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Gray SH. Managing menstruation for medically complex paediatric patients. Arch Dis Child 2024:archdischild-2024-326968. [PMID: 38811058 DOI: 10.1136/archdischild-2024-326968] [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: 02/05/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024]
Abstract
Physicians who care for children and adolescents need evidence-based information about how to manage menses for medically complicated patients. The use of many hormonal medications for menstrual management is considered 'off-label' because many of these medications have indications only for contraception. A growing body of evidence supports the use of particular medications or strategies for a wide variety of medical conditions, but this information has been slow to reach all paediatric patients, perhaps in part because of the off-label nature of prescribing. Specialists skilled in hormone management are in short supply and often not immediately available for consultation, and they may also be inexperienced prescribing for medically complex paediatric patients. Misconceptions about the necessity of menstruation or concerns regarding use of contraceptives in young patients may also limit the use of medically indicated off-label hormonal regimens. This review will outline current patient-centred strategies to inform physicians' choices about when and how to intervene medically to improve quality of life for medically complex girls with problematic periods-whether by making periods more predictable, preventing ovulation, reducing pain or eliminating menses altogether.
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Affiliation(s)
- Susan H Gray
- Pediatrics, University of Virginia School of Medicine, Charlottesville, USA
- Teen and Young Adult Health Center, University of Virginia Health System, Charlottesville, Virginia, USA
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2
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Zingone F, Borsato A, Maniero D, Della Loggia F, Lorenzon G, Zanini A, Canova C, Barberio B, Savarino EV. Impact of inflammatory bowel disease on women's reproductive life: a questionnaire-based study. Therap Adv Gastroenterol 2024; 17:17562848241249440. [PMID: 38766477 PMCID: PMC11102668 DOI: 10.1177/17562848241249440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/07/2024] [Indexed: 05/22/2024] Open
Abstract
Background Inflammatory bowel diseases (IBDs) have a peak incidence between the second and fourth decades of life and can affect women's reproductive life. Objectives Our study aimed to assess the impact of IBD on the reproductive life of female patients with this condition. Design Cross-sectional study. Methods Women with IBD followed at our IBD Unit and a group of healthy controls were enrolled. Data on reproductive life were collected using a dedicated questionnaire. Results The study included 457 women, of whom 228 had IBD, and 229 age-matched healthy controls. No differences were found in the use of contraceptives, infertility, and endometriosis. The risk of spontaneous and voluntary abortions was significantly higher in IBD patients than in healthy controls [odds ratio (OR) 2 and 3.62, respectively]. The risk of obstetrical complications in the IBD population was more than six times higher in patients who experienced disease reactivations during pregnancy than in those with persistent remission [OR 6.9, 95% confidence interval (CI) 1.51-31.28]. Finally, we found that the chances of breastfeeding were 66% lower in patients with IBD than in controls (OR 0.44, 95% CI 0.22-0.91). Conclusion Our study underlines the negative impact of IBD on women's reproductive life, supporting the need for proactive preconception counseling.
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Affiliation(s)
- Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 235128, Italy
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padova, Italy
| | - Alessandro Borsato
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padova, Italy
| | - Daria Maniero
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Greta Lorenzon
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Annalisa Zanini
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padova, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Brigida Barberio
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padova, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padova, Italy
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Dolovich C, Shafer LA, Graff LA, Vagianos K, Witges K, Targownik LE, Bernstein CN. Hormonal Contraceptives Reduce Active Symptomatic Disease but May Increase Intestinal Inflammation in IBD. J Clin Gastroenterol 2024; 58:271-276. [PMID: 38349017 DOI: 10.1097/mcg.0000000000001846] [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: 06/28/2022] [Accepted: 02/26/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Among women of reproductive age with inflammatory bowel disease (IBD), we aimed to assess the relationship of hormonal contraceptives (HCs) with IBD-related symptoms, and intestinal inflammation. METHODS A nested cohort of women in the longitudinal Manitoba Living with IBD Study, ages 18 to 49, were followed for 1 year, with bi-weekly online surveys. This included a validated measure of disease activity; IBD Symptom Inventory (IBDSI), and stool samples obtained at 3 time-points for assessment of fecal calprotectin (FCAL). Use of HC included oral and vaginal intrauterine devices. Logistic regression analysis was used to assess the association between HC and IBD-related symptoms (IBDSI>14 for Crohn disease, >13 for ulcerative colitis), or inflammation (FCAL>250 ug/g) at any measurement point in the study. RESULTS Of 71 women, 17 (24%) reported taking HC in the 1 year period. Adjusting for age, disease type, disease duration, and smoking status, the odds of having increased IBD-related symptoms (IBDSI) during the year were lower for women using HC compared with women not using HC [adjusted odds ratio 0.16, 95% CI, 0.02-0.90]. Conversely, women using HC were more likely to have inflammation during the year [adjusted odds ratio 5.7, 95% CI, 1.23-43.6]. CONCLUSIONS HC use among women with IBD was associated with a lower likelihood of IBD-related symptoms but a higher likelihood of experiencing intestinal inflammation (FCAL>250 ug/g) over 1 year. Further work is needed to examine this dichotomous result, potentially examining aspects such as duration of HC use, and the types of HC.
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Affiliation(s)
- Casandra Dolovich
- Departments of Internal Medicine
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB
| | - Leigh Anne Shafer
- Departments of Internal Medicine
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB
| | - Lesley A Graff
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kathy Vagianos
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB
| | - Kelcie Witges
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Charles N Bernstein
- Departments of Internal Medicine
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB
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Pham HN, Ibrahim R, Sainbayar E, Aiti D, Mouhaffel R, Shahid M, Ozturk NB, Olson A, Ferreira JP, Lee K. Ischemic heart disease mortality in individuals with inflammatory bowel disease: A nationwide analysis of disparities in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00072-1. [PMID: 38431496 DOI: 10.1016/j.carrev.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is linked to immune-mediated pathogenesis and a pro-inflammatory state, leading to accelerated atherosclerosis. This earlier onset of clinical cardiovascular disease poses significant morbidity and mortality. We sought to identify IHD mortality trends in individuals with IBD in the United States (US). METHODS Mortality due to ischemic heart diseases (IHD) as the underlying cause of death with the IBD as a contributor of death were queried from death certificates using the CDC database from 1999 to 2020. Yearly crude mortality rates (CMR) were estimated by dividing the death count by the respective population size, reported per 100,000 persons. Mortality rates were adjusted for age using the Direct method and compared by demographic subpopulations. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality. RESULTS Age-adjusted mortality rates (AAMR) decreased from 0.11 in 1999 to 0.07 in 2020, primarily between 1999 and 2018 (APC -4.41, p < 0.001). AAMR was higher among male (AAMR 0.08) and White (AAMR 0.08) populations compared to female populations (AAMR 0.06) and Black (AAMR 0.04) populations, respectively. No significant differences were seen when comparing mortality between urban (AAMR 0.07) and rural (AAMR 0.08) regions. Southern US regions (AAMR 0.06) had the lowest mortality rates when compared to the other US census regions: Northeastern (AAMR 0.08), Midwestern (AAMR 0.08), and Western (AAMR 0.08). CONCLUSION Disparities in IHD mortality exist among individuals with IBD in the US based on demographic factors, with an overall decline in mortality during the 22-year period. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.
