Inflammatory bowel diseases
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Inflamm. Bowel Dis. · Jun 2017
Modified Delphi Process for the Development of Choosing Wisely for Inflammatory Bowel Disease.
The prevalence and incidence of inflammatory bowel disease (IBD) in North America is among the highest in the world and imparts substantial direct and indirect medical costs. The Choosing Wisely Campaign was launched in wide variety of medical specialties and disciplines to reduce unnecessary or harmful tests or treatment interventions. ⋯ The Choosing Wisely recommendations will foster patient-physician discussions to optimize IBD therapy, reduce adverse effects from testing and treatment, and reduce medical expenditure.
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Patients with Crohn's disease (CD) are often prescribed opioids chronically to manage pain associated with their disease. However, little evidence exists to support this practice. Here, we examine newly diagnosed patients with CD with and without chronic opioid use (COU) and sought to identify predictors and consequences of COU. ⋯ This study presents a nationally representative assessment of COU in newly diagnosed patients with CD. The results may be used to determine the impact of COU in this population and to alert clinicians to those patients with CD at high risk of COU. Chronic opioids are consistently associated with indicators of more severe disease; however, additional research is needed to determine whether COU drives disease severity or vice versa.
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Inflamm. Bowel Dis. · May 2017
Patient-Reported Outcomes of Quality of Life, Functioning, and GI/Psychiatric Symptom Severity in Patients with Inflammatory Bowel Disease (IBD).
Patients with inflammatory bowel disease (IBD) are at risk for psychiatric disorders that impact symptom experience and health-related quality of life (HRQOL). Therefore, comprehensive biopsychosocial assessments should be considered in ambulatory care settings. Patient-Reported Outcomes Measurement Information System (PROMIS) measures created by the National Institutes of Health have shown construct validity in a large IBD internet-based cohort, but their validity in ambulatory settings has not been examined. We sought to validate PROMIS patient-reported measures of HRQOL, functioning, and psychiatric symptom severity at a tertiary IBD clinic. ⋯ PROMIS instruments provide valid assessment of HRQOL and functioning in ambulatory adults with IBD. Of note, patients with Crohn's disease demonstrated significantly worse impairments than those with ulcerative colitis.
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Inflamm. Bowel Dis. · Apr 2017
Review Meta AnalysisRisk for Overall Infection with Anti-TNF and Anti-integrin Agents Used in IBD: A Systematic Review and Meta-analysis.
The overall risk for infection with contemporary biological agents in treating Crohn's disease (CD) and ulcerative colitis (UC) has not been systematically assessed. ⋯ Anti-tumor necrosis factor therapy but not anti-integrin therapy is associated with a greater infection risk than placebo in treating UC. Neither class of therapy is associated with increased infection risk over placebo in treating CD. Our findings can help guide patient-centered discussions regarding the risk for infection with biological agents.
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Inflamm. Bowel Dis. · Feb 2017
Comparative Study Observational StudyDiffusion-weighted MRI Enables to Accurately Grade Inflammatory Activity in Patients of Ileocolonic Crohn's Disease: Results from an Observational Study.
Diffusion-weighted imaging (DWI) is a novel technique to evaluate bowel inflammation in Crohn's disease (CD). It remains unclear whether DWI could differentiate grades of inflammation activity and add to the accuracy of conventional magnetic resonance enterography (MRE) in defining disease activity. We aimed to assess the accuracy of DWI for evaluating ileocolonic CD inflammation compared with conventional MRE, using ileocolonoscopy as reference standard. ⋯ DWI enables to accurately grade inflammatory activity in patients of ileocolonic CD and may be better suited than conventional MRE for monitoring the activity of CD.