Contraceptive use among women with inflammatory bowel disease: A systematic review

Background

There are theoretical concerns that use of hormonal contraceptives by women with inflammatory bowel disease (IBD) might increase disease relapse and risk of other adverse health outcomes, including thrombosis. In addition, there are concerns that IBD-related malabsorption might decrease the effectiveness of orally ingested contraceptives. The objective of this systematic review was to evaluate the evidence on the safety and effectiveness of contraceptive use among women with IBD.

Study Design

We searched the PubMed database for peer-reviewed articles relevant to contraceptive use and IBD that were published in any language from inception of the database through February 2009. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence.

Results

From 207 articles, we identified 10 studies that met our inclusion criteria. Evidence from five cohort studies (Level II-2, fair to good) suggests no increased risk of IBD relapse with use of oral contraceptives. Evidence from two pharmacokinetic studies (not graded) suggests that women with mild ulcerative colitis and those with an ileostomy following a proctocolectomy with small ileal resections have plasma concentrations of steroid hormones after oral ingestion of higher doses of combined oral contraceptives that are similar to the plasma concentrations among healthy volunteers. No studies were found that examined the risk of thrombosis among women with IBD who used hormonal contraceptives.

Conclusions

Limited evidence suggests there is no increased risk of disease relapse among women with IBD who use oral contraceptives, and there seem to be no differences in the absorption of higher-dose combined oral contraceptives between women with mild ulcerative colitis and small ileal resections and healthy women.     

Immune response to influenza and pneumococcal vaccines in adults with inflammatory bowel disease: A systematic review and meta-analysis of 1429 patients

BackgroundPatients with inflammatory bowel disease (IBD) have a high risk for infection. Pneumonia related to influenza and pneumococcal infection is one of the most common infection-related complications in IBD.AimsTo evaluate the immunogenicity of pneumococcal and influenza vaccination in patients with IBD receiving different treatments.MethodsWe searched four databases for studies evaluating seroprotection and seroconversion rates after influenza or pneumococcal vaccination in IBD on 20th October 2020. In the meta-analysis, odds ratios (OR) were calculated with 95% confidence intervals (CI).ResultsWe included twelve studies (1429 patients with IBD) in this meta-analysis. The seroconversion rate after pneumococcal vaccination and the seroprotection rate after influenza vaccination were not significantly lower in patients receiving conventional immunosuppressive treatment compared to the non-immunosuppressed patients. Meanwhile, the seroconversion rate following pneumococcal vaccine was significantly lower in patients with anti-TNF mono- or combination therapy (OR = 0.28, CI: 0.15–0.53, and OR = 0.27, CI: 0.15–0.49, respectively). In the analysis of patients with IBD on conventional immunosuppressive monotherapy versus anti-TNF therapy, the seroprotection rate after influenza immunization did not differ between patients receiving either anti-TNF mono-or combination therapy (OR = 1.45, CI: 0.62–3.38 and OR = 0.91, CI: 0.37–2.22, respectively).ConclusionOur data suggest that the immunization against Pneumococcus and influenza is safe and immunogenic despite immunosuppression.     

New nutritional approach to inflammatory bowel disease: the nutraceuticals

The clinical course of inflammatory bowel disease (IBD) is characterised by periods of quiescent disease interspersed with episodes of active inflammation; consequently, malabsorption and malnutrition are the most important problems in IBD patients. It has been widely demonstrated that nutritional support allows more tolerability both to drugs and surgery therapy increases the duration of remission. Among enteral formula enriched in specific nutraceuticals like glutamine or transforming growth factor β2 used in IBD, we tested those enriched with omega 3, soluble fibre and arginine. We observed a high compliance and a statistically significant improvement of symptoms, nutritional status, inflammatory index and Crohn’s disease activity index. A specific nutritional intervention, in particular specific enteral nutrition formula, is essential in the prevention and treatment of malnutrition caused by IBD.     