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Affiliation(s)
- Hoang Nhat Pham
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America. https://twitter.com/ramziw_
| | - Enkhtsogt Sainbayar
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Danny Aiti
- Department of Medicine, Canton Medical Education Foundation-Northeast Ohio Medical University, Canton, OH, United States of America
| | - Rama Mouhaffel
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Mahek Shahid
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Nazli Begum Ozturk
- Department of Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - April Olson
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - João Paulo Ferreira
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Kwan Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States of America
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Brenner EJ, Zhang X, Long MD, Dubinsky MC, Kappelman MD. High Use of Estrogen-based Contraceptives in Young Women With Inflammatory Bowel Disease in the United States. Clin Gastroenterol Hepatol 2024; 22:427-429.e28. [PMID: 37482173 PMCID: PMC10800639 DOI: 10.1016/j.cgh.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Erica J Brenner
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Xian Zhang
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Millie D Long
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marla C Dubinsky
- Dr. Henry D. Janowitz Division of Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael D Kappelman
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Mitchel EB, Grossman A. Health Care Maintenance in Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am 2023; 52:609-627. [PMID: 37543404 DOI: 10.1016/j.gtc.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Patients with pediatric inflammatory bowel disease (pIBD) are at an increased risk for complications and comorbidities including infection, nutritional deficiencies, growth delay, bone disease, eye disease, malignancy, and psychologic disorders. Preventative health maintenance and monitoring is an important part to caring for patients with pIBD. Although practice is variable and published study within pIBD is limited, this article summarizes the important field of health-care maintenance in pIBD. A multidisciplinary approach, including the gastroenterologist provider, primary care provider, social worker, psychologist, as well as other subspecialists is necessary.
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Affiliation(s)
- Elana B Mitchel
- Children's Hospital of Philadelphia, Gastroenterology, Hepatology and Nutrition, 3500 Civic Center Boulevard, Floor 6, Philadelphia, PA 19104, USA.
| | - Andrew Grossman
- Children's Hospital of Philadelphia, Gastroenterology, Hepatology and Nutrition, 3500 Civic Center Boulevard, Floor 6, Philadelphia, PA 19104, USA
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7
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Kim SE. [How Should We Do Different Approach to Treat Inflammatory Bowel Disease by Gender Difference?]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:241-247. [PMID: 34035202 DOI: 10.4166/kjg.2021.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/03/2022]
Abstract
Although not as prominent, there are gender/sex differences in incidence/prevalence, clinical manifestation and disease course, comorbidities, therapeutic response, and patients coping strategy to the disease of inflammatory bowel disease (IBD). In this review, current knowledge about gender-specific differences in IBD would be provided and how to apply this in clinical practice be discussed.
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Affiliation(s)
- Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Clark-Snustad K, Butnariu M, Afzali A. Women's Health and Ulcerative Colitis. Gastroenterol Clin North Am 2020; 49:769-789. [PMID: 33121695 DOI: 10.1016/j.gtc.2020.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although ulcerative colitis affects males and females at similar rates, certain sex-specific differences influence the disease-related risks and experiences of females with ulcerative colitis. This article reviews topics that affect females with ulcerative colitis, including the impact of disease on the menstrual cycle, fertility, child bearing, sexual health, and recommendations for health care maintenance.
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Affiliation(s)
- Kindra Clark-Snustad
- Inflammatory Bowel Disease Program, Division of Gastroenterology, University of Washington, 1959 Northeast Pacific Street, Box 356424, Seattle, WA 98195, USA
| | - Madalina Butnariu
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 410 W. 10(th) Ave. 2(nd) floor, Columbus, OH 43210, USA
| | - Anita Afzali
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12(th) Avenue, Room 280, Columbus, OH 43210, USA.
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9
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Shirwaikar Thomas A, Duran A, Abraham BP. Correlation of menstrual distress to severity of gastrointestinal symptoms in inflammatory bowel disease patients. Indian J Gastroenterol 2020; 39:514-520. [PMID: 32960406 DOI: 10.1007/s12664-020-01064-5] [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: 05/15/2019] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
Inflammatory bowel diseases (IBD), namely, Crohn's disease (CD) and ulcerative colitis (UC) are idiopathic chronic, relapsing, inflammatory diseases of the gastrointestinal (GI) tract. Triggers for disease flares include medications, infection, acute stress, and the menstrual cycle. Varying ovarian hormone levels i.e. prostaglandins and progesterone may exaggerate GI symptoms in IBD. We aimed to determine the relationship between quality of life, endoscopic and clinical disease activity and the menstrual cycle among females with IBD through a questionnaire based cross-sectional study. The first 75 women of child-bearing age seen at IBD clinic completed a questionnaire incorporating the short IBD questionnaire (SIBDQ). Menstrual symptoms were evaluated using the validated Moos Menstrual Distress Questionnaire (MDQ) to measure cyclical peri-menstrual symptoms. Endoscopic disease severity was assessed using the Rutgeert's score (post ileo-cecal resection patients) or Simple Endoscopic Score for CD and the Mayo score for UC. There was a statistically negative correlation between MDQ and SIBDQ scores (p<0.001); i.e. patients with lower menstrual distress scores had better quality of life. We found no correlation between the SIBDQ, MDQ and endoscopic scores (p = 0.094, 0.626 respectively). Previous studies suggest that the severity of menstrual symptoms correlate with a poorer quality of life among women with IBD. However, this may not be reflective of the endoscopic disease severity. Larger studies are necessary to evaluate adjusting medication closer to menstrual period and adding supportive therapy peri-menstrually in anticipation of symptoms.
