liver enzyme abnormalities. Conclusions: In conclusion, our results underline the importance of assessing the comorbidity status instead of the age prior to initiating biological therapy, analyzing additional safety risks, and close monitoring in IBD patients with multiple comorbidities.
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Affiliation(s)
- Renata Talar-Wojnarowska
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
| | - Miłosz Caban
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, 92-215 Lodz, Poland
| | - Marta Jastrzębska
- Department of Gastroenterology, Health Care Center, 26-200 Konskie, Poland;
| | - Małgorzata Woźniak
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
| | - Aleksandra Strigáč
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
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Yang Y, Ludvigsson JF, Olén O, Sjölander A, Carrero JJ. Estimated Glomerular Filtration Rate and the Risk of Inflammatory Bowel Disease in Adults: A Swedish Population-Based Study. Inflamm Bowel Dis 2024; 30:718-725. [PMID: 36617285 PMCID: PMC11063554 DOI: 10.1093/ibd/izac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Kidney complications are common in patients with long-standing inflammatory bowel disease (IBD). Whether kidney complications, defined as low estimated glomerular filtration rate (eGFR), may predispose to later IBD is unknown. METHODS We analyzed the association between eGFR and the risk of being subsequently diagnosed with IBD among 1 612 160 adults from Stockholm. The exposure was categories of eGFR, with 90 to 104 mL/min/1.73 m2 as the reference. Cox regression models were used to investigate the association between eGFR, IBD, and IBD subtypes. Subgroup analyses included age strata, sex, education, and comorbidities. To explore the possibility of detection bias or reverse causation, we estimated IBD hazard ratios (HRs) after excluding cases and individuals censored during early years of follow-up. RESULTS During a median of 9 years of follow-up, we detected 9663 cases of IBD (3299 Crohn's disease, 5072 ulcerative colitis, 1292 IBD unclassified). Lower eGFR levels were associated with higher IBD risk (for eGFR 30-59 mL/min/1.73 m2: adjusted HR, 1.15; 95% confidence interval [CI], 1.01-1.33; and for eGFR <30 mL/min/1.73 m2: adjusted HR, 1.65; 95% CI, 1.16-2.37). This association was stronger in magnitude for Crohn's disease (for eGFR 30-59 mL/min/1.73 m2: HR, 1.33, 95% CI, 1.04-1.72; and for eGFR <30 mL/min/1.73 m2: HR, 2.25; 95% CI, 1.26-3.99). Results were consistent across strata of age, comorbidities, and attained education but suggested the association between eGFR and IBD to be stronger in women (P for interaction <.05). Results attenuated but were robust to exclusion of early IBD cases. CONCLUSIONS We observed an association between reduced eGFR and the risk of developing IBD, which was stronger in magnitude for Crohn's disease.
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Affiliation(s)
- Yuanhang Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital Stockholm, Stockholm South General Hospital, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Nandi N, Tai FWD, McAlindon M, Sidhu R. Idiopathic terminal ileitis: myth or true entity? Curr Opin Gastroenterol 2024; 40:217-224. [PMID: 38353269 DOI: 10.1097/mog.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Isolated terminal ileitis is an increasing phenomenon identified during colonoscopy. Idiopathic terminal ileitis (IDTI) is a diagnosis of exclusion, representing a significant challenge from a diagnostic and management point of view. This review provides an overview of the most recent and relevant evidence on idiopathic IDTI, focusing on its evolution, the natural history and the management strategies proposed in the literature. RECENT FINDINGS IDTI is uncommon, with a reported prevalence between 0.5 and 7%. The main differential is with Crohn's disease and intestinal tuberculosis in endemic countries. A proportion of patients (0-50%) can progress and develop Crohn's disease; however, there are no reliable predictive factors to stratify IDTI patients. SUMMARY IDTI is a challenging entity, with a small proportion of patients progressing to Crohn's disease over time thus requiring follow-up. Noninvasive modalities such as capsule endoscopy are useful for follow-up, but further research is required to better understand this entity.
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Affiliation(s)
- Nicoletta Nandi
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Foong Way David Tai
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Mark McAlindon
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Reena Sidhu
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Umar N, Harvey P, Adderley NJ, Haroon S, Trudgill N. The Time to Inflammatory Bowel Disease Diagnosis for Patients Presenting with Abdominal Symptoms in Primary Care and its Association with Emergency Hospital Admissions and Surgery: A Retrospective Cohort Study. Inflamm Bowel Dis 2024:izae057. [PMID: 38563769 DOI: 10.1093/ibd/izae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) presenting to primary care may experience diagnostic delays. We aimed to evaluate this and assess whether time to diagnosis is associated with clinical outcomes. METHODS A retrospective cohort study using English primary care data from January 1, 2010, to December 31, 2019, linked to hospital admission data was undertaken. Patients were followed from the first IBD-related presentation in primary care to IBD diagnosis. Associations of time to diagnosis exceeding a year were assessed using a Robust Poisson regression model. Associations between time to diagnosis and IBD-related emergency hospital admissions and surgery were assessed using Poisson and Cox proportional hazards models, respectively. RESULTS Of 28 092 IBD patients, 60% had ulcerative colitis (UC) and 40% had Crohn's disease (CD). The median age was 43 (interquartile range, 30-58) years and 51.9% were female. Median time to diagnosis was 15.6 (interquartile range, 4.3-28.1) months. Factors associated with more than a year to diagnosis included female sex (adjusted risk ratio [aRR], 1.23; 95% CI, 1.21-1.26), older age (aRR, 1.05; 95% CI, 1.01-1.10; comparing >70 years of age with 18-30 years of age), obesity (aRR, 1.03; 95% CI, 1.00-1.06), smoking (aRR, 1.05; 95% CI, 1.02-1.08), CD compared with UC (aRR, 1.13; 95% CI, 1.11-1.16), and a fecal calprotectin over 500 μg/g (aRR, 0.89; 95% CI, 0.82-0.95). The highest quartile of time to diagnosis compared with the lowest was associated with IBD-related emergency admissions (incidence rate ratio, 1.06; 95% CI, 1.01-1.11). CONCLUSION Longer times to IBD diagnoses were associated with being female, advanced age, obesity, smoking, and Crohn's disease. More IBD-related emergency admissions were observed in patients with a prolonged time to diagnosis.
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Affiliation(s)
- Nosheen Umar
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Phil Harvey
- Gastroenterology Department, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nigel Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
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5
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Bianchi PI, Lenti MV, Petrucci C, Gambini G, Aronico N, Varallo M, Rossi CM, Pozzi E, Groppali E, Siccardo F, Franchino G, Zuccotti GV, Di Leo G, Zanchi C, Cristofori F, Francavilla R, Aloi M, Gagliostro G, Montuori M, Romaggioli S, Strisciuglio C, Crocco M, Zampatti N, Calvi A, Auricchio R, De Giacomo C, Caimmi SME, Carraro C, Staiano A, Cenni S, Congia M, Schirru E, Ferretti F, Ciacci C, Vecchione N, Latorre MA, Resuli S, Moltisanti GC, Abruzzese GM, Quadrelli A, Saglio S, Canu P, Ruggeri D, De Silvestri A, Klersy C, Marseglia GL, Corazza GR, Di Sabatino A. Diagnostic Delay of Celiac Disease in Childhood. JAMA Netw Open 2024; 7:e245671. [PMID: 38592719 PMCID: PMC11004829 DOI: 10.1001/jamanetworkopen.2024.5671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 04/10/2024] Open
Abstract
Importance The extent and factors associated with risk of diagnostic delay in pediatric celiac disease (CD) are poorly understood. Objectives To investigate the diagnostic delay of CD in childhood, and to assess factors associated with this delay. Design, Setting, and Participants Multicenter, retrospective, cross-sectional study (2010-2019) of pediatric (aged 0-18 years) patients with CD from 13 pediatric tertiary referral centers in Italy. Data were analyzed from January to June 2023. Main Outcomes and Measures The overall diagnostic delay (ie, the time lapse occurring from the first symptoms or clinical data indicative of CD and the definitive diagnosis), further split into preconsultation and postconsultation diagnostic delay, were described. Univariable and multivariable linear regression models for factors associated with diagnostic delay were fitted. Factors associated with extreme diagnostic delay (ie, 1.5 × 75th percentile) and misdiagnosis were assessed. Results A total of 3171 patients with CD were included. The mean (SD) age was 6.2 (3.9) years; 2010 patients (63.4%) were female; and 10 patients (0.3%) were Asian, 41 (1.3%) were Northern African, and 3115 (98.3%) were White. The median (IQR) overall diagnostic delay was 5 (2-11) months, and preconsultation and postconsultation diagnostic delay were 2 (0-6) months and 1 (0-3) month, respectively. The median (IQR) extreme overall diagnostic delay (586 cases [18.5%]) was 11 (5-131) months, and the preconsultation and postconsultation delays were 6 (2-120) and 3 (1-131) months, respectively. Patients who had a first diagnosis when aged less than 3 years (650 patients [20.5%]) showed a shorter diagnostic delay, both overall (median [IQR], 4 [1-7] months for patients aged less than 3 years vs 5 [2-12] months for others) and postconsultation (median [IQR], 1 [0-2] month for patients aged less than 3 years vs 2 [0-4] months for others). A shorter delay was registered in male patients, both overall (median [IQR], 4 [1-10] months for male patients vs 5 [2-12] months for female patients) and preconsultation (median [IQR], 1 [0-6] month for male patients vs 2 [0-6] months for female patients). Family history of CD was associated with lower preconsultation delay (odds ratio [OR], 0.59; 95% CI, 0.47-0.74) and lower overall extreme diagnostic delay (OR, 0.75; 95% CI, 0.56-0.99). Neurological symptoms (78 patients [21.5%]; OR, 1.35; 95% CI, 1.03-1.78), gastroesophageal reflux (9 patients [28.1%]; OR, 1.87; 95% CI, 1.02-3.42), and failure to thrive (215 patients [22.6%]; OR, 1.62; 95% CI, 1.31-2.00) showed a more frequent extreme diagnostic delay. A previous misdiagnosis (124 patients [4.0%]) was more frequently associated with gastroesophageal reflux disease, diarrhea, bloating, abdominal pain, constipation, fatigue, osteopenia, and villous atrophy (Marsh 3 classification). Conclusions and Relevance In this cross-sectional study of pediatric CD, the diagnostic delay was rather short. Some factors associated with risk for longer diagnostic delay and misdiagnosis emerged, and these should be addressed in future studies.
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Affiliation(s)
- Paola Ilaria Bianchi
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Clarissa Petrucci
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giulia Gambini
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Nicola Aronico
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
| | - Matteo Varallo
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Carlo Maria Rossi
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Elena Pozzi
- Department of Pediatrics, Buzzi Children’s Hospital, Milan, Italy
| | - Elena Groppali
- Department of Pediatrics, Buzzi Children’s Hospital, Milan, Italy
| | | | - Giulia Franchino
- Department of Pediatrics, Azienda Socio Sanitaria Territoriale Lariana, San Fermo della Battaglia, Como, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Grazia Di Leo
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Chiara Zanchi
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Fernanda Cristofori
- Interdisciplinary Department of Medicine—Pediatric Section, Aldo Moro University of Bari, Bari, Italy
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine—Pediatric Section, Aldo Moro University of Bari, Bari, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Giulia Gagliostro
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Monica Montuori
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Sara Romaggioli
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Caterina Strisciuglio
- Università della Campania Luigi Vanvitelli, Dipartimento della donna, del bambino e della chirurgia generale e specialistica, Naples, Italy
| | - Marco Crocco
- ”Pediatric Gastroenterology and Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini Institute, Genoa, Italy
| | - Noemi Zampatti
- ”Pediatric Gastroenterology and Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini Institute, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genoa, Genoa, Italy
| | - Angela Calvi
- ”Pediatric Gastroenterology and Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini Institute, Genoa, Italy
| | - Renata Auricchio
- Deparment of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Istituto Europeo per lo Studio delle Malattie correlate ad Alimenti, Naples, Italy
| | - Costantino De Giacomo
- Division of Pediatrics, Department of Mother and Child Health, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Maria Elena Caimmi
- Paediatric Clinic, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Carolina Carraro
- Paediatric Clinic, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Annamaria Staiano
- Deparment of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Sabrina Cenni
- Università della Campania Luigi Vanvitelli, Dipartimento della donna, del bambino e della chirurgia generale e specialistica, Naples, Italy
- Deparment of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Mauro Congia
- Gastroenterologia Pediatrica Clinica Pediatrica e Malattie Rare Ospedale Pediatrico Microcitemico Antonio Cao, Azienda Sanitaria Locale 8, Cagliari, Italy
| | - Enrico Schirru
- Centro Servizi di Ateneo per gli Stabulari, Università degli Studi di Cagliari, Cittadella Universitaria, Monserrato, Cagliari, Italy
| | - Francesca Ferretti
- UO di Gastroenterologia e Riabilitazione Nutrizionale, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Carolina Ciacci
- University of Salerno Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggi d’Aragona of Salerno, Salerno, Italy
| | - Nicoletta Vecchione
- University of Salerno Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggi d’Aragona of Salerno, Salerno, Italy
| | - Mario Andrea Latorre
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Semela Resuli
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giusy Cinzia Moltisanti
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giulia Maria Abruzzese
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Andrea Quadrelli
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Simone Saglio
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Pietro Canu
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Damiano Ruggeri
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Paediatric Clinic, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
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6
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Rossi CM, Lenti MV, Merli S, Lo Bello A, Mauro A, Anderloni A, Ribaldone DG, Marabotto E, Vernero M, Sheijani SD, Maniero D, Vanoli A, Klersy C, Savarino EV, Di Sabatino A. Clinical and atopic features of patients with primary eosinophilic colitis: an Italian multicentre study. Intern Emerg Med 2024:10.1007/s11739-024-03568-w. [PMID: 38461469 DOI: 10.1007/s11739-024-03568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
Eosinophilic colitis (EC) is the rarest among primary eosinophilic gastrointestinal disorders (EGID). EC is underdiagnosed due to its blurred and proteiform clinical manifestations. To explore the clinical and atopic characteristic of EC adult patients, the diagnostic delay, and relapse-associated factors, by comparison with patients with eosinophilic esophagitis (EoE) and irritable bowel syndrome (IBS). EC patients followed-up at four clinics were included, and clinical, histopathological, and laboratory data were retrieved. As control groups, age-matched patients with EoE and IBS were recruited. Allergy tests included skin prick test and serum specific IgE. Diagnostic delay was assessed. Overall, data from 73 patients were retrieved, including 40 with EC (median age 39 years IQR 22.5-59, F:M 2.1:1), 12 with EoE (F:M ratio: 1:5), and 21 with IBS (F:M ratio: 1:0.9). The most common features in EC patients were female sex (67.5%), atopy (77.5%), abdominal pain/distention (70%), diarrhoea (77.5%), and faecal calprotectin elevation (22.5%). Blood eosinophils were elevated in EoE, but not in EC (p < 0.001), while ECP did not differ across the three groups (p = 0.4). The frequency of allergen sensitization reached 25% of patients. Several frequent pan-allergens for this region were present. The overall diagnostic delay was 10 months (IQR 4-15). Factors contributing to a greater diagnostic delay were atopy, weight loss, and a previous misdiagnosis. EC is mostly a diagnosis of exclusion, burdened by a substantial diagnostic delay. In female patients the presence of allergen sensitization, abdominal symptoms and faecal calprotectin elevation should raise the suspicion of EC.
