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Balram B, winczura N, Kao DH, Dieleman LA, Halloran B, Kroeker K, Peerani F, Huang V, Wong K. A163 MAJORITY OF INFLAMMATORY BOWEL DISEASE PATIENTS WITH RECURRENT CLOSTRIDIOIDES INFECTION DO NOT REQUIRE FECAL MICROBIOTA TRANSPLANTATION. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with inflammatory bowel disease (IBD) are at increased risk of developing Clostridioides difficile infection (CDI) and have worse outcomes including higher rates of colectomy and death, and experience higher rates of recurrent CDI (rCDI). However, it is still not clear whether rCDI is a cause of refractory IBD or a consequence of the inflammatory state in the colon.
Aims
We aimed to assess the outcomes of rCDI in patients with active IBD compared to inactive IBD in the era of fecal microbiota transplantation (FMT)
Methods
This is a retrospective cohort of adult IBD patients with rCDI at the IBD centre at the University of Alberta hospital between 2014–2017. rCDI was defined as a recurrent episode occurring within 60 days of the prior after successful treatment with antibiotics. We collected demographic and clinical characteristics, along with the rCDI-related and FMT outcomes in patients with active and inactive IBD. Active IBD was based on clinical assessment using a combination of disease severity scores (Harvey Bradshaw Index, partial Mayo scores), presence of active disease on colonoscopy, clinical symptoms and/or treatment escalation or change in the month leading up to rCDI diagnosis.
Results
Over the study period, 56 IBD patients (50% ulcerative colitis, 28/56) had a total of 85 rCDI episodes. Thirty-four percent (19/56) of patients had two or more rCDI episodes. Forty-one percent (35/85) of rCDI episodes were toxin positive while the remainder were only PCR positive. Thirty-nine percent (33/85) had active IBD at the time of CDI diagnosis. Patients with active IBD were more likely to have rCDI (1.7 rCDI episodes vs. 1.5, p=0.018). IBD treatment escalation was also more likely in the active IBD cases (79% vs. 44%, p = 0.002) with the use of steroids (27% vs 2%, p = 0.001) and addition of biologics (18% vs. 2%, p = 0.013). Active IBD cases were also more likely to be hospitalized (30% vs. 10%, p = 0.02) and were more likely to receive FMT (27% vs. 4%, p = 0.003). There was no difference in the time between rCDI episodes, antibiotic exposure or colectomy rates between the two groups.
Conclusions
Compared to IBD patients in remission, patients with active IBD are more likely to experience rCDI, IBD treatment escalation and FMT. It is interesting to note that only 27% of patients with recurrent CDI required FMT suggesting CDI may be a marker of active or refractory disease rather than a cause. Larger, prospective studies are needed to help clarify this association.
Funding Agencies
None
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Affiliation(s)
- B Balram
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - n winczura
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - D H Kao
- University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B Halloran
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Kroeker
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Medicine, University of Alberta, Edmonton, AB, Canada
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Balram B, Al Khoury A, Bessissow T, Afif W, gonczi L, abreu M, Lakatos PL. A174 PATIENT PERSPECTIVES AND EXPECTATIONS IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Shared decision making is gaining favour in clinical practice and increasingly patients want to be involved in their disease process.
Aims
In this systematic review, our objective was to assess inflammatory bowel disease (IBD) patient preferences and perspectives relating to their disease diagnosis, treatment, knowledge needs and telemedicine.
Methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Four databases and conference proceedings were searched between January 1, 1980, and May 1, 2020. The methodological quality of the included studies was assessed using the Standards for reporting qualitative research (SRQR) checklist.
Results
Our search identified 240 citations and 51 studies met the inclusion criteria. The major expectations of the patients are symptomatic and pain control, quality of life and normal endoscopy. Patients’ main concerns are access to information and healthcare, and shared decision making. At the time of diagnosis, patients expressed a greater need for knowledge about their IBD, preferentially by their treating gastroenterologist. The main treatment expectations in active disease are efficacy, safety and convenience. Patients are willing to accept relatively high risks of complications from medical therapy to avoid a permanent ostomy and to achieve durable remission. Patients are more interested in disease monitoring, research and development during the time of remission. Telemedicine and self-management with supervised e-health tools are feasible and acceptable amongst IBD patients.
Conclusions
This systematic review demonstrates that IBD patients expect more information about their disease process, shared decision making and symptom control. Further research is needed to help align patient and physician expectations in order to improve the quality of care provided to IBD patients.
Funding Agencies
None
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Affiliation(s)
- B Balram
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - A Al Khoury
- University of Miami School of Medicine, Miami, FL
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - l gonczi
- Semmelweis Egyetem, Budapest, Hungary
| | - m abreu
- University of Miami School of Medicine, Miami, FL
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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Rambabu N, Dubey P, Ram B, Balram B. Synthesis, Characterization and Antimicrobial Evaluation of (E)-N'-[(1-(2-methoxy-6-pentadecylbenzyl)-1H-1,2,3-triazol-4-yl]- methylene)benzohydrazide Derivatives. ACTA ACUST UNITED AC 2016. [DOI: 10.14233/ajchem.2016.19310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Venkatasatyanarayana G, Rao VL, Chary MT, Ram B, Balram B, Laxminarayana E. Synthesis and Biological Evaluation of 4-(4-Chlorophenyl)cyclohexane Carbohydrazide Derivatives as Anti-Bacterial Agents. ACTA ACUST UNITED AC 2015. [DOI: 10.14233/ajchem.2015.18731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Narisetty R, Chandrasekhar K, Mohanty S, Balram B. Synthesis of Novel Hydrazone Derivatives of 2, 5-difluorobenzoic Acid as Potential Antibacterial Agents. LETT DRUG DES DISCOV 2013. [DOI: 10.2174/1570180811310070009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Balram B, Johri M, Ako-Arrey D, Lambert G, Claessens C, Klein M, Cajas JM, Peeling R, Pai NP. P1-S4.30 Point-of-Care HIV Testing with OraQuick Advance HIV-1/2 antibody assay: a systematic review of cost outcomes. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ram B, Balram B, Sai Prakash P. (±)-Trans-2-[3-methoxy-4-(4-chlorophenyl thioethoxy)-5-cyanophenyl]-5-(3,4,5-trimethoxyphenyl)tetrahydrofuran, a potent PAF-receptor antagonist. Tetrahedron 1999. [DOI: 10.1016/s0040-4020(99)00544-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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