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Affiliation(s)
- Anusha Shirwaikar Thomas
- Underwood Center for Digestive Disorders, Houston Methodist Hospital, 6550 Fannin St. Suite 1201, Houston, TX, 77030, USA. .,Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
| | - Antonio Duran
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Bincy P Abraham
- Underwood Center for Digestive Disorders, Houston Methodist Hospital, 6550 Fannin St. Suite 1201, Houston, TX, 77030, USA.,Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
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Druvefors E, Landerholm K, Hammar U, Myrelid P, Andersson RE. Impaired Fertility in Women With Inflammatory Bowel Disease: A National Cohort Study From Sweden. J Crohns Colitis 2020; 15:383-390. [PMID: 32949133 PMCID: PMC7944497 DOI: 10.1093/ecco-jcc/jjaa191] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] has been associated with reduced female fertility. We analyse fertility in a national cohort of women with IBD. METHODS Fertility was assessed in women with IBD aged 15-44 years in 1964-2014, identified from the Swedish National Patient Register and a matched cohort [ratio 1:5]. Patients with indeterminate colitis or inconsistent IBD coding were classified as IBD-unclassified [IBD-U]. RESULTS The cohorts included 27 331 women with IBD and 131 892 matched individuals. The fertility rate in IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years and 1.62 [SD 1.28] [p <0.001] in matched individuals. Fertility was impaired in all IBD subtypes compared with the matched cohort (hazard ratio Crohn's disease [CD] 0.88, 95% confidence interval [CI] 0.85-0.91; IBD-U 0.86, 95% CI 0.83-0.89; and ulcerative colitis [UC] 0.96, 95% CI 0.93-0.98). Fertility improved during the study period for the IBD cohort except for CD. Parity progression ratio, the proportion of IBD women progressing from one parity to the next compared with the matched cohort, was decreased at all parity levels for CD and IBD-U, but only for multiparous women in UC. Contraceptive usage was higher in IBD, both before and after the diagnosis. Disease severity, bowel resections, and perianal disease in CD affected fertility negatively. CONCLUSIONS Fertility was impaired mainly in women with CD and IBD-U, and less so in UC. During the study period, fertility improved in women with UC or IBD-U. Some results suggest a role of voluntarily reduced fertility.
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Affiliation(s)
- Emma Druvefors
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Corresponding author: Emma Druvefors, MD, Department of Surgery, County Hospital Ryhov, SE- 55185 Jönköping, Sweden. Tel,: +46 - 10 - 242 13 54;
| | - Kalle Landerholm
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Myrelid
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - Roland E Andersson
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Lahat A, Falach-Malik A, Haj O, shatz Z, Ben- Horin S. Change in bowel habits during menstruation: are IBD patients different? Therap Adv Gastroenterol 2020; 13:1756284820929806. [PMID: 32577133 PMCID: PMC7290266 DOI: 10.1177/1756284820929806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/05/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIM Many female inflammatory bowel disease (IBD) patients report symptoms exacerbation before and during menses. Our aim was to characterize their symptoms and specific risk factors in comparison with healthy controls. METHODS Female IBD patients aged 18-50 years were asked to fill out a questionnaire recording their demographic and disease characteristics, menstruation history and symptoms. Disease activity was defined by Harvey-Bradshaw index (HBI) for Crohn's disease (CD) patients and modified mayo score for ulcerative colitis (UC) patients. Healthcare providers answering an internet survey assessing bowel symptoms during menstruation served as healthy controls. RESULTS A total of 139 IBD patients, of whom 100 were CD patients, filled the questionnaire. The mean age was 30.4 [±7.7 standard deviation (SD)], mean disease duration was 7.8 (±6 SD), mean HBI was 4.7 (±3.8 SD), and mean Mayo score was 2.1 (±2.5 SD). A change in bowel habits during menstruation was reported by 72% of CD patients compared with 56% of UC patients (p = 0.07). Out of 258 healthy controls, 93% reported a change in bowel habits during menstruation compared with 68% of IBD patients (p < 0.001). However, other abdominal and constitutional symptoms were significantly more prevalent among IBD patients compared with healthy controls (p < 0.01 for most parameters). Smoking status, biologic treatment, and previous abdominal operation were found to significantly aggravate symptoms during menses in IBD patients. CONCLUSION IBD patients experience various symptoms during menses significantly more commonly than healthy women. Smoking, biologic treatment, and previous abdominal operations are risk factors for higher symptomatic burden. Following future validation and research, these results can help in patients' risk stratification and possibly in risk reduction.
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Affiliation(s)
| | - Alona Falach-Malik
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ola Haj
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zina shatz
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben- Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Ghoneim S, Shah A, Dhorepatil A, Butt MU, Waghray N. The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National Study. Clin Exp Gastroenterol 2020; 13:123-129. [PMID: 32440189 PMCID: PMC7210027 DOI: 10.2147/ceg.s250182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) has been associated with an increased risk of cardiovascular events, but the risk of cerebrovascular accidents (CVA) remains unknown. Hypercoagulability and systemic inflammation are two proposed mechanisms by which the presence of IBD might lead to the development of CVA. Objective To assess the risk of CVA in patients with IBD compared to those without IBD with known traditional risk factors for CVA. Methods We reviewed data from a large commercial database (Explorys, IBM) that aggregated records from 26 health-care systems nationwide. Using systemized nomenclature of medicine – clinical terms, we identified adult patients diagnosed with IBD (ulcerative colitis or Crohn’s disease) between September 1994 and September 2019. We then examined the risk of CVA in these patients. Known risk factors such as age ≥65-years old, diabetes mellitus (DM), hypertension (HTN), female gender, atrial fibrillation (Afib) were collected. A univariate binary logistic model was constructed using CVA as the dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates was created to test for CVA. Results A total of 52,176,550 patients were included in this analysis, and 261,890 had IBD. The prevalence of CVA was higher in IBD patients compared to non-IBD patients (6.24% versus 0.48%, p <0.0001). The univariate binary logistic regression showed 13.7 times higher odds of having CVA in IBD patients than without IBD (odds ratio (OR) 13.74, p <0.0001). In multivariate binary logistic regression, after adjusting for traditional risk factors for CVA (Afib, HTN, female gender, DM, age ≥65 years), odds ratio of CVA in IBD patients remained significantly higher (OR 8.07, 95% CI: 7.9–8.2, p<0.0001). Conclusion In our large cohort of patients, IBD appears to be an independent risk factor for CVA. Further prospective studies are needed to understand the underlying mechanisms by which IBD increases the risk of CVA. This may lead to early identification and intervention to reduce the risk of CVA in this highly heterogeneous group of patients.