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Affiliation(s)
- Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Merli
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Lo Bello
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aurelio Mauro
- Gastrointestinal Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastrointestinal Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Vernero
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Shirin Djahandideh Sheijani
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daria Maniero
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy
| | | | - Catherine Klersy
- Biostatistics and Clinical Trial Centre, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy.
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università Di Pavia, Viale Golgi 19, 27100, Pavia, Italy.
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7
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Zhou R, Sun X, Guo M, Zhang H, Chen X, Wu M, Liang H, Bai X, Ruan G, Yang H. A Shortened Diagnostic Interval and Its Associated Clinical Factors and Related Outcomes in Inflammatory Bowel Disease Patients from a Cohort Study in China. J Inflamm Res 2024; 17:387-398. [PMID: 38264424 PMCID: PMC10803283 DOI: 10.2147/jir.s434673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
Aim The diagnosis of inflammatory bowel disease (IBD) worldwide is complicated and results in diagnostic delay. However, the diagnostic interval of IBD and the factors associated with diagnostic delay in patients in China have not been determined. Methods We retrospectively analyzed clinical data of hospitalized IBD patients in Peking Union Medical College Hospital from January 1998 to January 2018. Patients were divided into non-delayed and delayed groups according to their diagnostic interval. Results A total of 516 and 848 patients were confirmed to have Crohn's disease (CD) and ulcerative colitis (UC), respectively. The median diagnostic intervals were 6 and 20 months in patients with UC and CD, respectively (P<0.05). A decreasing trend in the diagnostic interval for IBD was observed over time, from 9 months to 1 month in UC patients and from 30 months to 3 months in CD patients. The longest diagnostic interval was 29.5 months in CD patients with first symptoms at the age of 51-60 years and 12.5 months in UC patients at the age of 41-50 years. In patients with CD, intestinal obstruction (OR=2.71), comorbid diabetes (OR=4.42), and appendectomy history (OR=2.18) were risk factors for diagnostic delay, whereas having fever as the first symptom may reduce its risk (OR=0.39). In patients with UC, the misdiagnosis of chronic enteritis (OR=2.10) was a risk factor for diagnostic delay. Conclusion The diagnostic interval for IBD has decreased over the years. Some clinical manifestations, such as initial symptoms and age at symptom onset, may help to shorten this interval. Diseases such as tuberculosis and infectious enteritis should be considered during differentiation.
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Affiliation(s)
- Runing Zhou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xiyu Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Mingyue Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Huimin Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xuanfu Chen
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Meixu Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Haozheng Liang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Gechong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
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8
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Santacroce G, Lenti MV, Abruzzese GM, Alunno G, Di Terlizzi F, Frenna C, Gentile A, Latorre MA, Petrucci C, Ruggeri D, Soriano S, Aronico N, Rossi CM, De Silvestri A, Corazza GR, Di Sabatino A. Diagnostic delay in symptomatic uncomplicated diverticular disease: an Italian tertiary referral centre study. Intern Emerg Med 2024; 19:99-106. [PMID: 37891452 PMCID: PMC10827944 DOI: 10.1007/s11739-023-03446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
The magnitude of the diagnostic delay of symptomatic uncomplicated diverticular disease (SUDD) is unknown; we aimed to evaluate SUDD diagnostic delay and its risk factors. SUDD patients diagnosed at a tertiary referral centre were retrospectively enrolled (2010-2022). Demographic and clinical data were retrieved. Overall, patient-, and physician-dependant diagnostic delays were assessed. Univariate and multivariate analyses were fitted to identify risk factors for diagnostic delay. Overall, 70 SUDD patients (median age 65 years, IQR 52-74; F:M ratio = 1.6:1) were assessed. The median overall diagnostic delay was 7 months (IQR 2-24), patient-dependant delay was 3 months (IQR 0-15), and physician-dependant delay was 1 month (IQR 0-6). Further, 25% of patients were misdiagnosed with irritable bowel syndrome (IBS). At multivariate analysis, previous misdiagnosis was a significant risk factor for overall and physician-dependant diagnostic delay (OR 9.99, p = 0.01, and OR 6.46, p = 0.02, respectively). Also, a high educational level (> 13 years) was associated with a greater overall diagnostic delay (OR 8.74 p = 0.02), while previous abdominal surgery was significantly associated to reduced physician-dependant diagnostic delay (OR 0.19 p = 0.04). To conclude, SUDD may be diagnosed late, IBS being the most frequent misdiagnosis. Timely diagnosis is crucial to tackle the burden of SUDD on patients and healthcare.
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Affiliation(s)
- Giovanni Santacroce
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Giulia Maria Abruzzese
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Giacomo Alunno
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Di Terlizzi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Carmine Frenna
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Mario Andrea Latorre
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Clarissa Petrucci
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Damiano Ruggeri
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Simone Soriano
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Nicola Aronico
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy.
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy.
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9
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Rabinowitz LG. Gender Biases and Diagnostic Delay in Inflammatory Bowel Disease: Multicenter Observational Study. Inflamm Bowel Dis 2023; 29:2001-2002. [PMID: 36933204 DOI: 10.1093/ibd/izad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Loren G Rabinowitz
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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10
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Sempere L, Bernabeu P, Cameo J, Gutiérrez A, García MG, García MF, Aguas M, Belén O, Zapater P, Jover R, van-der Hofstadt C, Ruiz-Cantero MT. Gender Biases and Diagnostic Delay in Inflammatory Bowel Disease: Multicenter Observational Study. Inflamm Bowel Dis 2023; 29:1886-1894. [PMID: 36719111 PMCID: PMC10697413 DOI: 10.1093/ibd/izad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female gender could be a cause of diagnostic delay in inflammatory bowel disease (IBD). The aim of this study was to investigate the diagnostic delay in women vs men and potential causes. METHODS This multicenter cohort study included 190 patients with recent diagnosis of IBD (disease duration <7 months). Reconstruction of the clinical presentation and diagnostic process was carried out in conjunction with the semistructured patient interview, review, and electronic medical records. RESULTS The median time from symptom onset to IBD diagnosis was longer in women than in men: 12.6 (interquartile range, 3.7-31) vs 4.5 (2.2-9.8) months for Crohn's disease (CD; P = .008) and 6.1 (3-11.2) vs 2.7 (1.5-5.6) months for ulcerative colitis (UC; P = .008). Sex was an independent variable related to the time to IBD diagnosis in Cox regression analysis. The clinical presentation of IBD was similar in both sexes. Women had a higher percentage of misdiagnosis than men (CD, odds ratio [OR], 3.9; 95% confidence [CI], 1.5-9.9; UC, OR 3.0; 95% CI, 1.2-7.4). Gender inequities in misdiagnosis were found at all levels of the health system (emergency department, OR 2.4; 95% CI, 1.1-5.1; primary care, OR 2.5; 95% CI, 1.3-4.7; gastroenterology secondary care, OR 3.2; 95% CI, 1.2-8.4; and hospital admission, OR 4.3; 95% CI, 1.1-16.9). CONCLUSIONS There is a longer diagnostic delay in women than in men for both CD and UC due to a drawn-out evaluation of women, with a higher number of misdiagnoses at all levels of the health care system.
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Affiliation(s)
- Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Purificación Bernabeu
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Cameo
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana Gutiérrez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Mariana Fe García
- Gastroenterology Department, General University Hospital-Elche, Elche, Spain
| | - Mariam Aguas
- Gastroenterology Department, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Olivia Belén
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmachology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carlos van-der Hofstadt
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Teresa Ruiz-Cantero
- Public Health Department, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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11
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Cantoro L, Monterubbianesi R, Falasco G, Camastra C, Pantanella P, Allocca M, Cosintino R, Faggiani R, Danese S, Fiorino G. The Earlier You Find, the Better You Treat: Red Flags for Early Diagnosis of Inflammatory Bowel Disease. Diagnostics (Basel) 2023; 13:3183. [PMID: 37892004 PMCID: PMC10605540 DOI: 10.3390/diagnostics13203183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Delayed diagnosis is a challenge in the management of inflammatory bowel disease (IBD). Several studies show a significant association between diagnostic delay and disease progression to complications and surgery, especially in Crohn's disease (CD). What risk factors are associated with diagnostic delay in IBD remains unclear. In order to reduce diagnostic delay, the Red Flags Index has been developed and validated. The combination of the Red Flags Index score and non-invasive biomarkers such as fecal calprotectin seems to be highly accurate in screening patients with underlying IBD to be referred for further diagnostic workup and eventual early effective treatment strategies. Our literature review aims to obtain a comprehensive overview of the impacts of diagnostic delay in IBD on the potential risk factors associated with IBD, how diagnostic tools may be effective in reducing diagnostic delay, and future perspectives in this field.
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Affiliation(s)
- Laura Cantoro
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Rita Monterubbianesi
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Giuliano Falasco
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Caterina Camastra
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Paolo Pantanella
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Mariangela Allocca
- Department of Gastroenterology and Digestive Endoscopy and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (S.D.)
| | - Rocco Cosintino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Roberto Faggiani
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (S.D.)
| | - Gionata Fiorino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
- Department of Gastroenterology and Digestive Endoscopy and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (S.D.)
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12
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Xie J, Chen M, Wang W, Shao R. Factors associated with delayed diagnosis of Crohn's disease: A systematic review and meta-analysis. Heliyon 2023; 9:e20863. [PMID: 37860523 PMCID: PMC10582495 DOI: 10.1016/j.heliyon.2023.e20863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
Background Delayed diagnosis is a major barrier to the effective management of Crohn's disease (CD). Several studies have investigated factors responsible for delays in diagnosis, but no meta-analyses have systematically assessed the impact of these factors. Aim To assess the impact of various factors on the delayed diagnosis of CD. Methods PubMed, EMBASE, and Web of Science databases were searched to identify observational studies published before April 2022 that assessed factors associated with delays in CD diagnosis. Further, we excluded review articles, case reports, or commentaries without original data. We pooled effect siee distinct samples. The assessment of study quality was performed utilizing the Newcastle-Ottawa Scale, while the presence of between-study heterogeneity was investigated. For a visual appraisal of potential publication bias, a funnel plot was employed. The study protocol was registered with PROSPERO, CRD42022322251. Results A total of 18 studies were included in the paper, covering 13 countries. The study sample consisted of 9669 cases. Ileal CD (OR = 1.46, 95 % CI = 1.21-1.76), smoking at the time of diagnosis (OR = 1.19, 95 % CI = 1.02-1.38), and use of NSAIDs (OR = 1.34, 95 % CI = 1.04-1.72) were significantly associated with a delay in CD diagnosis. However, no significant associations were observed between diagnostic delay and sex, age, endoscopic ileocolonoscopy, or diarrhea. Funnel plot analysis, indicating potential risks of publication bias, suggested the existence of unpublished or unreported study findings. Conclusion The findings suggest that ileal CD, use of NSAIDs, and smoking are risk factors for the delayed diagnosis of CD. Enhancing education of patients and primary care providers about these factors is warranted.
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Affiliation(s)
| | | | - Wenrui Wang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, 211198, China
| | - Rong Shao
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, 211198, China
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13
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Ginard D, Ricote M, Nos P, Pejenaute ME, Sans M, Fontanillas N, Barreiro-de Acosta M, Polo Garcia J. Spanish Society of Primary Care Physicians (SEMERGEN) and Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) survey on the management of patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:647-656. [PMID: 36402262 DOI: 10.1016/j.gastrohep.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Collaboration between Primary Care (PC) and Gastroenterology in inflammatory bowel disease (IBD) is crucial to provide high-quality healthcare. The aim of this study is to analyse the relationship between PC and gastroenterologists at a national level in order to identify areas for improvement in the management of patients with inflammatory bowel disease (IBD) and how to address them, with the aim of subsequently developing concrete proposals and projects between SEMERGEN and GETECCU. METHODS Descriptive, observational, cross-sectional study, was carried out using an anonymous online questionnaire between October 2021 and March 2022. RESULTS A total of 157 surveys from Gastroenterology and 222 from PC were collected. 43.8% and 34.3% of gastroenterologists and family practitioners, respectively, considered that there was a good relationship between the units. The level of knowledge from family practitioners regarding different aspects of IBD out of 10 was: clinical 6.67±1.48, diagnosis 6.47±1.46, treatment 5.63±1.51, follow-up 5.53±1.68 and complications 6.05±1.54. The perception of support between both units did not exceed 4.5 on a scale from 0 to 10 in either of the surveys. The most highly voted improvement proposals were better coordination between the units, implementation of IBD units, and nursing collaboration. CONCLUSION There are deficiencies in the relationship between PC and Gastroenterology with special dedication to IBD that require the efforts of the scientific societies that represent them for greater coordination with the development of joint protocols and agile, fast, and effective communication channels.
