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Ghersin I, Weisshof R, Koifman E, Bar-Yoseph H, Ben Hur D, Maza I, Hasnis E, Nasser R, Ovadia B, Dror Zur D, Waterman M, Gorelik Y. Comparative evaluation of a language model and human specialists in the application of European guidelines for the management of inflammatory bowel diseases and malignancies. Endoscopy 2024. [PMID: 38499197 DOI: 10.1055/a-2289-5732] [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: 03/20/2024]
Abstract
BACKGROUND Society guidelines on colorectal dysplasia screening, surveillance, and endoscopic management in inflammatory bowel disease (IBD) are complex, and physician adherence to them is suboptimal. We aimed to evaluate the use of ChatGPT, a large language model, in generating accurate guideline-based recommendations for colorectal dysplasia screening, surveillance, and endoscopic management in IBD in line with European Crohn's and Colitis Organization (ECCO) guidelines. METHODS 30 clinical scenarios in the form of free text were prepared and presented to three separate sessions of ChatGPT and to eight gastroenterologists (four IBD specialists and four non-IBD gastroenterologists). Two additional IBD specialists subsequently assessed all responses provided by ChatGPT and the eight gastroenterologists, judging their accuracy according to ECCO guidelines. RESULTS ChatGPT had a mean correct response rate of 87.8%. Among the eight gastroenterologists, the mean correct response rates were 85.8% for IBD experts and 89.2% for non-IBD experts. No statistically significant differences in accuracy were observed between ChatGPT and all gastroenterologists (P=0.95), or between ChatGPT and the IBD experts and non-IBD expert gastroenterologists, respectively (P=0.82). CONCLUSIONS This study highlights the potential of language models in enhancing guideline adherence regarding colorectal dysplasia in IBD. Further investigation of additional resources and prospective evaluation in real-world settings are warranted.
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Affiliation(s)
- Itai Ghersin
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Roni Weisshof
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Eduard Koifman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Haggai Bar-Yoseph
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Dana Ben Hur
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Itay Maza
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Erez Hasnis
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Roni Nasser
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dikla Dror Zur
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
| | - Matti Waterman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yuri Gorelik
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
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Lichtenstein L, Koslowsky B, Ben Ya’acov A, Avni-Biron I, Ovadia B, Ben-Bassat O, Naftali T, Kopylov U, Haberman Y, Eran HB, Eliakim R, Lahat-Zok A, Hirsch A, Zittan E, Maharshak N, Waterman M, Israeli E, Goren I, Ollech JE, Yanai H, Ungar B, Avidan B, Ben Hur D, Melamud B, Segol O, Shalem Z, Dotan I, Odes SH, Ben-Horin S, Snir Y, Milgrom Y, Broide E, Goldin E, Delgado S, Ron Y, Cohen NA, Maoz E, Zborovsky M, Odeh S, Abu Freha N, Shachar E, Chowers Y, Engel T, Reiss-Mintz H, Segal A, Zinger A, Bar-Gil Shitrit A. COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience. Vaccines (Basel) 2022; 10:vaccines10030376. [PMID: 35335008 PMCID: PMC8950285 DOI: 10.3390/vaccines10030376] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.
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Affiliation(s)
- Lev Lichtenstein
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | - Benjamin Koslowsky
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Ami Ben Ya’acov
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel;
| | | | - Timna Naftali
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yael Haberman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hagar Banai Eran
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Adi Lahat-Zok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ayal Hirsch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Zittan
- Inflammatory Bowel Disease Unit, Ha’emek Medical Center, Faculty of Medicine, Israel Institute of Technology, Afula, Israel;
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
| | - Nitsan Maharshak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Matti Waterman
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Israeli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel
| | - Idan Goren
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Jacob E. Ollech
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Bella Ungar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Benjamin Avidan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dana Ben Hur
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernardo Melamud
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel
| | - Ori Segol
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel;
| | - Zippora Shalem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Selwyn H. Odes
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Shomron Ben-Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yf’at Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Yael Milgrom
- Hadassah Medical Center, Jerusalem, Israel; (Y.M.); (A.Z.)
| | - Efrat Broide
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Eran Goldin
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Shmuel Delgado
- Assuta Medical Center, Ben-Gurion University, Negev, Be’er Sheva, Israel;
| | - Yulia Ron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Nathaniel Aviv Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Maoz
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | - Maya Zborovsky
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | | | - Naim Abu Freha
- Soroka Medical Center, Be’er Sheva, Israel; (N.A.F.); (A.S.)
| | - Eyal Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yehuda Chowers
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Engel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hila Reiss-Mintz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Arie Segal
- Soroka Medical Center, Be’er Sheva, Israel; (N.A.F.); (A.S.)
| | - Adar Zinger
- Hadassah Medical Center, Jerusalem, Israel; (Y.M.); (A.Z.)
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
- Correspondence:
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Bar-Yoseph H, Daoud H, Ben Hur D, Chowers Y, Waterman M. Does early corticosteroid therapy affect prognosis in IBD patients hospitalized with Clostridioides difficile infection? Int J Colorectal Dis 2020; 35:513-519. [PMID: 31927638 DOI: 10.1007/s00384-019-03502-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Corticosteroids (CS) therapy to Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) flares may worsen CDI outcomes. AIM Assess the impact of early CS exposure on outcomes of IBD patients diagnosed with CDI. METHODS Retrospective study of IBD patients admitted with first-time CDI between 2002 and 2018. Comparisons were made based on CS exposure 48 h from admission. Patients were further subdivided to 5 groups based on CS-antibiotics temporal exposure. The primary outcome was all-cause mortality or colectomy within 3 months. Secondary outcomes were colectomy and mortality rates at 1 year, length of stay, readmissions, bacteremia, and diarrhea improvement by day 7/discharge. Cox proportional hazard model and Kaplan-Meier curves were used to assess the effects on survival. Logistic and ordinal regressions were used to assess primary and secondary outcomes. RESULTS One hundred thirteen patients (64 CD, 46 UC, and 3 IBDU) were included, 82 (72.5%) received early CS. At baseline, CRP was significantly lower and albumin was higher in the group not exposed to early CS. At 3 months, 4 (4.8%) patients required colectomy and 6 (5.8%) died (p = NS). Length of stay was significantly reduced among patients not exposed to early CS. All other endpoints were not associated with CS exposure. In subgroup analysis, the primary outcome was not significantly different among the sub-groups. Mortality rate at 1 year was significantly lower in patients who did not receive antibiotics for CDI. CONCLUSION Early CS therapy in IBD patients hospitalized with CDI is not associated with worse clinical outcomes. However, additional prospective research is required.
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Affiliation(s)
- Haggai Bar-Yoseph
- Department of Gastroenterology, Rambam Health Care Campus, 8th Haalia Hashnia st., 3109601, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Haneen Daoud
- Department of Internal Medicine H, Rambam Health Care Campus, 8th Haalia Hashnia st., 3109601, Haifa, Israel
| | - Dana Ben Hur
- Department of Gastroenterology, Rambam Health Care Campus, 8th Haalia Hashnia st., 3109601, Haifa, Israel
- Department of Internal Medicine H, Rambam Health Care Campus, 8th Haalia Hashnia st., 3109601, Haifa, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, 8th Haalia Hashnia st., 3109601, Haifa, Israel
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Clinical Research Institute, Rambam Health Care Campus, Haifa, Israel
| | - Matti Waterman
- Department of Gastroenterology, Rambam Health Care Campus, 8th Haalia Hashnia st., 3109601, Haifa, Israel
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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