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Affiliation(s)
- Sara Ghoneim
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Aun Shah
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Aneesh Dhorepatil
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Muhammad Umer Butt
- Division of Cardiology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Nisheet Waghray
- Division of Gastroenterology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA
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Axelrad JE, Bazarbashi A, Zhou J, Castañeda D, Gujral A, Sperling D, Glass J, Agrawal M, Hong S, Lawlor G, Hudesman D, Chang S, Shah S, Yajnik V, Ananthakrishnan A, Khalili H, Colombel JF, Itzkowitz S. Hormone Therapy for Cancer Is a Risk Factor for Relapse of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:872-880.e1. [PMID: 31302306 PMCID: PMC7354097 DOI: 10.1016/j.cgh.2019.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Exposure to hormone contraception has been associated with an increased risk of relapse of inflammatory bowel diseases (IBDs). Little is known about the effects of cancer therapies, specifically hormone therapies, on the course of IBD. METHODS We conducted a retrospective cohort study, collecting data from 5 medical centers, on patients with IBD who received a subsequent diagnosis of breast or prostate cancer from 1997 through 2018. For patients with quiescent IBD at their cancer diagnosis, the primary outcome was relapse of IBD. For patients with active IBD at their cancer diagnosis, the primary outcome was IBD remission. RESULTS Our analysis included 447 patients with IBD (44% with Crohn's disease, 53% with ulcerative colitis, and 3% with IBD unclassified) who had either breast (78%) or prostate (22%) cancer. At their cancer diagnosis, 400 patients (90%) had inactive IBD, and 47 (10%) had active IBD. Among patients with inactive IBD, 112 (28%) developed active IBD. Previous exposure to steroids, immunomodulators, or biologics was associated with IBD relapse after a cancer diagnosis (hazard ratio [HR] for steroids, 1.79; 95% CI, 1.18-2.71; HR for immunomodulators, 2.22; 95% CI, 1.38-3.55; HR for biologics, 1.95; 95% CI, 1.01-5.36). Hormone monotherapy (HR, 2.00; 95% CI, 1.21-3.29) and combination cytotoxic and hormone therapy (HR, 1.86; 95% CI, 1.01-3.43) was associated with IBD relapse. Among 34 patients who received only cytotoxic chemotherapy, 75% remained in remission from IBD at 250 months compared with 42% of those who received hormone monotherapy (log rank, 0.02). Among patients with active IBD at their cancer diagnosis, 14 (30%) entered remission from IBD, but there were no significant factors of achieving IBD remission. CONCLUSIONS In a multicenter retrospective study, we found that patients with IBD and breast or prostate cancer who receive hormone therapy have an increased risk for relapse of IBD and related adverse outcomes.
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Affiliation(s)
- Jordan E Axelrad
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - Ahmad Bazarbashi
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Zhou
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Daniel Castañeda
- Division of Gastroenterology and Hepatology, Department of Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Amandeep Gujral
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dylan Sperling
- Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason Glass
- Division of Gastroenterology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manasi Agrawal
- Division of Gastroenterology, Department of Medicine, Lenox Hill Hospital, New York, New York
| | - Simon Hong
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, New York, New York
| | - Garrett Lawlor
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
| | - David Hudesman
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Shannon Chang
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Shailja Shah
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vijay Yajnik
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ashwin Ananthakrishnan
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Hamed Khalili
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven Itzkowitz
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Rottenstreich A, Bar-Gil Shitrit A. Preconception counseling of females with inflammatory bowel disease. Best Pract Res Clin Gastroenterol 2020; 44-45:101666. [PMID: 32359680 DOI: 10.1016/j.bpg.2020.101666] [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] [Received: 07/21/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel diseases (IBD) are commonly diagnosed in women of childbearing age. As such, pregnancy is often encountered in this subset of patients. Management of pregnancy in IBD patients poses numerous challenges as ensuring the safety of the mother and the fetus is required. Disease remission prior to pregnancy is a key determinant of both the course of IBD throughout gestation and pregnancy outcome. Thus, adequate preconception care is of paramount importance in order to achieve optimal maternal and perinatal outcomes and maintain disease quiescence throughout gestation. In addition, preconception care has a major role in improving patient's knowledge, concerns and misbeliefs related to reproductive-health issues among IBD patients. In this review, we discuss the various aspects involved in the preconception care of IBD patients.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel.
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15
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Chen Y, Wang Y, Shen J. Role of environmental factors in the pathogenesis of Crohn's disease: a critical review. Int J Colorectal Dis 2019; 34:2023-2034. [PMID: 31732875 DOI: 10.1007/s00384-019-03441-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To review role of environmental factors in the pathogenesis of Crohn's disease. METHODS We systematically reviewed trials and systematic reviews using PubMed and Web of science databases. Here, we review the current information on the causative factors and mechanisms of CD, including smoking, exercise, diet, animal protein, breastfeeding, history of childhood infection and vaccination, oral contraceptives, and antibiotics of CD. We also highlight important knowledge gaps that need to be filled in order to advance the field of CD research. RESULTS Epidemiological studies have indicated the significance of environmental factors in the disease behavior and outcome of Crohn's disease (CD). There are a few recognized environmental factors, such as cigarette smoking, exercise, dietary habits, and breastfeeding, which are associated with the pathogenesis of CD. These factors are hypothesized to change the epithelial barrier function, which disturbs both the innate and adaptive immune systems and the intestinal flora. However, the effect of several risk factors, such as appendectomy and pharmaceutical use, differs across several studies, indicating the need for more rigorous research. Furthermore, few studies have examined effective interventions based on environmental factors that can improve disease outcomes. Recent studies have indicated that the pathogenesis of CD is related to environmental and genetic factors. CONCLUSION We review the current information on the causative factors and mechanisms of CD, including smoking, exercise, diet, animal protein, breastfeeding, history of childhood infection and vaccination, oral contraceptives, and antibiotics of CD. However, further studies are needed to understand knowledge gaps in the field of CD.