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Affiliation(s)
- Daniel Ginard
- Servicio de Aparato Digestivo/IDISBA, Hospital Universitario Son Espases, Palma de Mallorca, España; Miembro de GETECCU.
| | - Mercedes Ricote
- Medicina Familiar y Comunitaria, Centro de Salud Mar Báltico, Madrid, España; Miembro del grupo de trabajo de Aparato Digestivo de SEMERGEN
| | - Pilar Nos
- Miembro de GETECCU; Servicio de Medicina Digestiva, Hospital Universitari y Politècnic de València, Valencia, España
| | - M Elena Pejenaute
- Medicina Familiar y Comunitaria, Centro de Salud Mar Báltico, Madrid, España; Miembro del grupo de trabajo de Aparato Digestivo de SEMERGEN
| | - Miquel Sans
- Miembro de GETECCU; Servicio de Aparato Digestivo, Centro Médico Teknon/ISADMU, Barcelona, España
| | - Noelia Fontanillas
- Miembro del grupo de trabajo de Aparato Digestivo de SEMERGEN; Medicina Familiar y Comunitaria, Centro de Salud Bezana, Santa Cruz de Bezana, Cantabria, España; Coordinadora Grupo de Digestivo de SEMERGEN
| | - Manuel Barreiro-de Acosta
- Miembro de GETECCU; Servicio de Aparato Digestivo, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España; Presidente de GETECCU
| | - José Polo Garcia
- Miembro del grupo de trabajo de Aparato Digestivo de SEMERGEN; Medicina Familiar, Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España; Presidente de SEMERGEN
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14
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de Brito CAA, Celani LMS, de Araújo MVT, de Lucena MT, Vasconcelos GBS, Lima GAS, Nóbrega FJF, Diniz GTN, Lucena-Silva N, Toneto GT, Falcão JVDC, Barbosa PM, de Oliveira PRF, Dantas LSX, Fernandes LKC, de Araújo SA, Martinelli VF. A Multicentre Study of the Clinical and Epidemiological Profile of Inflammatory Bowel Disease in Northeast Brazil. Clin Exp Gastroenterol 2023; 16:87-99. [PMID: 37366396 PMCID: PMC10290862 DOI: 10.2147/ceg.s411936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical-epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil. Patients and Methods This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021. Results Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years. Conclusion More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.
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Affiliation(s)
- Carlos Alexandre Antunes de Brito
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Internal Medicine, Centre of Medical Sciences of the Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Lívia Medeiros Soares Celani
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marcelo Vicente Toledo de Araújo
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Graciana Bandeira Salgado Vasconcelos
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gustavo André Silva Lima
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Fernando Jorge Firmino Nóbrega
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | | | - Germano Tose Toneto
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | | | | | | | - Luan Samy Xavier Dantas
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Luanna Karen Chagas Fernandes
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Samara Amorim de Araújo
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Valéria Ferreira Martinelli
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
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15
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Vernon-Roberts A, Aluzaite K, Khalilipour B, Day AS. Systematic Review of Diagnostic Delay for Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2023; 76:304-312. [PMID: 36730088 DOI: 10.1097/mpg.0000000000003670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Pediatric inflammatory bowel disease (IBD) is a complex inflammatory condition of the gut. Diagnosing IBD involves distinct longitudinal periods from first symptoms to primary care assessment, tertiary care referral, and then endoscopic confirmation. The term diagnostic delay (DD) is used if these periods are prolonged. The aim of this review was to amalgamate DD data for children with IBD, and identify factors associated with prolonged DD. METHODS Six health literature databases were searched (December 2020). Inclusion criteria for papers were children diagnosed with IBD before the age of 18 years, DD central tendency data, and to report a central tendency of their DD data, cohort >10 children. For analysis, all data were weighted by cohort sample size. RESULTS Searches identified 236 papers, and 26 were included in the final analysis with a pooled cohort of 7030 children. The overall DD periods were IBD 4.5 months [Interquartile range (IQR) 3.6-8.7 months], Crohn disease (CD) 5 months (IQR 4-7.2 months), and ulcerative colitis/indeterminate colitis/IBD-unclassified (UC/IC/IBDU) 3 months (IQR 2.2-4.9 months). The difference between subtypes was significant ( P < 0.001), with shorter DD for UC/IC/IBDU than CD ( P < 0.001) and IBD ( P < 0.001). DD periods were longer for CD than IBD ( P < 0.001). DD decreased over time for IBD ( P < 0.001) and UC ( P < 0.001) but the trend suggested an increase for CD ( P 0.069). CONCLUSIONS This data can be used to benchmark DD for children with IBD. Individual centers could determine whether improvements to awareness or infrastructure may reduce DD in order to minimize the risk of poor outcomes.
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Affiliation(s)
| | - Kristina Aluzaite
- the Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Andrew S Day
- From the Department of Pediatrics, University of Otago, Christchurch, New Zealand
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16
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Jayasooriya N, Baillie S, Blackwell J, Bottle A, Petersen I, Creese H, Saxena S, Pollok RC. Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Aliment Pharmacol Ther 2023; 57:635-652. [PMID: 36627691 DOI: 10.1111/apt.17370] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The impact of diagnostic delay on the clinical course of inflammatory bowel disease (IBD) remains uncertain. AIM To perform a systematic review of time to diagnosis and the impact of delayed diagnosis on clinical outcomes in Crohn's disease (CD) and ulcerative colitis (UC). METHODS We searched EMBASE and Medline from inception to 30th November 2022 for studies reporting diagnostic interval, from symptom onset to IBD diagnosis. We calculated the median, interquartile range (IQR) and pooled weighted median, of median diagnostic intervals of eligible studies. We defined delayed diagnosis as individuals above the 75th centile of longest time to diagnosis in each study. Using random effects meta-analysis, we pooled odds ratios (ORs) with 95% confidence intervals (CI) for studies reporting clinical outcomes, according to delayed diagnosis. RESULTS One hundred and one studies representing 112,194 patients with IBD (CD = 59,359; UC = 52,835) met inclusion criteria. The median of median times to diagnosis was 8.0 (IQR: 5.0-15.2) and 3.7 months (IQR: 2.0-6.7) in CD and UC, respectively. In high-income countries, this was 6.2 (IQR: 5.0-12.3) and 3.2 months (IQR: 2.2-5.3), compared with 11.7 (IQR: 8.3-18.0) and 7.8 months (IQR: 5.2-21.8) in low-middle-income, countries, for CD and UC respectively. The pooled weighted median was 7.0 (95% CI: 3.0-26.4) and 4.6 (95% CI: 1.0-96.0) months, for CD and UC respectively. Eleven studies, representing 6164 patients (CD = 4858; UC = 1306), were included in the meta-analysis that examined the impact of diagnostic delay on clinical outcomes. In CD, delayed diagnosis was associated with higher odds of stricturing (OR = 1.88; CI: 1.35-2.62), penetrating disease (OR = 1.64; CI: 1.21-2.20) and intestinal surgery (OR = 2.24; CI: 1.57-3.19). In UC, delayed diagnosis was associated with higher odds of colectomy (OR = 4.13; CI: 1.04-16.40). CONCLUSION Delayed diagnosis is associated with disease progression in CD, and intestinal surgery in both CD and UC. Strategies are needed to achieve earlier diagnosis of IBD.
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Affiliation(s)
- Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hanna Creese
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
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17
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Cross E, Saunders B, Farmer AD, Prior JA. Diagnostic delay in adult inflammatory bowel disease: A systematic review. Indian J Gastroenterol 2023; 42:40-52. [PMID: 36715839 PMCID: PMC10038954 DOI: 10.1007/s12664-022-01303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/20/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The extent of diagnostic delay in inflammatory bowel disease (IBD) is incompletely understood. We aimed to understand the extent of diagnostic delay of IBD in adults and identify associations between patient or healthcare characteristics and length of delay. METHODS Articles were sourced from EMBASE, Medline and CINAHL from inception to April 2021. Inclusion criteria were adult cohorts (18 ≥ years old) reporting median time periods between onset of symptoms for Crohn's disease (CD), ulcerative colitis (UC) or IBD (i.e. CD and UC together) and a final diagnosis (diagnostic delay). Narrative synthesis was used to examine the extent of diagnostic delay and characteristics associated with delay. Sensitivity analysis was applied by the removal of outliers. RESULTS Thirty-one articles reporting median diagnostic delay for IBD, CD or UC were included. After sensitivity analysis, the majority of IBD studies (7 of 8) reported a median delay of between 2 and 5.3 months. From the studies examining median delay in UC, three-quarters (12 of 16) reported a delay between 2 and 6 months. In contrast, three-quarters of the CD studies (17 of 23) reported a delay of between 2 and 12 months. No characteristic had been examined enough to understand their role in diagnostic delay in these populations. CONCLUSIONS This systematic review provides robust insight into the extent of diagnostic delay in IBD and suggests further intervention is needed to reduce delay in CD particularly. Furthermore, our findings provide a benchmark value range for diagnostic delay, which such future work can be measured against.
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Affiliation(s)
- Eleanor Cross
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
- University of North Midlands (UHNM) NHS Trust, Stoke-On-Trent, UK
| | - Benjamin Saunders
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Adam D Farmer
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Department of Gastroenterology, University Hospital of North Midlands (UHNM) NHS Trust, Stoke-On-Trent, UK
| | - James A Prior
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
- Midlands Partnership NHS Foundation Trust, Trust Headquarters, St. George's Hospital, Stafford, UK.
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18
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Cohen NA, Kliper E, Zamstein N, Ziv-Baran T, Waterman M, Hodik G, Tov AB, Kariv R. Trends in Biochemical Parameters, Healthcare Resource and Medication Use in the 5 Years Preceding IBD Diagnosis: A Health Maintenance Organization Cohort Study. Dig Dis Sci 2023; 68:414-422. [PMID: 36221010 DOI: 10.1007/s10620-022-07714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Few data describing pre-diagnosis changes in patients with inflammatory bowel disease (IBD) exist. We aimed to determine if there is a pattern of change in use of health resources, medications and laboratory results in the years preceding diagnosis. METHODS This retrospective study used electronic medical records of Maccabi Health Services (MHS). Patients with IBD ≥ 16 years of age and minimum of 5-years follow-up were identified by entry into the MHS IBD registry and included in the analysis. Demographic, clinical, medication and laboratory data were collected. Generalized estimating equation model was applied to study trends and compare between years. RESULTS This study included 5643 patients with IBD. Of these, 3039 (53.8%) had Crohn's disease (CD), 2322 (41.1%) had ulcerative colitis (UC) and 282 (5%) had indeterminate colitis (IC). Laboratory parameters including white blood cells, platelets and C-reactive protein showed significant increases while haemoglobin and mean cell volume showed significant decreases in mean values in the 2 years prior to diagnosis with stable values prior to that (p < 0.0001). Parameters such as creatinine, total protein and albumin showed significant, progressive decreases in mean values starting 5 years prior to diagnosis (p < 0.0001). Patients with CD had distinct laboratory trends when compared with patients with UC. CONCLUSIONS Changes in laboratory parameters, healthcare service and medication use occur during the 5-year period before IBD diagnosis. These data can have future clinical applicability by developing a composite score and referral algorithm introducing red flags into primary care visits and appropriate referral for specialist care.
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Affiliation(s)
- Nathaniel A Cohen
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 6 Weizmann Street, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel.
| | | | | | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Matti Waterman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Gabriel Hodik
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 6 Weizmann Street, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ben Tov
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 6 Weizmann Street, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Revital Kariv
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 6 Weizmann Street, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
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19
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Lenti MV, Aronico N, Bianchi PI, D'Agate CC, Neri M, Volta U, Mumolo MG, Astegiano M, Calabrò AS, Zingone F, Latella G, Di Sario A, Carroccio A, Ciacci C, Luzza F, Bagnato C, Fantini MC, Elli L, Cammarota G, Gasbarrini A, Portincasa P, Latorre MA, Petrucci C, Quatraccioni C, Iannelli C, Vecchione N, Rossi CM, Broglio G, Ianiro G, Marsilio I, Bibbò S, Marinoni B, Tomaselli D, Abenavoli L, Pilia R, Santacroce G, Lynch E, Carrieri A, Mansueto P, Gabba M, Alunno G, Rossi C, Onnis F, Efthymakis K, Cesaro N, Vernero M, Baiano Svizzero F, Semeraro FP, Silano M, Vanoli A, Klersy C, Corazza GR, Di Sabatino A. Diagnostic delay in adult coeliac disease: An Italian multicentre study. Dig Liver Dis 2022; 55:743-750. [PMID: 36567177 DOI: 10.1016/j.dld.2022.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD). AIMS To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD. METHODS CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted. RESULTS Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay. CONCLUSION We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicola Aronico
- First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Ilaria Bianchi
- First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmela Cinzia D'Agate
- Department of Gastroenterology and Endoscopy, University Hospital "G. Rodolico", Catania, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Gloria Mumolo
- Department of General Surgery and Gastroenterology, Pisa University Hospital, Pisa, Italy
| | - Marco Astegiano
- SC Gastroenterologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonino Salvatore Calabrò
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio" University of Florence, Florence, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, and Gastroenterology Unit, Azienda Ospedale Università, Padova, Italy
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Di Sario
- Department of Gastroenterology and Transplantation, Polytechnic Marche University, Ancona, Italy
| | - Antonio Carroccio
- Internal Medicine Unit, "V. Cervello Hospital", University of Palermo, Palermo, Italy
| | - Carolina Ciacci
- Department of Medicine and Surgery, Gastroenterology Unit, University of Salerno, Salerno, Italy
| | - Francesco Luzza
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Carmela Bagnato
- Clinical Nutrition Unit, Madonna delle Grazie Hospital, Matera, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giovanni Cammarota
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Clinica Medica "A. Murri", Bari, Italy
| | - Mario Andrea Latorre
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Clarissa Petrucci
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Quatraccioni
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Iannelli
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Nicoletta Vecchione
- Department of Gastroenterology and Endoscopy, University Hospital "G. Rodolico", Catania, Italy
| | - Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Broglio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Ianiro
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Ilaria Marsilio
- Department of Surgery, Oncology and Gastroenterology, University of Padua, and Gastroenterology Unit, Azienda Ospedale Università, Padova, Italy
| | - Stefano Bibbò
- Digestive Disease Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina Interna e Gastroenterologia, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Beatrice Marinoni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Ludovico Abenavoli
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Riccardo Pilia
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giovanni Santacroce
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erica Lynch
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio" University of Florence, Florence, Italy
| | - Antonella Carrieri
- Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Clinica Medica "A. Murri", Bari, Italy
| | - Pasquale Mansueto
- Internal Medicine Unit, "V. Cervello Hospital", University of Palermo, Palermo, Italy
| | - Margherita Gabba
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Alunno
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Rossi
- Department of Gastroenterology and Transplantation, Polytechnic Marche University, Ancona, Italy
| | - Francesca Onnis
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Konstantinos Efthymakis
- Department of Medicine and Ageing Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Nicola Cesaro
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marta Vernero
- SC Gastroenterologia AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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20
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Leiz M, Knorr M, Moon K, Tischler L, de Laffolie J, van den Berg N. Diagnostic delay in children with inflammatory bowel disease in the German-Austrian patient registry CEDATA-GPGE 2014-2018. Sci Rep 2022; 12:21162. [PMID: 36477258 PMCID: PMC9729560 DOI: 10.1038/s41598-022-25487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
The incidence and prevalence of pediatric-onset inflammatory bowel disease (PIBD) are on the rise worldwide. Initial symptoms are often recognized with a delay, which reduces the quality of life and may lead to an increased rate of complications. The aim of this study was to determine the diagnostic delay in PIBD and to identify potential influencing factors. Therefore, data from the German-Austrian patient registry CEDATA-GPGE for children and adolescents with PIBD were analyzed for the period January 2014 to December 2018. There were 456 children identified in the data, thereof 258 children (57%) with Crohn's disease (CD) and 198 children (43%) with Ulcerative colitis (UC). The median age was 13.3 years (interquartile range (IQR) = 10.9-15.0), and 44% were females. The median diagnostic delay was 4.1 months (IQR = 2.1-7.0) in CD and 2.4 months (IQR = 1.2-5.1) in UC (p = 0.01). UC was associated with earlier diagnosis than CD (p < 0.001). Only a few factors influencing the diagnostic delay have been verified, e.g., abdominal pain at night and if video capsule endoscopy was performed. Diagnostic delay improved over the years in participating centers, but the level of awareness needs to be high even in common symptoms like abdominal pain.
