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Urquhart SA, Chedid VG, Kane SV. Use of Upadacitinib as Salvage Therapy for Ulcerative Colitis in Pregnancy: A Case Report. Inflamm Bowel Dis 2024:izae146. [PMID: 38970379 DOI: 10.1093/ibd/izae146] [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: 05/27/2024] [Indexed: 07/08/2024]
Abstract
Lay Summary
Upadacitinib, a selective JAK-1 inhibitor, was used as rescue therapy for ulcerative colitis in the setting of pregnancy following use of mesalamine, vedolizumab, infliximab, and corticosteroids. This resulted in an uncomplicated live full birth without need for surgical intervention.
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Affiliation(s)
- Siri A Urquhart
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor G Chedid
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Rodriguez AK, Muir SM, Tjiattas-Saleski L. Newly Diagnosed Ulcerative Colitis in the Third Trimester: A Case Report. Cureus 2023; 15:e46004. [PMID: 37900441 PMCID: PMC10602013 DOI: 10.7759/cureus.46004] [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] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Ulcerative colitis is a chronic inflammatory bowel disease that results in continuous colon inflammation. It is uncommonly diagnosed during pregnancy, and if quiescent before pregnancy, becomes active very rarely. Current literature has found that amelioration of the disease can be common during the second and third trimesters. However, if ulcerative colitis is active, it has the potential to result in premature delivery and low birth weight. This case focuses on a rare presentation of primary ulcerative colitis diagnosed in a 22-year-old multiparous patient to highlight the importance of a comprehensive differential diagnosis in pregnant patients with seemingly benign symptomatology.
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Affiliation(s)
- Arley K Rodriguez
- Obstetrics and Gynecology, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Sean M Muir
- Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Lindsay Tjiattas-Saleski
- Clinical Affairs, Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, USA
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Laube R, Selinger CP, Seow CH, Christensen B, Flanagan E, Kennedy D, Mountifield R, Seeho S, Shand A, Williams AJ, Leong RW. Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding. Gut 2023; 72:1040-1053. [PMID: 36944479 DOI: 10.1136/gutjnl-2022-329304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD. DESIGN A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported. RESULTS Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary. CONCLUSION These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.
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Affiliation(s)
- Robyn Laube
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
| | | | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Britt Christensen
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Reme Mountifield
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sean Seeho
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Antonia Shand
- Department of Maternal Foetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Rupert W Leong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Chaparro M, Kunovský L, Aguas M, Livne M, Rivière P, Bar-Gil Shitrit A, Myrelid P, Arroyo M, Barreiro-de Acosta M, Bautista M, Biancone L, Biron IA, Boysen T, Carpio D, Castro B, Dragoni G, Ellul P, Holubar SD, de Jorge MÁ, Leo E, Manceñido N, Moens A, Molnár T, Ramírez de la Piscina P, Ricanek P, Sebkova L, Sempere L, Teich N, Gisbert JP, Julsgaard M. Surgery due to Inflammatory Bowel Disease During Pregnancy: Mothers and Offspring Outcomes From an ECCO Confer Multicentre Case Series [Scar Study]. J Crohns Colitis 2022; 16:1428-1435. [PMID: 35380641 DOI: 10.1093/ecco-jcc/jjac050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS i] To evaluate the evolution of pregnancies and offspring after inflammatory bowel disease [IBD] surgery during pregnancy; and ii] to describe the indications, the surgical techniques, and the frequency of caesarean section concomitant with surgery. METHODS Patients operated on due to IBD during pregnancy after 1998 were included. Participating clinicians were asked to review their databases to identify cases. Data on patients' demographics, IBD characteristics, medical treatments, IBD activity, pregnancy outcomes, surgery, delivery, and foetal and maternal outcomes, were recorded. RESULTS In all, 44 IBD patients were included, of whom 75% had Crohn's disease; 18% of the surgeries were performed in the first trimester, 55% in the second, and 27% in the third trimester. One patient had complications during surgery, and 27% had postsurgical complications. No patient died. Of deliveries, 70% were carried out by caesarean section. There were 40 newborns alive. There were four miscarriages/stillbirths [one in the first, two in the second, and one in the third trimester]; two occurred during surgery, and another two occurred 2 weeks after surgery; 14% of the surgeries during the second trimester and 64% of those in the third trimester ended up with a simultaneous caesarean section or vaginal delivery. Of the 40 newborns, 61% were premature and 47% had low birth weight; 42% of newborns needed hospitalisation [25% in the intensive care unit]. CONCLUSIONS IBD surgery during pregnancy remains an extremely serious situation. Therefore, surgical management should be performed in a multidisciplinary team, involving gastroenterologists, colorectal surgeons, obstetricians, and neonatal specialists.