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Affiliation(s)
- Yueying Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China
| | - Yining Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China
| | - Jun Shen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China.
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16
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Inflammatory bowel disease and the risk for cardiovascular disease: Does all inflammation lead to heart disease? Trends Cardiovasc Med 2019; 30:463-469. [PMID: 31653485 DOI: 10.1016/j.tcm.2019.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
Inflammation has a strong role in the development of atherosclerotic cardiovascular disease (ASCVD). Several systemic inflammatory conditions have been linked to an increased risk of ASCVD; however, this has not been well established in Inflammatory Bowel Disease (IBD). IBD is comprised of Ulcerative Colitis and Crohn's disease, both of which involve chronic inflammation of the intestinal tract, often with evidence of systemic involvement. Several ASCVD risk factors such as smoking, diabetes, poor diet and the presence of obesity may increase the risk of ASCVD in patients suffering from IBD, despite a lower prevalence of hypertension and hypercholesterolemia. Medications used to treat IBD and target inflammation, such as steroids, may also accelerate the risk of the risk for ASCVD heart failure while exacerbating ASCVD risk factors. Several studies have demonstrated an elevated risk of acute myocardial infarction and stroke in these patients, most notably in women and in younger patients. Some cohort studies have also suggested a link between IBD and both atrial fibrillation and heart failure, particularly during periods of active flares. All IBD patients, particularly younger individuals, should be screened for ASCVD risk factors with aggressive risk factor modification to reduce the risk of cardiovascular events. Further research is needed to identify how to prevent and treat cardiovascular events that occur in patients with IBD, particularly during active flares.
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17
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Limdi JK, Farraye J, Cannon R, Woodhams E, Farraye FA. Contraception, Venous Thromboembolism, and Inflammatory Bowel Disease: What Clinicians (and Patients) Should Know. Inflamm Bowel Dis 2019; 25:1603-1612. [PMID: 30877770 DOI: 10.1093/ibd/izz025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/14/2019] [Accepted: 02/05/2019] [Indexed: 12/13/2022]
Abstract
The peak incidence of the inflammatory bowel diseases (IBDs) is between the second and fourth decades of life, which coincides with prime reproductive years. Unplanned or mistimed pregnancies may account for nearly half of all pregnancies and are associated with adverse consequences such as a higher risk of delayed preconceptual care, increased risk of preterm birth, low birth weight, and adverse maternal and neonatal outcomes. Increased IBD activity during pregnancy is also associated with adverse pregnancy-related outcomes, such as miscarriage, intrauterine growth retardation, and preterm birth. Furthermore, the increased risk of venous thromboembolism (VTE) conferred by active IBD may be potentially augmented by hormonal contraceptives. Recent literature suggests that women with IBD seek counseling on contraception from gastroenterologists in preference to their primary care physicians. Meanwhile, attitudes and awareness regarding contraception counseling remain suboptimal, underpinning the importance and need for physician and patient education in this area. We discuss the association between contraception and IBD, benefits and risks associated with various contraceptive methods in women with IBD, and practical recommendations for clinicians caring for women with IBD. 10.1093/ibd/izz025_video1 izz025.video1 6014727518001 10.1093/ibd/izz025_video2 izz025.video2 6014726992001.
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Affiliation(s)
- Jimmy K Limdi
- Head-Inflammatory Bowel Diseases Section, The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.,Manchester Academic Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jennifer Farraye
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Rachel Cannon
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Elisabeth Woodhams
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Francis A Farraye
- Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts
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18
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Purewal S, Chapman S, Czuber‐Dochan W, Selinger C, Steed H, Brookes MJ. Systematic review: the consequences of psychosocial effects of inflammatory bowel disease on patients' reproductive health. Aliment Pharmacol Ther 2018; 48:1202-1212. [PMID: 30411389 PMCID: PMC6587548 DOI: 10.1111/apt.15019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/25/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND High levels of voluntary childlessness and pregnancy-related fears have been reported amongst inflammatory bowel disease (IBD) patients. AIMS To investigate what factors determine IBD patients' childbearing decisions; and to examine psychosocial consequences of IBD on various aspects of patients' reproductive health. METHODS Six electronic databases were searched in a pre-specified and structured manner. RESULTS A total of 41 articles with data on 7122 patients were included. Between one-fifth to one-third of IBD patients had chosen voluntary childlessness. Around 50% of all IBD patients have poor knowledge of pregnancy-related issues in IBD. Poor knowledge of pregnancy-related issues in IBD was associated with voluntary childlessness. Observational studies have found preconception counselling is associated with patients choosing parenthood. Pregnancy-related fears and concerns are multifaceted, stemming partly from lack of knowledge of pregnancy-related issues in IBD. Many female patients are considered at increased risk for pregnancy because between one-fifth to one-third of patients do not use contraception. Research evidence for sexual dysfunction after disease diagnosis and treatment is inconsistent. There are limited data on patients' pregnancy, postpartum and parenting experiences. A few shortcomings of the literature are evident; sample sizes were small, participation rates were low, use of non-validated questionnaires was common, and few studies included men and/or ethnic minority groups. The design of intervention studies is also weak. CONCLUSION This review recommends pre-conception counselling for all IBD patients of childbearing age to tackle poor knowledge and allow patients to make an informed decision on their reproductive health.