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Affiliation(s)
- Maren Leiz
- grid.5603.0Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Melanie Knorr
- grid.5603.0Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Kilson Moon
- grid.5603.0Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Luisa Tischler
- grid.5603.0Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Jan de Laffolie
- grid.8664.c0000 0001 2165 8627General Pediatrics & Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Neeltje van den Berg
- grid.5603.0Institute for Community Medicine, University Medicine, Greifswald, Germany
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21
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Fu T, Ye S, Sun Y, Dan L, Wang X, Chen J. Greater Adherence to Cardioprotective Diet Can Reduce Inflammatory Bowel Disease Risk: A Longitudinal Cohort Study. Nutrients 2022; 14:nu14194058. [PMID: 36235711 PMCID: PMC9573093 DOI: 10.3390/nu14194058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The cardioprotective diet was reported to be associated with several chronic cardiometabolic diseases through an anti-inflammation effect. However, the association between the cardioprotective diet and the risk of inflammatory bowel disease (IBD) was unclear and deserved to be further explored. Methods: We calculated the cardioprotective diet score based on the consumptions of seven common food groups using the validated food frequency questionnaire data in the UK Biobank. Incident IBD was ascertained from primary care data, inpatient data, and the death registry. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between the cardioprotective diet score and the risk of IBD. Results: During a mean follow-up of 12.1 years, we documented 2717 incident IBD cases, including 851 cases of Crohn’s disease and 1866 cases of ulcerative colitis. Compared to participants with a cardioprotective diet score of 0−1, we observed a decreased risk of IBD among participants with cardioprotective diet scores of 3 (HR 0.85, 95% CI 0.73−0.99), 4 (HR 0.84, 95% CI 0.72−0.98), and 5−7 (HR 0.77, 95% CI 0.66−0.89) (p-trend < 0.001). Conclusions: A greater adherence to the cardioprotective diet was associated with a lower risk of IBD. Our finding highlighted the importance of focusing on the cardioprotective diet to prevent IBD.
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Affiliation(s)
- Tian Fu
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha 410013, China
| | - Shuyu Ye
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha 410013, China
| | - Yuhao Sun
- Center for Global Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Lintao Dan
- Center for Global Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha 410013, China
- Correspondence: (X.W.); (J.C.)
| | - Jie Chen
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha 410013, China
- Center for Global Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou 310058, China
- Correspondence: (X.W.); (J.C.)
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22
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Marabotto E, Kayali S, Buccilli S, Levo F, Bodini G, Giannini EG, Savarino V, Savarino EV. Colorectal Cancer in Inflammatory Bowel Diseases: Epidemiology and Prevention: A Review. Cancers (Basel) 2022; 14:cancers14174254. [PMID: 36077786 PMCID: PMC9454776 DOI: 10.3390/cancers14174254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Colorectal cancer (CRC) is one of the most serious potential complications of inflammatory bowel diseases (IBDs). The aging of patients affected by IBDs makes this issue a challenge that will increasingly be faced by clinicians in clinical practice, especially in light of the poorer prognosis for CRC in this group of people when compared with the general population. In this review, we summarize the current epidemiology, risk factors and various prevention strategies proposed for CRC in patients with IBDs. Abstract Colorectal cancer (CRC) is currently the third most frequent form of malignancy and the second in terms of mortality. Inflammatory bowel diseases (IBDs) are recognized risk factors for this type of cancer. Despite a worldwide increase in the incidence of CRC, the risk of CRC-related death in IBD patients has declined over time, probably because of successful surveillance strategies, the use of more effective drugs in the management of remission and improved indications to colectomy. This notwithstanding, CRC 5-year survival in patients with IBD is poorer than in the general population. This review provides a summary of the epidemiological features, risk factors and various prevention strategies proposed for CRC in IBD patients. Moreover, there is a special focus on reporting and highlighting the various prevention strategies proposed by the most important international scientific societies, both in terms of chemoprevention and endoscopic surveillance. Indeed, in conducting the analysis, we have given attention to the current primary, secondary and tertiary prevention guidelines, attempting to emphasize unresolved research and clinical problems related to this topic in order to improve diagnostic strategies and management.
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Affiliation(s)
- Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Silvia Buccilli
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Francesca Levo
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35137 Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, 35128 Padua, Italy
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23
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Signs and Symptoms of Acute Bowel Inflammation and the Risk of Progression to Inflammatory Bowel Disease: A Retrospective Analysis. J Clin Med 2022; 11:jcm11154595. [PMID: 35956209 PMCID: PMC9369956 DOI: 10.3390/jcm11154595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Episodes of acute ileitis or colitis have been associated with future development of inflammatory bowel diseases (IBD). Nevertheless, the rate of future IBD among patients diagnosed with signs or symptoms of acute bowel inflammation is unknown. We aimed to assess the risk of IBD development among patients presenting with signs or symptoms of ileitis or colitis. We searched for all patients that visited the emergency department (ED) and underwent abdominal computed tomography (CT) who were eventually diagnosed with IBD during gastroenterology follow-ups within 9 years from the index admission. Multivariable models identified possible predictors of patients to develop IBD. Overall, 488 patients visited the ED and underwent abdominal imaging with abnormal findings, and 23 patients (4.7%) were eventually diagnosed with IBD (19 Crohn’s, 4 ulcerative colitis). Patients with a future IBD diagnosis were significantly younger (28 vs. 56 years, p < 0.001) with higher rates of diarrhea as a presenting symptom (17.4% vs. 4.1%, p = 0.015) compared to non-IBD patients. On multivariable analysis, age (p < 0.001), colitis (p = 0.004) or enteritis (p < 0.001) on imaging and a diagnosis of diarrhea in the ED (p = 0.02) were associated with development of IBD. Although alarming to patients and families, ED admission with intestinal inflammatory symptoms leads to eventual diagnosis of IBD in <5% of patients during long-term follow-up.
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24
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Diagnostic Delay in Paediatric Inflammatory Bowel Disease-A Systematic Investigation. J Clin Med 2022; 11:jcm11144161. [PMID: 35887925 PMCID: PMC9316086 DOI: 10.3390/jcm11144161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
Diagnostic delays (time from the first symptoms to diagnosis) are common in inflammatory bowel disease (IBD) and may lead to worse disease progression and treatment outcomes. This study aimed to determine the duration of diagnostic delays (DD) and to explore associated factors in a cohort of children with IBD in New Zealand. In this study, patients with IBD diagnosed as children and their parents/caregivers completed questionnaires on the patients’ medical history, diagnostic experience, and demographic characteristics. The parent/caregiver questionnaire also included the Barriers to Care Questionnaire (BCQ). Patients’ healthcare data was reviewed to summarise the history of clinical visits and determine symptoms. Total DD, healthcare DD, patient DD and parent DD were derived from the primary dataset. Factors associated with the different types of DD were explored with a series of simple linear and logistical ordinal regressions. A total of 36 patients (Crohn’s disease 25, ulcerative colitis 10; male 17) were included. They were diagnosed at a median age of 12 years (interquartile range (IQR) 10−15 years). Total healthcare delay (from first healthcare visit to formal diagnosis) was median (IQR) 15.4 (6.5−34.2) months. The median (IQR) specialist-associated delay was 4.5 (0−34) days. Higher household income was associated with shorter healthcare delay (p < 0.018), while lower overall BCQ scores (indicating more barriers experienced) were associated with longer total healthcare DD. Higher scores in each subscale of BCQ (Skills; Pragmatics; Expectations; Marginalization; Knowledge and Beliefs) were also significantly associated with shorter total healthcare delay (p < 0.04). This study found substantial diagnostic delays in paediatric patients with IBD and identified significant associations between longer total healthcare diagnostic delays and overall household income and higher self-reported barriers to accessing healthcare.
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25
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van Erp LW, Neijenhuis MK, Heida W, Derwig J, Geleijns CE, Groenen MJM, Wahab PJ. Improving Care for Recently Diagnosed Inflammatory Bowel Disease Patients: Lessons Learned From a Patient-Centred, Mixed-Method Study. J Crohns Colitis 2022; 16:737-745. [PMID: 34758088 DOI: 10.1093/ecco-jcc/jjab196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Newly diagnosed inflammatory bowel disease [IBD] patients need to deal with the physical and emotional impact of the disease. We aimed to evaluate care for recently diagnosed IBD patients from the patient perspective and assess themes for improvement. METHODS A mixed-method study with adult IBD patients 4-15 months after diagnosis was performed. First, relevant themes were identified through semi-structured interviews until data saturation. Next, a questionnaire assessing satisfaction with care [SATI-Q] was developed and validated with 15 items divided into two domains: medical care and information and psychosocial care. Higher scores indicate higher patient satisfaction [0-100]. RESULTS We interviewed 20 patients. Next, 84/107 patients completed the SATI-Q: 51% female, aged 37 years (interquartile range [IQR 25-58]), 36% Crohn's disease, disease duration 9 months [IQR 6-12] and 74% in clinical remission. The median SATI-Q score was 82 [IQR 72-92]. Patients were more satisfied with medical care than with information and psychosocial care (score 92 [IQR 81-98] vs 74 [IQR 60-90], p < 0.001). Patients were least satisfied with the attention given to IBD-related emotions and information on IBD medication, diet and future perspectives [77, 76, 57 and 54% of patients satisfied]. Patients [81%] preferred spoken information. Only 26-27% preferred brochures and websites. CONCLUSIONS In this study, the SATI-Q questionnaire was developed and validated to assess patient satisfaction with care in early IBD. Our findings suggest that psychosocial care and information on IBD medication, diet influence and future perspectives for recently diagnosed IBD patients require improvement.
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Affiliation(s)
- Liselot W van Erp
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Myrte K Neijenhuis
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Wendy Heida
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Joost Derwig
- Department of Medical Psychology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Caroline E Geleijns
- Department of Medical Psychology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Marcel J M Groenen
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Peter J Wahab
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
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26
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Molina-Infante J, Rodríguez-Lago I. Modifying the natural history of gastrointestinal diseases in Europe as a result of early diagnosis: From eosinophilic esophagitis to inflammatory bowel disease. United European Gastroenterol J 2022; 10:612-613. [PMID: 35614522 PMCID: PMC9486485 DOI: 10.1002/ueg2.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Javier Molina-Infante
- Gastroenterology Department, Hospital Universitario de Cáceres, Cáceres, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain.,School of Medicine, University of Deusto, Bilbao, Spain
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27
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Sung KY, Zhang B, Wang HE, Bai YM, Tsai SJ, Su TP, Chen TJ, Hou MC, Lu CL, Wang YP, Chen MH. Schizophrenia and risk of new-onset inflammatory bowel disease: a nationwide longitudinal study. Aliment Pharmacol Ther 2022; 55:1192-1201. [PMID: 35261051 DOI: 10.1111/apt.16856] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/16/2021] [Accepted: 02/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is a chronic gastrointestinal inflammatory disorder with increasing global prevalence. The risk of IBD in patients with schizophrenia remains unclear. We aim to investigate the risk of new-onset IBD in patients with schizophrenia compared with matched controls. METHODS We conducted a retrospective, population-based cohort study utilising patient data from the Taiwan National Health Insurance Research Database collected between January 1, 2001, and December 31, 2011. Patients diagnosed with schizophrenia by board-certified psychiatrists without prior diagnosis of IBD were enrolled and matched to controls in 1:4 fashion by age, sex, residence, income level and medical comorbidities. Adjusted hazard ratios (HRs) for new-onset IBD and sub-analyses were determined using Cox regression analysis with adjustments. RESULTS Among 116 164 patients with schizophrenia and 464 656 matched controls, overall incidence of IBD among patients was significantly higher (1.14% vs. 0.25%). Average age of IBD diagnosis was 46.82 among patients with schizophrenia, versus 55.30 among controls. The HR of developing IBD among patients was 3.28, with a 95% confidence interval (95% CI) 2.49-4.33. IBD risk was higher among patients with psychiatric admissions more than once per year (HR 7.99, 95% CI 5.25-12.15) compared to those hospitalised less frequently (HR 2.72, 95% CI 2.03-3.66). CONCLUSIONS This population-based cohort study demonstrates a significant association between schizophrenia and subsequent IBD development. Patients with schizophrenia develop IBD at a younger age, and the risk increases with inadequately controlled schizophrenia. Physician vigilance and awareness of this correlation will improve IBD diagnosis and management among this vulnerable patient population.