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Affiliation(s)
- María Chaparro
- Hospital Universitario de La Princesa, [IIS-IP], UAM, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - Lumír Kunovský
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mariam Aguas
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | | | | | | | - Pär Myrelid
- Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Maite Arroyo
- Hospital Clínico Universitario Lozano Blesa and CIBERehd, IIS Aragón, Zaragoza, Spain
| | | | | | | | | | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Pontevedra, Spain
| | - Beatriz Castro
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | | | | | - Eduardo Leo
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Noemí Manceñido
- Hospital Universitario Infanta Sofía. San Sebastián de los Reyes, Spain
| | | | - Tamás Molnár
- University of Szeged, Albert Szent-Györgyi Medical School, Department of Internal Medicine, Szeged, Hungary
| | | | | | | | - Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Niels Teich
- Practice for Internal Medicine, Leipzig, Germany
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, [IIS-IP], UAM, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
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5
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Ollech JE, Avni-Biron I, Glick L, Haider H, Dalal SR, Micic D, Pekow J, Yanai H, Cohen RD, Dotan I, Rubin DT, Sakuraba A. Effective Treatment of Acute Severe Ulcerative Colitis in Pregnancy Is Associated With Good Maternal and Fetal Outcomes. Clin Gastroenterol Hepatol 2021; 19:2444-2446.e2. [PMID: 33223497 DOI: 10.1016/j.cgh.2020.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Data regarding the management and outcomes of acute severe ulcerative colitis (ASUC) in pregnant patients is sparse, consisting mainly of case reports.1-3 We report on the largest cohort of pregnant patients hospitalized with ASUC and performed a systematic review of the medical literature.
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Affiliation(s)
- Jacob E Ollech
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois; Inflammatory Bowel Disease Center, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - Irit Avni-Biron
- Inflammatory Bowel Disease Center, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Laura Glick
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Haider Haider
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Sushila R Dalal
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Dejan Micic
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Joel Pekow
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Henit Yanai
- Inflammatory Bowel Disease Center, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Russel D Cohen
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Iris Dotan
- Inflammatory Bowel Disease Center, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Atsushi Sakuraba
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
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Singh G, Prentice R, Langsford D, Christensen B, Garg M. Altered bowel habit and rectal bleeding in pregnancy: the importance of recognising undiagnosed inflammatory bowel disease. Intern Med J 2021; 51:424-427. [PMID: 33738932 DOI: 10.1111/imj.15231] [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: 05/30/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
Worsening of disease activity during pregnancy in patients with known inflammatory bowel disease, especially ulcerative colitis (UC), is well recognised, but the diagnosis of new-onset or previously undiagnosed UC in pregnancy has been inadequately studied to date. Recognition of gastrointestinal symptoms in pregnancy as potentially indicating UC is of paramount importance, as this allows appropriate investigation and instigation of therapies to optimise maternal and foetal outcomes. Here, we report three cases of women with gastrointestinal symptoms in pregnancy with disparate outcomes.
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Affiliation(s)
- Gurpreet Singh
- Department of Gastroenterology, Northern Hospital, Melbourne, Victoria, Australia
| | - Ralley Prentice
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Langsford
- Department of Nephrology and Obstetric Medicine, Northern Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mayur Garg
- Department of Gastroenterology, Northern Hospital, Melbourne, Victoria, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Laparoscopic right and transverse colectomy for fulminant colitis during pregnancy. Tech Coloproctol 2021; 25:889-890. [PMID: 33761032 DOI: 10.1007/s10151-021-02414-x] [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: 11/30/2020] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
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