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Affiliation(s)
- Satvinder Purewal
- Institute of Sport and Human Science, Faculty of Education, Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Sarah Chapman
- Department of Pharmacy & PharmacologyUniversity of BathBathUK
| | | | | | - Helen Steed
- The Royal Wolverhampton NHS Trust, New Cross HospitalWolverhamptonUK
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19
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Piette JC, Dion J, Costedoat-Chalumeau N. News on Relapsing Polychondritis: The Patient's Experience. Arthritis Care Res (Hoboken) 2018; 70:1121-1123. [DOI: 10.1002/acr.23490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/05/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Jean-Charles Piette
- AP-HP; Pitié-Salpêtrière Hospital; Université Pierre et Marie Curie; Paris France
| | | | - Nathalie Costedoat-Chalumeau
- AP-HP; Cochin Hospital; Université Paris Descartes-Sorbonne Paris Cité; and INSERM U 1153; Center for Epidemiology and Statistics Sorbonne Paris Cité; Paris France
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20
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Gawron LM. Contraceptive Use in Women With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2018; 14:176-179. [PMID: 29928162 PMCID: PMC6004041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lori M Gawron
- Assistant Clinical Professor, Obstetrics and Gynecology University of Utah School of Medicine Salt Lake City, Utah
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21
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Bonthala N, Kane S. Updates on Women's Health Issues in Patients with Inflammatory Bowel Disease. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2018; 16:86-100. [PMID: 29479656 DOI: 10.1007/s11938-018-0172-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Inflammatory bowel disease affects approximately 800,000 women in the USA with the peak incidence between ages 15 to 40. Thus for many females, IBD can impact nearly every stage of their life from menarche to pregnancy, menopause, and beyond. This paper will review the most recent updates on the topics of sexual health, cervical cancer screening, menstruation, fertility, contraception, and menopause. RECENT FINDINGS Menarche can be delayed in females especially those who are underweight, malnourished, or with active inflammatory bowel disease. Cyclical GI symptoms during a menstrual cycle are very common in women with IBD and should not be confused with flares. Overall fertility is similar to the general population unless females with IBD have had significant abdominal surgery but reassuringly this infertility appears to be restored with the use of in vitro fertilization. Discussion regarding family planning is imperative in women with IBD with a strong recommendation to consider long-acting highly effective contraceptives such as intrauterine devices or implants. Cervical cancer screening should be tailored in women on immunosuppressive medications and all women under 26 years of age should be advised to receive the human papilloma virus vaccination. As gastroenterologists will have longitudinal relationships with their female IBD patients, they must be knowledgeable about sex-specific issues during each stage of life from puberty to after menopause to optimize their patient's care.
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Affiliation(s)
- Nirupama Bonthala
- Inflammatory Bowel Disease Center, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sunanda Kane
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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22
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Rolston VS, Boroujerdi L, Long MD, McGovern DPB, Chen W, Martin CF, Sandler RS, Carmichael JD, Dubinsky M, Melmed GY. The Influence of Hormonal Fluctuation on Inflammatory Bowel Disease Symptom Severity-A Cross-Sectional Cohort Study. Inflamm Bowel Dis 2018; 24:387-393. [PMID: 29361085 PMCID: PMC6196767 DOI: 10.1093/ibd/izx004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many women with inflammatory bowel disease (IBD) report changes in symptoms in association with hormonal changes during menses, pregnancy, and hormonal contraceptive use, suggesting a hormonal influence on disease activity. We aimed to identify and characterize IBD symptom fluctuations in women during times of hormonal variation. METHODS From June 2012 through September 2012, women enrolled in Crohn's and Colitis Foundation of America Partners , an online Internet cohort of patients with IBD, were invited to participate in this study. Using a 5-point Likert scale, participants were asked to rate symptom changes during their menstrual cycle, pregnancy, the postpartum period, and after menopause. Clinical and demographic differences were assessed using univariate and multivariable methods. RESULTS A total of 1,203 female patients with Crohn's disease (CD) and ulcerative colitis (UC) participated (64% CD, 34% UC). Over half of the women with IBD reported worsening symptoms during menses. Symptom changes were similar between women with CD vs UC, except in pregnancy, where symptom worsening during pregnancy was more commonly seen in UC than CD (P = 0.02). Overall, women reporting symptom worsening were younger at the time of IBD diagnosis (P < 0.01), had lower quality of life (SIBDQ) scores (P < 0.01), and had a higher BMI (25 vs 24) than women without symptom worsening. CONCLUSIONS Women with IBD report changes in symptom severity during times of hormone fluctuation. Further clarification of the role of hormones in IBD is warranted in order to understand these relationships and to identify potential management strategies for women with IBD and hormonally sensitive gastrointestinal symptoms.
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Affiliation(s)
- Vineet S Rolston
- F.Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles
| | | | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill
| | - Dermot P B McGovern
- F.Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles
| | - Wenli Chen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill
| | - Christopher F Martin
- Susan and Leonard Feinstein IBD Center, Icahn School of Medicine, Mount Sinai New York
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill
| | - John D Carmichael
- F.Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles
| | - Marla Dubinsky
- Susan and Leonard Feinstein IBD Center, Icahn School of Medicine, Mount Sinai New York
| | - Gil Y Melmed
- F.Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles,Address correspondence to: Gil Y. Melmed, MD, MS, 8730 Alden Dr, Thalians Bldg 239E, Los Angeles, CA 90048. E-mail:
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Linares PM, Algaba A, Urzainqui A, Guijarro-Rojas M, González-Tajuelo R, Garrido J, Chaparro M, Gisbert JP, Bermejo F, Guerra I, Castellano V, Fernández-Contreras ME. Ratio of Circulating Estrogen Receptors Beta and Alpha (ERβ/ERα) Indicates Endoscopic Activity in Patients with Crohn's Disease. Dig Dis Sci 2017; 62:2744-2754. [PMID: 28823012 DOI: 10.1007/s10620-017-4717-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/07/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data supporting a role of female hormones and/or their receptors in inflammatory bowel disease (IBD) are increasing, but most of them are derived from animal models. Estrogen receptors alpha (ERα) and beta (ERβ) participate in immune and inflammatory response, among a variety of biological processes. Their effects are antagonistic, and the net action of estrogens may depend on their relative proportions. AIM To determine the possible association between the balance of circulating ERβ and ERα (ERβ/ERα) and IBD risk and activity. METHODS Serum samples from 145 patients with IBD (79 Crohn's disease [CD] and 66 ulcerative colitis [UC]) and 39 controls were retrospectively studied. Circulating ERα and ERβ were measured by ELISA. Disease activities were assessed by clinical and endoscopic indices specific for CD and UC. RESULTS Low values of ERβ/ERα ratio were directly associated with clinical (p = 0.019) and endoscopic (p = 0.002) disease activity. Further analyses by type of IBD confirmed a strong association between low ERβ/ERα ratio and CD clinical (p = 0.011) and endoscopic activity (p = 0.002). The receiver operating curve (ROC) analysis showed that an ERβ/ERα ratio under 0.85 was a good marker of CD endoscopic activity (area under the curve [AUC]: 0.84; p = 0.002; sensitivity: 70%; specificity: 91%). ERβ/ERα ratio was not useful to predict UC activity. CONCLUSIONS An ERβ/ERα ratio under 0.85 indicated CD endoscopic activity. The determination of serum ERβ/ERα might be a useful noninvasive screening tool for CD endoscopic activity.