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Affiliation(s)
- Kuan-Yi Sung
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bing Zhang
- Department of Medicine, Division of Gastrointestinal and Liver Disease, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hohui E Wang
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Departments of Psychiatry and Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Po Wang
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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28
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Yamamoto-Furusho JK, Parra-Holguín NN. Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients. Inflamm Intest Dis 2021; 7:72-80. [PMID: 35979192 PMCID: PMC9294956 DOI: 10.1159/000520522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD) characterized by a fluctuating course with periods of clinical activity and remission. No previous studies have demonstrated the frequency of delay at diagnosis and its associated factors in Mexico and Latin America. The aim of this study was to evaluate diagnostic delay of IBD in the last 4 decades in 2 different health care systems (public vs. private) and its associated factors. Methods This is a cohort study that included 1,056 patients with a confirmed diagnosis of IBD from public and private health care systems. The diagnostic delay was defined as time >1 year from the onset of symptoms to the confirmed diagnosis for patients with UC and 2 years for patients with CD. Statistical analysis was performed with the SPSS v.24 program. A value of p ≤ 0.05 was taken as significant. Results The delay at diagnosis decreased significantly by 24.9% in the last 4 decades. The factors associated with the diagnostic delay were proctitis in UC, clinical course >2 relapses per year and IBD surgeries for CD. We found a delay at diagnosis in 35.2% of IBD patients in the public versus 16.9% in the private health care system (p = 0.00001). Conclusions We found a significant diagnosis delay of IBD in 35.2% from the public health care system versus 16.9% in the private health care system.
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Affiliation(s)
- Jesús K. Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- Gastroenterology and Obesity Service, Médica Sur Hospital, Mexico City, Mexico
- *Jesús K. Yamamoto-Furusho,
| | - Norma N. Parra-Holguín
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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29
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Lenti MV, Savarino E, Mauro A, Penagini R, Racca F, Ghisa M, Laserra G, Merli S, Arsiè E, Longoni V, de Bortoli N, Sostilio A, Marabotto E, Ziola S, Vanoli A, Zingone F, Barberio B, Tolone S, Docimo L, Pellegatta G, Paoletti G, Ribolsi M, Repici A, Klersy C, Di Sabatino A. Diagnostic delay and misdiagnosis in eosinophilic oesophagitis. Dig Liver Dis 2021; 53:1632-1639. [PMID: 34116974 DOI: 10.1016/j.dld.2021.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) may lead to severe complications if not promptly recognised. AIMS To assess the diagnostic delay in patients with EoE and to explore its risk factors. METHODS EoE patients followed-up at eight clinics were included via retrospective chart review. Diagnostic delay was estimated as the time lapse occurring between the appearance of the first likely symptoms indicative of EoE and the final diagnosis. Patient-dependent and physician-dependent diagnostic delays were assessed. Multivariable regression models were computed. RESULTS 261 patients with EoE (mean age 34±14 years; M:F ratio=3:1) were included. The median overall diagnostic delay was 36 months (IQR 12-88), while patient- and physician-dependent diagnostic delays were 18 months (IQR 5-49) and 6 months (IQR 1-24). Patient-dependent delay was greater compared to physician-dependent delay (95% CI 5.1-19.3, p<0.001). A previous misdiagnosis was formulated in 109 cases (41.8%; gastro-oesophageal reflux disease in 67 patients, 25.7%). The variables significantly associated with greater overall diagnostic delay were being a non-smoker, >1 episode of food impaction, previous endoscopy with no biopsies, regurgitation, and ≥2 assessing physicians. Being single was significantly associated with lower overall and patient-dependent diagnostic delay. CONCLUSION EoE is burdened by substantial diagnostic delay, depending on both patient-related and physician-related factors.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University Hospital of Padua, Padova, Italy
| | - Aurelio Mauro
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Matteo Ghisa
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University Hospital of Padua, Padova, Italy
| | - Giorgio Laserra
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University Hospital of Padua, Padova, Italy
| | - Stefania Merli
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Elena Arsiè
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Valeria Longoni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery; University of Pisa, Pisa, Italy
| | - Andrea Sostilio
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery; University of Pisa, Pisa, Italy
| | - Elisa Marabotto
- Cattedra di Gastroenterologia, Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, IRCCS Ospedale Policlinico San Martino
| | - Sebastiano Ziola
- Cattedra di Gastroenterologia, Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, IRCCS Ospedale Policlinico San Martino
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and IRCCS San Matteo Hospital, Pavia, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University Hospital of Padua, Padova, Italy
| | - Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University Hospital of Padua, Padova, Italy
| | - Salvatore Tolone
- UOC di Chirurgia Generale, Mininvasiva e dell'Obesità; Dipartimento di Scienze Mediche e Chirurgiche Avanzate; Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Ludovico Docimo
- UOC di Chirurgia Generale, Mininvasiva e dell'Obesità; Dipartimento di Scienze Mediche e Chirurgiche Avanzate; Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Gaia Pellegatta
- Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS -, Milano - Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Mentore Ribolsi
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | - Alessandro Repici
- Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS -, Milano - Italy; Department of Biomedical Sciences, Humanitas University, - Milan, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
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30
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Kraszewski S, Szczurek W, Szymczak J, Reguła M, Neubauer K. Machine Learning Prediction Model for Inflammatory Bowel Disease Based on Laboratory Markers. Working Model in a Discovery Cohort Study. J Clin Med 2021; 10:jcm10204745. [PMID: 34682868 PMCID: PMC8539616 DOI: 10.3390/jcm10204745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, incurable disease involving the gastrointestinal tract. It is characterized by complex, unclear pathogenesis, increased prevalence worldwide, and a wide spectrum of extraintestinal manifestations and comorbidities. Recognition of IBD remains challenging and delays in disease diagnosis still poses a significant clinical problem as it negatively impacts disease outcome. The main diagnostic tool in IBD continues to be invasive endoscopy. We aimed to create an IBD machine learning prediction model based on routinely performed blood, urine, and fecal tests. Based on historical patients’ data (702 medical records: 319 records from 180 patients with ulcerative colitis (UC) and 383 records from 192 patients with Crohn’s disease (CD)), and using a few simple machine learning classificators, we optimized necessary hyperparameters in order to get reliable few-features prediction models separately for CD and UC. Most robust classificators belonging to the random forest family obtained 97% and 91% mean average precision for CD and UC, respectively. For comparison, the commonly used one-parameter approach based on the C-reactive protein (CRP) level demonstrated only 81% and 61% average precision for CD and UC, respectively. Results of our study suggest that machine learning prediction models based on basic blood, urine, and fecal markers may with high accuracy support the diagnosis of IBD. However, the test requires validation in a prospective cohort.
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Affiliation(s)
- Sebastian Kraszewski
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Pl. Grunwaldzki 13, 50-377 Wroclaw, Poland
- Correspondence: (S.K.); (K.N.)
| | - Witold Szczurek
- Doctoral School, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland;
| | - Julia Szymczak
- Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland; (J.S.); (M.R.)
| | - Monika Reguła
- Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland; (J.S.); (M.R.)
| | - Katarzyna Neubauer
- Divison of Dietetics, Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
- Correspondence: (S.K.); (K.N.)
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Kuźnicki P, Neubauer K. Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse. J Clin Med 2021; 10:4623. [PMID: 34640641 PMCID: PMC8509435 DOI: 10.3390/jcm10194623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and potentially devastating condition of the digestive tract which is exemplified by increasing prevalence worldwide, byzantine pathogenesis with a poorly defined role of the environmental factors, and complex clinical demonstration. As a systemic disease, IBD may progress with a wide spectrum of extraintestinal manifestations (EMs) and comorbidities affecting different organs and systems, from anaemia, undernutrition, and cancer to those which are often neglected like anxiety and depression. Evolving IBD epidemiology and changing environment are reflected by an expanding list of IBD-related comorbidities. In contrast to the well-established role of smoking the connection between alcohol and IBD is still debatable on many levels, from pathogenesis to complications. Furthermore, little is known about narcotics use in IBD patients, even if there are obvious factors that may predispose them to narcotics as well as alcohol misuse. Last but not least, the question arises what is the prevalence of eating disorders in IBD. In our paper, we aimed to discuss the current knowledge on alcohol and drugs misuse and eating disorders as emerging extraintestinal comorbidities in IBD.
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Affiliation(s)
- Paweł Kuźnicki
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Division of Dietetics, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Chaparro M, Garre A, Núñez Ortiz A, Diz-Lois Palomares MT, Rodríguez C, Riestra S, Vela M, Benítez JM, Fernández Salgado E, Sánchez Rodríguez E, Hernández V, Ferreiro-Iglesias R, Ponferrada Díaz Á, Barrio J, Huguet JM, Sicilia B, Martín-Arranz MD, Calvet X, Ginard D, Alonso-Abreu I, Fernández-Salazar L, Varela Trastoy P, Rivero M, Vera-Mendoza I, Vega P, Navarro P, Sierra M, Cabriada JL, Aguas M, Vicente R, Navarro-Llavat M, Echarri A, Gomollón F, Guerra del Río E, Piñero C, Casanova MJ, Spicakova K, Ortiz de Zarate J, Torrella Cortés E, Gutiérrez A, Alonso-Galán H, Hernández-Martínez Á, Marrero JM, Lorente Poyatos R, Calafat M, Martí Romero L, Robledo P, Bosch O, Jiménez N, Esteve Comas M, Duque JM, Fuentes Coronel AM, Josefa Sampedro M, Sesé Abizanda E, Herreros Martínez B, Pozzati L, Fernández Rosáenz H, Crespo Suarez B, López Serrano P, Lucendo AJ, Muñoz Vicente M, Bermejo F, Ramírez Palanca JJ, Menacho M, Carmona A, Camargo R, Torra Alsina S, Maroto N, Nerín de la Puerta J, Castro E, Marín-Jiménez I, Botella B, Sapiña A, Cruz N, Forcelledo JLF, Bouhmidi A, Castaño-Milla C, Opio V, Nicolás I, Kutz M, Abraldes Bechiarelli A, Gordillo J, Ber Y, Torres Domínguez Y, Novella Durán MT, Rodríguez Mondéjar S, Martínez-Cerezo FJ, Kolle L, Sabat M, Ledezma C, Iyo E, Roncero Ó, Irisarri R, Lluis L, Blázquez Gómez I, Zapata EM, José Alcalá M, Martínez Pascual C, Montealegre M, Mata L, Monrobel A, Hernández Camba A, Hernández L, Tejada M, Mir A, Galve ML, Soler M, Hervías D, Gómez-Valero JA, Barreiro-de Acosta M, Rodríguez-Artalejo F, García-Esquinas E, Gisbert JP, GETECCU OBOTESGO. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J Clin Med 2021; 10:jcm10132885. [PMID: 34209680 PMCID: PMC8268420 DOI: 10.3390/jcm10132885] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.
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Affiliation(s)
- María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
- Correspondence: ; Tel.: +34-913093911
| | - Ana Garre
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
| | - Andrea Núñez Ortiz
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | | | - Cristina Rodríguez
- Department of Gastroenterology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Sabino Riestra
- Department of Gastroenterology, Hospital Universitario Central de Asturias and ISPA, 33011 Oviedo, Spain;
| | - Milagros Vela
- Department of Gastroenterology, Complejo Hospitalario Universitario Ntra. Sra. de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - José Manuel Benítez
- Department of Gastroenterology, Hospital Universitario Reina Sofía and IMIBIC, 14004 Córdoba, Spain;
| | - Estela Fernández Salgado
- Department of Gastroenterology, Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, 36071 Pontevedra, Spain;
| | | | - Vicent Hernández
- Department of Gastroenterology, Hospital Álvaro Cunqueiro, Estrutura Organizativa de Xestión Integrada de Vigo, 36213 Vigo, Spain;
| | - Rocío Ferreiro-Iglesias
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain; (R.F.-I.); (M.B.-d.A.)
| | - Ángel Ponferrada Díaz
- Department of Gastroenterology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain;
| | - José María Huguet
- Department of Gastroenterology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Beatriz Sicilia
- Department of Gastroenterology, Hospital Universitario de Burgos, 09006 Burgos, Spain;
| | | | - Xavier Calvet
- Servei de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, CIBEREHD—Instituto de Salud Carlos III, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain;
| | - Daniel Ginard
- Department of Gastroenterology, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Inmaculada Alonso-Abreu
- Department of Gastroenterology, Hospital Universitario de Canarias (H.U.C.), 38320 Santa Cruz de Tenerife, Spain;
| | - Luis Fernández-Salazar
- Department of Gastroenterology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | | | - Montserrat Rivero
- Department of Gastroenterology, Hospital Universitario Marqués de Valdecilla and IDIVAL, 39008 Santander, Spain;
| | - Isabel Vera-Mendoza
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Pablo Vega
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Pablo Navarro
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Universitat de València, 46010 Valencia, Spain;
| | - Mónica Sierra
- Department of Gastroenterology, Complejo Asistencial Universitario de León, 24001 León, Spain;
| | - José Luis Cabriada
- Department of Gastroenterology, Hospital de Galdakao-Usansolo, Galdakao, 48960 Vizcaya, Spain;
| | - Mariam Aguas
- Department of Gastroenterology, Hospital Universitari i Politecnic La Fe and CIBERehd, 46026 Valencia, Spain;
| | - Raquel Vicente
- Department of Gastroenterology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Mercè Navarro-Llavat
- Department of Gastroenterology, Hospital de Sant Joan Despí Moisès Broggi, 08970 Barcelona, Spain;
| | - Ana Echarri
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain;
| | - Fernando Gomollón
- Department of Gastroenterology, Hospital Clínico Universitario “Lozano Blesa”, IIS Aragón and CIBERehd, 50009 Zaragoza, Spain;
| | - Elena Guerra del Río
- Department of Gastroenterology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas, Spain;
| | - Concepción Piñero
- Department of Gastroenterology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - María José Casanova
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
| | - Katerina Spicakova
- Department of Gastroenterology, Hospital Universitario de Araba (sede Txagorritxu y sede Santiago), 01009 Álava, Spain; katerina.spicakova-@osakidetza.eus
| | - Jone Ortiz de Zarate
- Department of Gastroenterology, Hospital Universitario de Basurto, 48013 Bilbao, Spain;
| | - Emilio Torrella Cortés
- Department of Gastroenterology, Hospital General Universitario J.M. Morales Meseguer, 30008 Murcia, Spain;
| | - Ana Gutiérrez
- Department of Gastroenterology, Hospital General Universitario de Alicante and CIBERehd, 03010 Alicante, Spain;
| | - Horacio Alonso-Galán
- Department of Gastroenterology, Hospital Universitario Donostia-Donostia Unibertsitate Ospitalea, Guipuzkoa and Organizacion Sanitaria Integrada Tolosaldea, Clínica Santa María de la Asunción, 20014 Guipúzcoa, Spain;
| | - Álvaro Hernández-Martínez
- Department of Gastroenterology, Complejo Hospitalario de Especialidades Torrecárdenas, 04009 Almería, Spain;
| | - José Miguel Marrero
- Department of Gastroenterology, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas, Spain;
| | - Rufo Lorente Poyatos
- Department of Gastroenterology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain;
| | - Margalida Calafat
- Department of Gastroenterology, Hospital Son Llatzer, 07198 Palma de Mallorca, Spain;
| | - Lidia Martí Romero
- Department of Gastroenterology, Hospital Francesc De Borja de Gandía, 46702 Valencia, Spain;
| | - Pilar Robledo
- Department of Gastroenterology, Hospital Universitario de Cáceres, 10004 Cáceres, Spain;
| | - Orencio Bosch
- Department of Gastroenterology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Nuria Jiménez
- Department of Gastroenterology, Hospital General Universitario de Elche, 03203 Alicante, Spain;
| | - María Esteve Comas
- Department of Gastroenterology, Hospital Universitari Mutua Terrasa, 08221 Terrassa, Spain;
| | - José María Duque
- Department of Gastroenterology, Hospital San Agustín, 33401 Avilés, Spain;
| | - Ana María Fuentes Coronel
- Department of Gastroenterology, Hospital Virgen de La Concha, Complejo Asistencial de Zamora, 49022 Zamora, Spain;
| | | | - Eva Sesé Abizanda
- Department of Gastroenterology, Hospital Universitario Arnau de Vilanova, 25198 Lérida, Spain;
| | | | - Liliana Pozzati
- Department of Gastroenterology, Hospital de Mérida, 06800 Mérida, Spain;
| | | | - Belén Crespo Suarez
- Department of Gastroenterology, Hospital da Costa (EOXI Lugo-Cervo-Monforte), 27880 Lugo, Spain;
| | - Pilar López Serrano
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain;
| | - Alfredo J. Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Margarita Muñoz Vicente
- Department of Gastroenterology, Hospital General Universitario de Castellón, 12004 Castellón, Spain;
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria Hospital La Paz (IdiPaz), 28942 Madrid, Spain;
| | | | - Margarita Menacho
- Department of Gastroenterology, Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - Amalia Carmona
- Department of Gastroenterology, Hospital Povisa, 36211 Pontevedra, Spain;
| | - Raquel Camargo
- Department of Gastroenterology, Complejo Hospitalario de Especialidades Virgen de la Victoria, 29010 Málaga, Spain;
| | - Sandra Torra Alsina
- Department of Gastroenterology, Parc Sanitari Sant Joan de Déu, 08830 Barcelona, Spain;
| | - Nuria Maroto
- Department of Gastroenterology, Hospital de Manises, 46940 Valencia, Spain;
| | | | - Elena Castro
- Department of Gastroenterology, Complexo Hospitalario Universitario Xeral-Calde de Lugo, 27004 Lugo, Spain;
| | - Ignacio Marín-Jiménez
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Biomédica Gregorio Marañón (IiSGM), 28007 Madrid, Spain;
| | - Belén Botella
- Department of Gastroenterology, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain;
| | - Amparo Sapiña
- Department of Gastroenterology, Hospital de Manacor, 07500 Manacor, Spain;
| | - Noelia Cruz
- Department of Gastroenterology, Hospital Doctor José Molina Orosa, 35500 Lanzarote, Spain;
| | | | - Abdel Bouhmidi
- Department of Gastroenterology, Hospital Santa Bárbara, 13500 Puertollano, Spain;
| | | | - Verónica Opio
- Department of Gastroenterology, Hospital Universitario de Getafe, 28905 Madrid, Spain;
| | - Isabel Nicolás
- Department of Gastroenterology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain;
| | - Marcos Kutz
- Department of Gastroenterology, Hospital Reina Sofía, 31500 Tudela, Spain;
| | | | - Jordi Gordillo
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Yolanda Ber
- Department of Gastroenterology, Hospital San Jorge, 22004 Huesca, Spain;
| | | | | | | | | | - Lilyan Kolle
- Department of Gastroenterology, Hospital General de La Palma, 38713 Santa Cruz de Tenerife, Spain;
| | - Miriam Sabat
- Department of Gastroenterology, Hospital Santa Caterina, 17190 Gerona, Spain;
| | - Cesar Ledezma
- Department of Gastroenterology, Hospital Palamós, 17230 Girona, Spain;
| | - Eduardo Iyo
- Department of Gastroenterology, Hospital Comarcal de Inca, 07300 Inca, Spain;
| | - Óscar Roncero
- Department of Gastroenterology, Hospital General La Mancha Centro, 13600 Ciudad Real, Spain;
| | - Rebeca Irisarri
- Department of Gastroenterology, Hospital García Orcoyen, 31200 Estella, Spain;
| | - Laia Lluis
- Department of Gastroenterology, Hospital Sagrat Cor, 08029 Barcelona, Spain;
| | | | - Eva María Zapata
- Department of Gastroenterology, Hospital de Mendaro, 20850 Guipuzkoa, Spain;
| | - María José Alcalá
- Department of Gastroenterology, Hospital Obispo Polanco, 44002 Teruel, Spain;
| | - Cristina Martínez Pascual
- Department of Gastroenterology, Hospital General Universitario Los Arcos del Mar Menor, San Javier, 30739 Murcia, Spain;
| | - María Montealegre
- Department of Gastroenterology, Hospital General de Villarobledo, 02600 Albacete, Spain;
| | - Laura Mata
- Department of Gastroenterology, Hospital Medina del Campo, 47400 Valladolid, Spain;
| | - Ana Monrobel
- Department of Gastroenterology, Hospital de Montilla, 14550 Córdoba, Spain;
| | | | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, 09400 Aranda de Duero, Spain;
| | - María Tejada
- Department of Gastroenterology, Clínica Astarté, 11011 Cádiz, Spain;
| | - Alberto Mir
- Department of Gastroenterology, Hospital Ernest Lluch, 50299 Zaragoza, Spain;
| | - María Luisa Galve
- Department of Gastroenterology, Hospital Central de La Cruz Roja San José y Santa Adela, 28003 Madrid, Spain;
| | - Marta Soler
- Department of Gastroenterology, Hospital San Juan De Dios, 38009 Tenerife, Spain;
| | - Daniel Hervías
- Department of Gastroenterology, Hospital Virgen de Altagracia, 13002 Manzanares, Spain;
| | | | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain; (R.F.-I.); (M.B.-d.A.)
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, 28029 Madrid, Spain; (F.R.-A.); (E.G.-E.)
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, 28029 Madrid, Spain; (F.R.-A.); (E.G.-E.)
| | - Javier P. Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
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Bezzio C, Manes G, Schettino M, Arena I, de Nucci G, Della Corte C, Devani M, Mandelli E, Morganti D, Omazzi B, Pellegrini L, Picascia D, Redaelli D, Reati R, Saibeni S. Inflammatory bowel disease in a colorectal cancer screening population: Diagnosis and follow-up. Dig Liver Dis 2021; 53:587-591. [PMID: 32863160 DOI: 10.1016/j.dld.2020.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is usually diagnosed in subjects with gastrointestinal symptoms, but may also be asymptomatic and diagnosed incidentally. AIMS to determine the prevalence of IBD in asymptomatic adults. METHODS we identified subjects who underwent colonoscopy between 1 September 2013 and 31 August 2019 in a regional colorectal cancer screening program with endoscopic findings suggestive of IBD, and retrieved their clinical, histological and therapeutic information. RESULTS 5116 subjects underwent colonoscopy, and 4640 persons were considered assessable. Of these, 54 (1.16%) had endoscopic findings suggestive of IBD, including 40 of Crohn's disease (CD) and 14 of ulcerative colitis (UC). A definite diagnosis of IBD was made in 19 patients, for an overall IBD prevalence of 0.41%, with 13 cases of CD (0.28%) and 6 of UC (0.13%). The mean follow-up was 26.8 months after the first colonoscopy. Therapy was started in 5 of 13 CD patients and all UC patients. CONCLUSION Endoscopic findings suggestive of IBD are not infrequent in an asymptomatic colorectal cancer screening population. Visualization of the terminal ileum is recommended in this setting. A definite diagnosis of IBD was made in about 1 out of 3 subjects with endoscopic lesions. Most IBD patients had a mild form of disease, but some needed biologic therapy.
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Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Gianpiero Manes
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy; Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Mario Schettino
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Ilaria Arena
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Germana de Nucci
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Cristina Della Corte
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Massimo Devani
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Enzo Mandelli
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Daniela Morganti
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Barbara Omazzi
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Lucienne Pellegrini
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy
| | - Desirée Picascia
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Davide Redaelli
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Raffaella Reati
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho (MI), Italy.
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Fotis L, Kourti A, Prountzos S, Alexopoulou E, Papaevangelou V, Fessatou S. Takayasu arteritis in an adolescent with Crohn's disease. Rheumatol Int 2021; 42:563-570. [PMID: 33907878 PMCID: PMC8078095 DOI: 10.1007/s00296-021-04869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 12/04/2022]
Abstract
Crohn’s disease (CD) and Takayasu arteritis (TA) are two distinct clinical entities. Τhe likelihood of both diseases coexisting is low, and although CD co-occurs with all types of vasculitis, TA is the most common subtype. Herein, the case of a 15-year-old female, diagnosed with TA following an initial diagnosis of CD, is reported. A review of the literature, including a systemic review of the case reports and case series of children and adolescents up to the age of 21, with both CD and TA, follows the case description. In total, 28 cases of TA and CD were retrieved. The median age of patients was 14.8 years, they were mostly females (72%) and the median time between the two diagnoses was 3.7 years. In the majority of cases, CD was diagnosed first and TA followed. Computed tomography angiography and magnetic resonance angiography were the preferred imaging modalities to assist diagnosis.
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Affiliation(s)
- Lampros Fotis
- Department of Pediatrics, National and Kapodistrian University of Athens, "ATTIKON" General Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece.
| | - Afroditi Kourti
- Department of Pediatrics, National and Kapodistrian University of Athens, "ATTIKON" General Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece
| | - Spyridon Prountzos
- Department of Radiology, National and Kapodistrian University of Athens, "ATTIKON" General Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece
| | - Efthymia Alexopoulou
- Department of Radiology, National and Kapodistrian University of Athens, "ATTIKON" General Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece
| | - Vasiliki Papaevangelou
- Department of Pediatrics, National and Kapodistrian University of Athens, "ATTIKON" General Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece
| | - Smaragdi Fessatou
- Department of Pediatrics, National and Kapodistrian University of Athens, "ATTIKON" General Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece
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35
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Takeyama E, Wada H, Sato S, Tomooka K, Ikeda A, Tanigawa T. Association of diagnostic delay with medical cost for patients with Crohn's disease: A Japanese claims-based cohort study. JGH OPEN 2021; 5:568-572. [PMID: 34013056 PMCID: PMC8114978 DOI: 10.1002/jgh3.12534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/14/2022]
Abstract
Background and Aim Longer diagnostic delay (DD) in Crohn's disease (CD) is associated with complications and related surgeries. However, the impact of DD on medical cost after CD diagnosis remains uncertain. Methods This was a claims‐based cohort study. Our analysis used data from 2005 to 2018 from the Japanese Claims Database. We enrolled a total of 528 newly diagnosed CD patients (76.9% male) aged 31.5 ± 13.6 years. High medical cost was defined as the highest quartile of the average monthly medical cost. DD was defined as the interval between the first visit to a gastroenterologist and diagnosis with CD. In the multivariable logistic regression analysis, patients were stratified by the use of anti‐tumor necrosis factor alpha (anti‐TNFα) agents to exclude their influence on the observed effects. This study was approved by the ethics review board of the Juntendo University Faculty of Medicine (No. 2019178). Results The multivariable‐adjusted odds ratios and 95% confidence intervals of high medical cost were 1.41 (0.81–2.43) and 0.91 (0.57–1.46), respectively, for a DD of >12 months and 1 to ≤12 months compared to <1 month. In patients receiving anti‐TNFα agents, the multivariable‐adjusted odds ratios for high medical cost were 2.63 (1.34–5.16) and 1.35 (0.79–2.28) for a DD of >12 months and 1 to ≤12 months, respectively, compared to <1 month. In patients without anti‐TNFα, multivariable logistic regression analyses were not presented because of a small number of patients categorized into the high medical cost group. Conclusion A delayed diagnosis of CD may incur high medical cost in patients who develop aggressive disease that requires treatment with anti‐TNFα agents.