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Affiliation(s)
- Pablo M Linares
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), C/ Diego de León 62, 28006, Madrid, Spain
| | - Alicia Algaba
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, C/ Camino del Molino 2, 28942, Fuenlabrada-Madrid, Spain
| | - Ana Urzainqui
- Department of Immunology, Hospital Universitario de la Princesa, IIS-IP, C/ Diego de León 62, 28006, Madrid, Spain
| | - Mercedes Guijarro-Rojas
- Department of Pathology, Hospital Universitario de la Princesa, IIS-IP, C/ Diego de León 62, 28006, Madrid, Spain
| | - Rafael González-Tajuelo
- Department of Immunology, Hospital Universitario de la Princesa, IIS-IP, C/ Diego de León 62, 28006, Madrid, Spain
| | - Jesús Garrido
- Department of Social Psychology and Methodology, School of Psychology, Universidad Autónoma de Madrid (UAM), C/ Ivan Pavlov 6. Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), C/ Diego de León 62, 28006, Madrid, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), C/ Diego de León 62, 28006, Madrid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, C/ Camino del Molino 2, 28942, Fuenlabrada-Madrid, Spain
| | - Iván Guerra
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, C/ Camino del Molino 2, 28942, Fuenlabrada-Madrid, Spain
| | - Víctor Castellano
- Department of Pathology, Hospital Universitario de Fuenlabrada, C/ Camino del Molino 2, 28942, Fuenlabrada-Madrid, Spain
| | - María-Encarnación Fernández-Contreras
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), C/ Diego de León 62, 28006, Madrid, Spain. .,Departments of Anatomy I and Immunology, School of Medicine, Universidad Alfonso X El Sabio (UAX), Avda. de la Universidad 1, 28691, Villanueva de la Cañada, Madrid, Spain.
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24
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Böttcher B, Wildt L. Autoimmunerkrankungen und orale Kontrazeption. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Binette A, Howatt K, Waddington A, Reid RL. Ten Challenges in Contraception. J Womens Health (Larchmt) 2017; 26:44-49. [DOI: 10.1089/jwh.2016.5854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Audrey Binette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Kerry Howatt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Ashley Waddington
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Robert L. Reid
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
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Gawron L, Kane S. Oral Contraceptive Use and Crohn's Disease Complications. Gastroenterology 2016; 151:1038-1039. [PMID: 27702631 DOI: 10.1053/j.gastro.2016.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/17/2016] [Indexed: 12/02/2022]
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Cotton CC, Baird D, Sandler RS, Long MD. Hormonal Contraception Use is Common Among Patients with Inflammatory Bowel Diseases and an Elevated Risk of Deep Vein Thrombosis. Inflamm Bowel Dis 2016; 22:1631-8. [PMID: 27306071 PMCID: PMC5064836 DOI: 10.1097/mib.0000000000000800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Persons with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolism. We sought to examine whether the self-report of hormonal contraception (HC), as a proxy for exposure to estrogen-based contraception, was less common for women with multiple risk factors for venous thromboembolism. METHODS We examined the prevalence of personal use of hormonal birth control in a large internet-based cohort of patients with IBD. To determine whether HC was less common among patients with IBD with increased risk of thrombosis, we estimated unadjusted and adjusted prevalence ratios (PRs) for the use of HC. RESULTS Thousand four hundred ninety-nine female survey respondents answered optional fertility questions and were included in the analysis. The prevalence of HC was 33.7% (95% CI, 30.6%-36.9%) among women with Crohn's disease and was 32.6% (95% CI, 28.6%-36.8%) for women with ulcerative colitis. Women with one risk factor for thrombosis were not significantly less likely to receive HC (PR = 0.91, 95% CI: 0.76-1.08; adjusted PR = 0.94, 95% CI: 0.80-1.11) compared with women without risk factors nor were women with 2 or more risk factors (PR = 1.10, 95% CI 0.56-1.28; adjusted PR = 1.10, 95% CI: 0.83-1.45). The use of an intrauterine device was also similar between women with and without risk factors for venous thromboembolism. CONCLUSIONS The prevalence of HC use in women with multiple risk factors was similar to that in women without risk factors, which represents an opportunity for prevention. Gastroenterologists should ask patients with IBD using HC about risk factors for thromboembolic disease to identify patients who may benefit from alternative contraception.
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Affiliation(s)
- Cary C. Cotton
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, USA; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC, USA
| | - Donna Baird
- NIH, Epidemiology Branch, National Institute of Environmental Health Sciences, NC, USA
| | - Robert S. Sandler
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, USA; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC, USA
| | - Millie D. Long
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, USA; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC, USA
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Sanders JN, Gawron LM, Friedman S. Sexual satisfaction and inflammatory bowel diseases: an interdisciplinary clinical challenge. Am J Obstet Gynecol 2016; 215:58-62. [PMID: 26849974 DOI: 10.1016/j.ajog.2016.01.188] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the highest incidence during the reproductive years. IBD and its treatments increase the risk of sexual dysfunction for both men and women with these diseases. Women with IBD often seek care from their gynecologist and may preferentially discuss sexual experiences with them over other providers. An understanding of IBD and its impact on sexual functioning and satisfaction will improve screening, evaluation, and management for these patients. Identifying interdisciplinary providers for referrals, such as pelvic floor physical therapists and health psychologists, is a key component to long-term improvements in sexual satisfaction for women with IBD.