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Affiliation(s)
- Eisuke Takeyama
- Department of Public Health Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroo Wada
- Department of Public Health Juntendo University Graduate School of Medicine Tokyo Japan
| | - Setsuko Sato
- Department of Public Health Juntendo University Faculty of Medicine Tokyo Japan
| | - Kiyohide Tomooka
- Department of Public Health Juntendo University Faculty of Medicine Tokyo Japan
| | - Ai Ikeda
- Department of Public Health Juntendo University Faculty of Medicine Tokyo Japan
| | - Takeshi Tanigawa
- Department of Public Health Juntendo University Graduate School of Medicine Tokyo Japan
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Gomes TNF, de Azevedo FS, Argollo M, Miszputen SJ, Ambrogini O. Clinical and Demographic Profile of Inflammatory Bowel Disease Patients in a Reference Center of São Paulo, Brazil. Clin Exp Gastroenterol 2021; 14:91-102. [PMID: 33762838 PMCID: PMC7982433 DOI: 10.2147/ceg.s288688] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract with an increasing incidence in developing countries. Purpose To report clinical and demographic data of CD and UC at a referral center for inflammatory bowel disease (IBD) in São Paulo. Patients and Methods We conducted a retrospective cross-sectional study on adult patients with established IBD. Demographic and clinical data were obtained by medical records analysis from the IBD Outpatient Clinic of EPM-UNIFESP, from October 1997 to October 2017. Results Of 658 patients included, 355 had UC (54%) and 303 had CD (46%). UC was more prevalent in women than CD (219 [61.7%] vs 152 [50.2%], p=0.003). The median time between the onset of symptoms and diagnosis was 13 (5-38) months, with a longer duration for CD patients. CD mostly affected the ileocolonic location (47.9%). CD patients with stricture, fistula and/or perianal disease (213/303, 70.3%) were younger at diagnosis, had a longer disease duration, higher rates of corticosteroid, immunomodulatory, and biological therapy, hospitalization, and referral to surgery, compared to patients without complication. Extensive colitis was the most common extension of UC (50.6%), which was more frequently associated with younger age at diagnosis, hepatobiliary disease, increased need for hospitalization, higher use of immunomodulatory, and biologic therapy, compared to patients with less extensive disease. In the last 5 years, CD patients were more frequently on biologic and/or immunomodulatory (70.9%) therapy, and UC patients often received salicylates (78.1%) and immunomodulatory (28.1%) treatments. There was a consistent reduction in salicylate usage for CD in the last 5 years compared to the total period of follow-up. Conclusion Despite the increasing incidence, we highlight the diagnostic delay and a more complicated CD and extensive UC in this cohort, reflecting a high need for immunomodulatory and biological treatment, hospitalization, and surgery.
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Affiliation(s)
- Tarcia Nogueira Ferreira Gomes
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Fabio Silva de Azevedo
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marjorie Argollo
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sender Jankiel Miszputen
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Orlando Ambrogini
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Lenti MV, Di Sabatino A. Disease- and gender-related characteristics of coeliac disease influence diagnostic delay. Eur J Intern Med 2021; 83:12-13. [PMID: 33004263 DOI: 10.1016/j.ejim.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
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Hicks A, Hamlin PJ, Selinger CP. The Association of Introducing a Faecal Calprotectin Testing Pathway for Suspected Inflammatory Bowel Disease in Primary Care and Time to Diagnosis or Treatment. Inflamm Intest Dis 2020; 5:191-199. [PMID: 33313071 DOI: 10.1159/000509907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Primary care faecal calprotectin (FC) was introduced in Leeds in 2014 to distinguish inflammatory bowel disease (IBD) from irritable bowel syndrome and with the hope that it may reduce time to IBD diagnosis and treatment. This study examines the association of FC with referral routes, time to diagnosis, and time to treatment. Methods All patients newly referred to IBD clinics in 2013 and 2016 were studied. Data on referral routes and dates, FC, date of first treatment, and proxy outcomes for disease severity were collected. Results In 248 patients, there were no differences between 2013 and 2016 cohorts regarding baseline data and disease severity. The number of direct referrals to gastroenterology rose from 3% (2013) to 17% (2016), whilst 10% were diagnosed during emergency admissions. Referrals via suspected cancer pathways remained high (38% in 2013, 28% in 2016), whilst many had initial investigations at independent centres (16% in 2013, 24% in 2016). Time from referral to diagnosis was similar between 2013 (0.77 month) and 2016 (1.10 months, p = 0.2). A total of 48 (33.3%) patients had FC checked prior to referral, and 37.5% of these were referred directly to gastroenterology. Time from diagnosis to treatment reduced from 1.37 months (2013) to 0.72 month (2016, p = 0.01). Conclusion Patients present via a multitude of referral pathways, but FC was associated with increased direct referrals to gastroenterology. We found a variation in time to diagnosis and treatment depending on referral routes. Further work is required to ensure patients with suspected IBD get referred to IBD services in a timely manner.
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Affiliation(s)
- Amy Hicks
- Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - P John Hamlin
- Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Christian P Selinger
- Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
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39
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Fiorino G, Bonovas S, Gilardi D, Di Sabatino A, Allocca M, Furfaro F, Roda G, Lenti MV, Aronico N, Mengoli C, Angeli E, Gaffuri N, Peyrin-Biroulet L, Danese S. Validation of the Red Flags Index for Early Diagnosis of Crohn's Disease: A Prospective Observational IG-IBD Study Among General Practitioners. J Crohns Colitis 2020; 14:1777-1779. [PMID: 32990721 DOI: 10.1093/ecco-jcc/jjaa111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Diagnostic delay >12 months is frequent in Crohn's disease [CD]. Recently, the International Organization for Inflammatory Bowel Disease [IO-IBD] developed a tool to identify early CD and reduce diagnostic delay. Subjects with an index ≥8 are more likely to have suspected CD (odds ratio [OR] 205, p <0.0001). We aimed to validate this questionnaire at the community level in patients seen by the general practitioners [GPs] in two large areas of Lombardy, Italy. METHODS Consecutive adult patients referring to the GP were screened. The GPs administered the Red Flags [RF] questionnaire to the eligible patients. All patients were referred to the nearest participating centre to confirm or exclude the diagnosis of CD. Sensitivity, specificity, and positive and negative predictive values [PPV, NPV] of the RF index [RFI] were calculated. Patients lost to follow-up after the first gastroenterological visit were analysed using a non-responder imputation, assuming they were negative for CD diagnosis. RESULTS From November 2016 to November 2019, 112 patients were included. A total of 66 subjects [59%] completed the study after the first gastroenterological visit. The prevalence of CD was 3.6% in the study population [4/112]. The RF index had 50% sensitivity, 58% specificity, 4% PPV, and 97% NPV. A combined diagnostic strategy with faecal calprotectin [FC] [RFI ≥8 and/or FC >250 ng/g] resulted in significantly improved accuracy: sensitivity 100% [29-100%], specificity 72% [55-85%], PPV = 21% [5-51%], NPV = 100% [88-100%]. CONCLUSIONS The RF Index combined with FC is a valid tool to identify patients with high probability of having CD at early stage.
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Affiliation(s)
- Gionata Fiorino
- Humanitas University, Biomedical Sciences, Pieve Emanuele, Italy
| | - Stefanos Bonovas
- Humanitas University, Biomedical Sciences, Pieve Emanuele, Italy
| | - Daniela Gilardi
- Humanitas Clinical and Research Center - IRCCS, IBD Center, Department of Gastroenterology, Rozzano, Italy
| | - Antonio Di Sabatino
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | | | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, IBD Center, Department of Gastroenterology, Rozzano, Italy
| | - Giulia Roda
- Humanitas Clinical and Research Center - IRCCS, IBD Center, Department of Gastroenterology, Rozzano, Italy
| | - Marco V Lenti
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | - Nicola Aronico
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | - Caterina Mengoli
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | - Enzo Angeli
- Humanitas Gavazzeni, Radiology, Bergamo, Italy
| | - Nicola Gaffuri
- Humanitas Gavazzeni, Gastroenterology and Endoscopy, Bergamo, Italy
| | | | - Silvio Danese
- Humanitas University, Biomedical Sciences, Pieve Emanuele, Italy
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40
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Viola A, Fontana A, Belvedere A, Scoglio R, Costantino G, Sitibondo A, Muscianisi M, Inferrera S, Bruno LM, Alibrandi A, Trifirò G, Fries W. Diagnostic accuracy of faecal calprotectin in a symptom-based algorithm for early diagnosis of inflammatory bowel disease adjusting for differential verification bias using a Bayesian approach. Scand J Gastroenterol 2020; 55:1176-1184. [PMID: 32838582 DOI: 10.1080/00365521.2020.1807599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diagnostic delay in IBD is a major problem and diagnosis is frequently arrived when irreversible damage has already occurred. This study evaluated accuracy of faecal calprotectin (fCAL) integrated with diagnostic criteria for early diagnosis of IBD in a primary care setting. METHODS General practitioners (GPs) were trained to recognize alarm symptoms for IBD classified as major and minor criteria. Fulfilment of one major or at least two minor criteria was followed by free fCAL testing and a visit by an IBD specialist and follow-up over 12 months. All patients with positive fCAL testing, i.e., ≥70 μg/g underwent colonoscopy. The diagnostic accuracy of fCAL was estimated after adjusting for differential-verification bias following a Bayesian approach. RESULTS Thirty-four GPs participated in the study and 133 patients were tested for fCAL between July 2016 and August 2017. Positivity of fCAL was seen in 45/133 patients (34%) and a final IBD diagnosis was made in 10/45 (22%). According to the threshold of 70 μg/g, fCAL achieved a sensitivity of 74.8% (95%CI: 39.10-96.01%), a specificity of 70.4% (95%CI: 61.76-78.16%) and an overall diagnostic accuracy of 70.6% (95%CI: 61.04-78.37%). As for prognostic accuracy, despite positive predictive value being low, 21.9% (95%CI: 11.74-35.18%), the negative predictive value was definitely higher: 96.2% (95%CI: 84.96-99.51%). CONCLUSIONS fCAL with a threshold set at 70 μg/g seems to represent a potentially reliable negative test to be used in primary care settings for patients with symptoms suggestive of IBD.
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Affiliation(s)
- Anna Viola
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | | | - Riccardo Scoglio
- Italian Society of General Medicine (SIMG), Section Messina, Messina, Italy
| | - Giuseppe Costantino
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Aldo Sitibondo
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Santi Inferrera
- Italian Society of General Medicine (SIMG), Section Messina, Messina, Italy
| | - Lucia Maria Bruno
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | | | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
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Ricciuto A, Mack DR, Huynh HQ, Jacobson K, Otley AR, deBruyn J, El-Matary W, Deslandres C, Sherlock ME, Critch JN, Bax K, Jantchou P, Seidman EG, Carman N, Rashid M, Muise A, Wine E, Carroll MW, Lawrence S, Van Limbergen J, Benchimol EI, Walters TD, Griffiths AM, Church PC. Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn's Disease. J Crohns Colitis 2020; 15:419-431. [PMID: 32978629 PMCID: PMC7944510 DOI: 10.1093/ecco-jcc/jjaa197] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay. METHODS We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression. RESULTS Overall (64% Crohn's disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0-9.2) months. For the overall cohort, diagnostic delay was >9.2 months; in CD, >10.8 months and in UC/IBD-U, >6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005-0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay. CONCLUSIONS Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
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Affiliation(s)
- Amanda Ricciuto
- SickKids Hospital, University of Toronto, Toronto, ON, Canada,Corresponding author: Amanda Ricciuto, MD, PhD, FRCPC, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada, M5G 1X8. Tel.: 416-813-7654; fax: 416-813-6531; email
| | - David R Mack
- Children’s Hospital of Eastern Ontario [CHEO], Inflammatory Bowel Disease Centre, Ottawa, ON, Canada
| | - Hien Q Huynh
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | | | | | - Jennifer deBruyn
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Wael El-Matary
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Jeffrey N Critch
- Janeway Children’s Health and Rehabilitation Centre, St. John’s, NL, Canada
| | - Kevin Bax
- Children’s Hospital of Western Ontario, London, ON, Canada
| | | | | | - Nicholas Carman
- Children’s Hospital of Eastern Ontario [CHEO], Inflammatory Bowel Disease Centre, Ottawa, ON, Canada
| | | | - Aleixo Muise
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - Eytan Wine
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Matthew W Carroll
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | | | | | - Eric I Benchimol
- Children’s Hospital of Eastern Ontario [CHEO], Inflammatory Bowel Disease Centre, Ottawa, ON, Canada,CHEO Research Institute, Ottawa, ON, Canada,Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,ICES uOttawa, Ottawa, ON, Canada
| | | | | | - Peter C Church
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
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42
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Vadstrup K, Alulis S, Borsi A, Jørgensen TR, Nielsen A, Munkholm P, Qvist N. Extraintestinal Manifestations and Other Comorbidities in Ulcerative Colitis and Crohn Disease: A Danish Nationwide Registry Study 2003-2016. CROHN'S & COLITIS 360 2020; 2:otaa070. [PMID: 36776496 PMCID: PMC9802257 DOI: 10.1093/crocol/otaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) may be a frequent complication to an underlying abnormal immune response. This study investigated the occurrence of EIMs in Crohn disease (CD) and ulcerative colitis (UC) patients using population-based data in Denmark from 2003 to 2016. Methods In this national registry-based study, incident CD and UC patients between 2003 and 2015 were matched on age and gender with non-IBD controls and followed until 2016. The selected EIMs for this study included 51 different diagnoses divided into biological systems of diseases, which were tested for differences in the timing and occurrence of EIMs. Results The study cohort included 10,302 patients with CD and 22,144 patients with UC. The highest risk of patients experiencing EIM/comorbidities for the first time before their IBD diagnosis was in the skin and intestinal tract systems. For CD, the odds ratio of having an EIM before or after IBD diagnosis, as compared with controls, was significant in the skin, intestinal tract, hepatopancreatobiliary, musculoskeletal, ocular, renal, and respiratory systems. For UC, the risks were similar before and after UC diagnosis, apart from the nervous system where the odds ratio was significantly higher before the diagnosis of UC, and significantly lower after diagnosis for diseases in the ocular system. Conclusions EIMs in CD and UC patients may also precede their IBD diagnosis. These findings may indicate a significant diagnostic delay of CD and UC, and the occurrence of known EIMs should prompt physicians to look for patients possibly having underlying IBD.
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Affiliation(s)
- Kasper Vadstrup
- Janssen Immunology, Janssen-Cilag, Birkerød, Denmark,Address correspondence to: Kasper Vadstrup, PhD, Janssen Immunology, Bregnerødvej 133, 3460 Birkerød, Denmark ()
| | - Sarah Alulis
- Janssen Immunology, Janssen-Cilag, Birkerød, Denmark
| | - Andras Borsi
- Janssen Immunology, Janssen-Cilag, High Wycombe, UK
| | | | - Agnete Nielsen
- Department of Market Access and Health Economy, Incentive, Holte, Denmark
| | - Pia Munkholm
- Gastroenterology Department, North Zealand University Hospital, Capital Region, Frederikssund, Denmark
| | - Niels Qvist
- Surgical Department A and IBD Care, Odense University Hospital, Odense, Denmark
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43
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Krzystek-Korpacka M, Kempiński R, Bromke MA, Neubauer K. Oxidative Stress Markers in Inflammatory Bowel Diseases: Systematic Review. Diagnostics (Basel) 2020; 10:E601. [PMID: 32824619 PMCID: PMC7459713 DOI: 10.3390/diagnostics10080601] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Precise diagnostic biomarker in inflammatory bowel diseases (IBD) is still missing. We conducted a comprehensive overview of oxidative stress markers (OSMs) as potential diagnostic, differential, progression, and prognostic markers in IBD. A Pubmed, Web of Knowledge, and Scopus search of original articles on OSMs in IBD, published between January 2000 and April 2020, was conducted. Out of 874 articles, 79 eligible studies were identified and used to prepare the interpretative synthesis. Antioxidants followed by lipid peroxidation markers were the most popular and markers of oxidative DNA damage the least popular. There was a disparity in the number of retrieved papers evaluating biomarkers in the adult and pediatric population (n = 6). Of the reviewed OSMs, a promising performance has been reported for serum total antioxidant status as a mucosal healing marker, mucosal 8-OHdG as a progression marker, and for multi-analyte panels of lipid peroxidation products assessed non-invasively in breath as diagnostic and differential markers in the pediatric population. Bilirubin, in turn, was the only validated marker. There is a desperate need for non-invasive biomarkers in IBD which, however, will not be met in the near future by oxidative stress markers as they are promising but mostly at the early research phase of discovery.
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Affiliation(s)
| | - Radosław Kempiński
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Mariusz A. Bromke
- Department of Medical Biochemistry, Wroclaw Medical University, Chałubińskiego 10, 50-368 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
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44
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Walker GJ, Lin S, Chanchlani N, Thomas A, Hendy P, Heerasing N, Moore L, Green HD, Chee D, Bewshea C, Mays J, Kennedy NA, Ahmad T, Goodhand JR. Quality improvement project identifies factors associated with delay in IBD diagnosis. Aliment Pharmacol Ther 2020; 52:471-480. [PMID: 32573819 DOI: 10.1111/apt.15885] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/23/2020] [Accepted: 05/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Delay in the diagnosis of inflammatory bowel disease (IBD) is common and contemporary UK studies are lacking. AIM To determine factors associated with, and the consequences of, a prolonged time to diagnosis in IBD. METHODS This quality improvement study included 304 adults with a new IBD diagnosis made between January 2014 and December 2017 across 49 general practices (GP) and gastroenterology secondary care services. Outcome measures were demographic, clinical and laboratory factors associated with a delayed time, defined as greater than upper quartile, to: (a) patient presentation (b) GP referral (c) secondary care diagnosis, and factors associated with a complicated disease course (hospitalisation and/or surgery and/or biologic treatment) in the year after diagnosis. RESULTS The median [IQR] diagnosis sub-intervals were: (a) patient = 2.1 months [0.9-5.1]; (b) GP = 0.3 months [0.0-0.9]; (c) secondary care = 1.1 months [0.5-2.1]. 50% of patients were diagnosed within 4 months and 92% were diagnosed within 2 years of symptom onset. Diagnostic delay was more common in Crohn's disease (7.6 months [3.1-15.0]) than ulcerative colitis (3.3 months [1.9-7.3]) (P < 0.001). Patients who presented as an emergency (P < 0.001) but not those with a delayed overall time to diagnosis (P = 0.35) were more likely to have a complicated disease course. CONCLUSION Time to patient presentation is the largest component of time to IBD diagnosis. Emergency presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course.
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Affiliation(s)
- Gareth J Walker
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Simeng Lin
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Amanda Thomas
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Peter Hendy
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neel Heerasing
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Lucy Moore
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK
| | - Harry D Green
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK
| | - Desmond Chee
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Claire Bewshea
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK
| | - Joseph Mays
- NHS Devon Clinical Commissioning Group, Exeter, UK
| | - Nicholas A Kennedy
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Tariq Ahmad
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - James R Goodhand
- Exeter IBD and Pharmacogenetics Research Group, Exeter, UK.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Blackwell J, Saxena S, Jayasooriya N, Bottle A, Petersen I, Hotopf M, Alexakis C, Pollok RC. Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study. J Crohns Colitis 2020; 15:jjaa146. [PMID: 32667962 DOI: 10.1093/ecco-jcc/jjaa146] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD). AIMS To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn's Disease (CD) and ulcerative colitis (UC). METHODS Case-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016. RESULTS We identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98). CONCLUSIONS There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.
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Affiliation(s)
- J Blackwell
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - S Saxena
- School of Public Health, Imperial College London, London, UK
| | - N Jayasooriya
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - A Bottle
- School of Public Health, Imperial College London, London, UK
| | - I Petersen
- Dept. Primary Care and Population Health, University College London, London, UK
- Dept. Clinical Epidemiology, Aarhus University, Denmark
| | - M Hotopf
- Institute of Psychiatry, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - C Alexakis
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - R C Pollok
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
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Hamilton B, Green H, Heerasing N, Hendy P, Moore L, Chanchlani N, Walker G, Bewshea C, Kennedy NA, Ahmad T, Goodhand J. Incidence and prevalence of inflammatory bowel disease in Devon, UK. Frontline Gastroenterol 2020; 12:461-470. [PMID: 34712463 PMCID: PMC8515282 DOI: 10.1136/flgastro-2019-101369] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS We sought to define temporal changes in prevalence of inflammatory bowel disease (IBD) in East Devon, UK, in order to facilitate service planning over the next 5 years. METHODS Multiple primary and secondary care databases were used to identify and verify cases. Point prevalence and incidence of IBD were reported in April 2017 and from 2008 to 2016, respectively. Future prevalence and healthcare activity requirements were estimated by linear regression. RESULTS Prevalence of ulcerative colitis (UC), Crohn's disease (CD) and inflammatory bowel disease unclassified (IBDU) were 479.72, 265.94 and 35.34 per 100 000 persons, respectively. In 2016, the incidence rates of UC, CD and IBDU were 15.4, 10.7 and 1.4 per 100 000 persons per year, respectively. There were no significant changes in the incidence of CD (p=0.49, R=0.26) or UC (p=0.80, R=0.10). IBD prevalence has increased by 39.9% (95% CI 28.2 to 53.7) in the last 10 years without differences in the rate of change between UC and CD. Overall, 27% of patients were managed in primary care, a quarter of whom were eligible but not receiving endoscopic surveillance. Outpatient clinics, MRI and biologic use, but not helpline calls, admissions, or surgeries increased over and above the change in IBD prevalence. CONCLUSIONS We report one of the highest prevalence and incidence rates of IBD from Northern Europe. Overall, IBD incidence is static, but prevalence is increasing. We estimate that 1% of our population will live with IBD between 2025 and 2030.
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Affiliation(s)
- Ben Hamilton
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK
| | - Harry Green
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Genetics of Complex Traits, University of Exeter, Exeter, UK
| | - Neel Heerasing
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Peter Hendy
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Lucy Moore
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Neil Chanchlani
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK
| | - Gareth Walker
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK
| | - Claire Bewshea
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK
| | - Tariq Ahmad
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK
| | - James Goodhand
- Exeter IBD Pharmacogenetics Research Group, University of Exeter, Exeter, UK,Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK
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Lenti MV, Cococcia S, Ghorayeb J, Di Sabatino A, Selinger CP. Stigmatisation and resilience in inflammatory bowel disease. Intern Emerg Med 2020; 15:211-223. [PMID: 31893346 PMCID: PMC7054377 DOI: 10.1007/s11739-019-02268-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is an immune-mediated, chronic relapsing disorder characterised by severe gastrointestinal symptoms that dramatically impair patients' quality of life, affecting psychological, physical, sexual, and social functions. As a consequence, patients suffering from this condition may perceive social stigmatisation, which is the identification of negative attributes that distinguish a person as different and worthy of separation from the group. Stigmatisation has been widely studied in different chronic conditions, especially in mental illnesses and HIV-infected patients. There is a growing interest also for patients with inflammatory bowel disease, in which the possibility of disease flare and surgery-related issues seem to be the most important factors determining stigmatisation. Conversely, resilience represents the quality that allows one to adopt a positive attitude and good adjustments despite adverse life events. Likewise, resilience has been studied in different populations, age groups, and chronic conditions, especially mental illnesses and cancer, but little is known about this issue in patients with inflammatory bowel disease, even if this could be an interesting area of research. Resilience can be strengthened through dedicated interventions that could potentially improve the ability to cope with the disease. In this paper, we focus on the current knowledge of stigmatisation and resilience in patients with inflammatory bowel disease.
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Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Christian P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Beckett Lane, Leeds, LS9 7TF, UK.
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Prevalence and incidence of inflammatory bowel disease in two Italian islands, Sicily and Sardinia: A report based on health information systems. Dig Liver Dis 2019; 51:1270-1274. [PMID: 31176630 DOI: 10.1016/j.dld.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few epidemiological data about inflammatory bowel disease (IBD) in Italy are available. AIMS To estimate IBD prevalence and incidence in two Italian regions - Sicily and Sardinia - using regional health information systems. METHODS Data from hospital discharges and disease-specific payment exemptions register were retrieved and underwent record-linkage procedures. Standardized prevalence and incidence were calculated as rates per 100,000 inhabitants. RESULTS In Sicily, during the year 2013, the overall IBD incidence rate was 27 per 100,000 inhabitants, while the incidence rate of Crohn's disease (CD) was 16 for males and 13 for females, and the incidence of ulcerative colitis (UC) was 15 and 11 for males and females, respectively. At the date of December 31st, 2013, the standardized prevalence rate of IBD was estimated at 300 cases per 100,000 inhabitants. In Sardinia, during the period 2008-2010, the average IBD incidence rate per 100,000 was 15, with an incidence rate of 5 per 100,000 for CD, and 10 per 100,000 for UC, while the standardized prevalence rate of IBD was estimated at 187 cases per 100,000 inhabitants. CONCLUSIONS The particularly high incidence of CD in Sicily, and the marked difference of IBD occurrence between the two islands deserve future investigations.
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Lenti MV, Miceli E, Corazza GR, Di Sabatino A. Editorial: determinants of diagnostic delay in autoimmune atrophic gastritis-a salutary lesson. Authors' reply. Aliment Pharmacol Ther 2019; 50:459-460. [PMID: 31359467 DOI: 10.1111/apt.15415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Miceli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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50
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Lenti MV, Miceli E, Cococcia S, Klersy C, Staiani M, Guglielmi F, Giuffrida P, Vanoli A, Luinetti O, De Grazia F, Di Stefano M, Corazza GR, Di Sabatino A. Determinants of diagnostic delay in autoimmune atrophic gastritis. Aliment Pharmacol Ther 2019; 50:167-175. [PMID: 31115910 DOI: 10.1111/apt.15317] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/31/2019] [Accepted: 05/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Autoimmune atrophic gastritis (AAG) is characterised by a wide clinical spectrum that could delay its diagnosis. AIMS To quantify the diagnostic delay in patients suffering from AAG and to explore possible risk factors for longer diagnostic delay. METHODS Consecutive patients with AAG evaluated at our gastroenterological outpatient clinic between 2009 and 2018 were included. Diagnostic delay was estimated as the time lapse occurring between the appearance of the first likely symptoms, laboratory alterations, and other clues indicative of AAG and the final diagnosis. Patient-dependent and physician-dependent diagnostic delays were also assessed. Multivariable regression models were fitted. RESULTS 291 patients with AAG (mean age at diagnosis 61 ± 15 years; F:M ratio = 2.3:1) were included. The median overall diagnostic delay was 14 months (interquartile range [IQR] 4-41). Factors associated with longer median overall diagnostic delay were female sex (17 months, IQR 5-48), having a previous misdiagnosis (36 months, IQR 17-125) and a history of infertility/miscarriages (33 months, IQR 8-120), whereas a higher level of education was associated with longer patient-dependent diagnostic delay (4 months, IQR 1-12). First evaluation by a gastroenterologist was associated with a median longer diagnostic delay (6 months, IQR 2-15) compared to an internist (3 months, IQR 3-31) and a haematologist (1 month, IQR 0-2). Age, socioeconomic or marital status did not affect the diagnostic delay. CONCLUSIONS AAG is burdened by substantial diagnostic delay, especially in female patients, and due to lack of awareness, particularly among gastroenterologists. Uncommon vitamin B12 deficiency-related manifestations are overlooked and may prolong the diagnostic delay.
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Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emanuela Miceli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Martina Staiani
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Francesca Guglielmi
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paolo Giuffrida
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Department of Molecular Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Ombretta Luinetti
- Department of Molecular Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federico De Grazia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Michele Di Stefano
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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