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Affiliation(s)
- Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
| | - Sonia Friedman
- Division of Gastroenterology, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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Long MD, Hutfless S. Shifting Away From Estrogen-Containing Oral Contraceptives in Crohn's Disease. Gastroenterology 2016; 150:1518-1520. [PMID: 27138980 DOI: 10.1053/j.gastro.2016.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Millie D Long
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Susan Hutfless
- Gastrointestinal Epidemiology Research Center, Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Abstract
Ulcerative colitis and Crohn disease are chronic inflammatory diseases with typical onset in early adulthood. These diseases, therefore, can affect a woman throughout the many stages of her life, including menstruation, sexuality, pregnancy, and menopause. Unique health issues face women during these stages and can affect the course of their inflammatory bowel disease as well as treatment strategies and health maintenance. This article covers the non-pregnancy-related issues that are important in caring for women with inflammatory bowel disease. The topics of pregnancy and fertility are covered in a separate review.
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Affiliation(s)
- Linda A Feagins
- Division of Gastroenterology and Hepatology, VA North Texas Healthcare System, University of Texas Southwestern Medical Center, 4500 S. Lancaster Rd (111B1), Dallas, TX 75216, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Gawron LM, Sanders J, Steele KP, Flynn AD. Reproductive Planning and Contraception for Women with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2016; 22:459-64. [PMID: 26484636 PMCID: PMC6861010 DOI: 10.1097/mib.0000000000000606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk for adverse pregnancy outcomes. Pregnancy outcomes for these conditions are best during stable disease remission. Unfortunately, women with inflammatory bowel disease are equally as likely as the general population to have unintended pregnancies. Patients look to their gastroenterologist for contraceptive counseling; however, the current standards for disease management do not prioritize this topic. Guidelines based on available evidence and expert opinion, such as the Centers for Disease Control U.S. Medical Eligibility Criteria for Contraceptive Use, exist to help practitioners provide safe and effective contraception to women with chronic medical conditions. If health care providers were to educate themselves and screen women with inflammatory bowel disease for risk of unintended pregnancy, there would be a reduction in the number of unintended pregnancies and subsequent adverse neonatal and maternal outcomes.
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Affiliation(s)
- Lori M. Gawron
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Ann D. Flynn
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Martin J, Kane SV, Feagins LA. Fertility and Contraception in Women With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2016; 12:101-109. [PMID: 27182211 PMCID: PMC4865770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Inflammatory bowel disease (IBD) carries a high burden in women during their reproductive years, and family planning issues are often a significant cause of concern. Fertility is normal in women with nonsurgically treated ulcerative colitis and similar or slightly reduced in women with Crohn's disease. Women who undergo ileal pouch anastomosis have reduced fertility. Fertility is likely worsened by disease activity but unaffected by medications used to treat IBD. Infertile patients with IBD respond as well as non-IBD patients to in vitro fertilization (IVF). Despite normal fertility, patients with IBD have fewer children due to concerns regarding infertility, disease inheritance, congenital abnormalities, and disease-related sexual dysfunction. Patients rarely discuss these issues with a physician. When discussion does occur, it may lead to changes in decision-making. Contraceptives are an important part of family planning, particularly during times of high disease activity. All forms of contraceptives are acceptable in patients with IBD, although there are specific considerations. The risks of combined oral contraceptives outweigh the benefits in patients with active disease and patients with prior or high risk for thromboembolism. Oral contraceptives and IBD are independently associated with an increased risk for thromboembolism, although it is not known whether this effect is compounding. Depot medroxyprogesterone acetate injection should be avoided in patients with or at risk for osteopenia. Intrauterine devices and implants are the most effective form of contraception and should be a first-line recommendation. The use of oral contraceptives is associated with the development of IBD, although there is no increased risk of disease relapse with the use of any form of contraceptive.
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Affiliation(s)
- Jason Martin
- Dr Martin is a third-year gastroenterology fellow and Dr Feagins is an associate professor of medicine in the Division of Gastroenterology and Hepatology at the University of Texas Southwestern Medical Center and the VA North Texas Healthcare System in Dallas, Texas. Dr Kane is a professor of medicine in the Department of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota
| | - Sunanda V Kane
- Dr Martin is a third-year gastroenterology fellow and Dr Feagins is an associate professor of medicine in the Division of Gastroenterology and Hepatology at the University of Texas Southwestern Medical Center and the VA North Texas Healthcare System in Dallas, Texas. Dr Kane is a professor of medicine in the Department of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota
| | - Linda A Feagins
- Dr Martin is a third-year gastroenterology fellow and Dr Feagins is an associate professor of medicine in the Division of Gastroenterology and Hepatology at the University of Texas Southwestern Medical Center and the VA North Texas Healthcare System in Dallas, Texas. Dr Kane is a professor of medicine in the Department of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota
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Rosenblatt E, Kane S. Sex-Specific Issues in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2015; 11:592-601. [PMID: 27482181 PMCID: PMC4965619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Inflammatory bowel disease (IBD) affects approximately 1 in 500 people living in the United States and generally occurs with equal frequency in men and women. However, despite equal sex distribution of the disease, men and women face unique challenges that can significantly impact quality of life. As more is discovered regarding the pathogenesis, clinical manifestations, and treatment of IBD, physiologic and psychological differences between men and women with IBD have become increasingly apparent. It is important to understand these differences, as they have the potential to affect patient care and outcomes. This article will review sex-specific issues in IBD, such as impaired body image and sexuality, increased risk of cervical cancer, altered menstrual cycles, reduced fertility, and low bone mineral density.
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Affiliation(s)
- Elizabeth Rosenblatt
- Dr Rosenblatt is a fellow at the University of Washington in Seattle, Washington. Dr Kane is a professor of medicine in the Department of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota
| | - Sunanda Kane
- Dr Rosenblatt is a fellow at the University of Washington in Seattle, Washington. Dr Kane is a professor of medicine in the Department of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota
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Optimizing the Care and Health of Women with Inflammatory Bowel Disease. Gastroenterol Res Pract 2015; 2015:435820. [PMID: 26089868 PMCID: PMC4454754 DOI: 10.1155/2015/435820] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/21/2015] [Accepted: 05/11/2015] [Indexed: 12/24/2022] Open
Abstract
Inflammatory bowel disease (IBD) including both ulcerative colitis and Crohn's disease is increasing worldwide. Although diagnosis is equally found in men and women, the chronicity of IBD poses a unique impact on the milestones of a woman's life. As the gastroenterologist becomes increasingly important in the health maintenance of patients with IBD, this review stresses the unique gender issues in women with IBD related to menstruation, cervical cancer, sexual health, contraception, and menopause that may affect the course of disease, treatment decisions, and quality of life.
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