Familial aggregation of inflammatory bowel disease in a Mediterranean area

To evaluate familial aggregation of inflammatory bowel disease (IBD) in the Mediterranean area and to estimate the disease risk in first degree relatives. 427 patients with IBD were consecutively interviewed in order to obtain a complete pedigree of first degree relatives. Sufficient information was obtained in 98% of 2,685 family members. The prevalence ratio of IBD in family members was estimated and compared to the prevalence ratio of IBD in general population; the ratio was then standardized by age since the prevalence of the disease is age-dependent. The lifetime risk was assessed by the Kaplan Meier method. Thirty index cases (7%) had at least one affected first degree relative. As compared with the general population, first degree relatives of the 427 patients with IBD had a 4.38-fold increase in the age corrected risk of having the same disease. The Kaplan-Meier curve showed a higher risk at 25 years of age for offsprings (3%) than for parents (1%) and siblings (1%) whereas the crude ratio showed a higher risk for siblings (1.9%) compared to parents (0.8%) and offsprings (1%). In the Mediterranean area, the familial prevalence of IBD is higher than in the general population and comparable to North European rates.Abbreviations CD Crohn's disease - IBD inflammatory bowel disease - UC ulcerative colitis     

Factors predicting response to hepatitis B vaccination in patients with inflammatory bowel disease

Hepatitis-B-seronegative patients with inflammatory bowel disease (IBD) should be vaccinated. However, response to vaccination in this population seems to be poorer than in healthy people. The aim of this study is to assess which clinical, analytical and immunosuppressive therapy parameters affect the response to hepatitis B vaccination in patients with IBD. A follow-up including monitoring of the immunosuppressive therapy of a cohort of 123 patients with IBD was carried out after each round of vaccination against hepatitis B virus. The recombinant HBsAg vaccine (20 μg) was administered using the standard regimen (0, 1 and 6 months). Anti-HBs values >10 IU/L after 1–3 months post-vaccination were considered as a successful response to vaccination. One hundred and five patients (85.5%) completed the programme and response to vaccination was observed in 50 (47.6%) patients. Multivariate analysis showed an independent relationship, with weaker response to vaccination, for IBD duration equal to or longer than 110 months [adjusted OR (95% CI): 0.282 (0.114–0.701)], serum albumin levels below 3.6 mg/dl at the beginning of vaccination [adjusted OR (95% CI): 0.336 (0.112–1.009)], and corticosteroid therapy in more than one vaccination dose [adjusted OR (95% CI): 0.333 (0.135–0.820)]. This study confirms the poor response to hepatitis B vaccination in patients with IBD, being particularly weak in individuals with long-term IBD progression, low serum albumin levels and those on corticosteroid therapy.     

Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis

BACKGROUND: It has long been believed that breastfeeding provides protection against ulcerative colitis and Crohn disease. Studies designated to test this hypothesis were conducted without reaching conclusive results. OBJECTIVE: The aim of this meta-analysis was to examine the role of breastfeeding in preventing inflammatory bowel disease and to summarize the evidence gathered about this subject. DESIGN: A meta-analysis was performed on 17 relevant articles that were found by using MEDLINE, EMBASE, the Internet, and articles' references. The publications were fully reviewed and divided, on the basis of their quality, into 3 groups. RESULTS: Studies showed heterogeneous results. The pooled odds ratios of all the 17 reviewed studies, calculated according to the random-effects model, were 0.67 (95% CI: 0.52, 0.86) for Crohn disease and 0.77 (0.61, 0.96) for ulcerative colitis. However, only 4 studies for Crohn disease and 4 for ulcerative colitis were eventually included in the highest quality group. In this group, the pooled odds ratio was 0.45 (0.26, 0.79) for Crohn disease and 0.56 (0.38, 0.81) for ulcerative colitis. CONCLUSIONS: The results of this meta-analysis support the hypothesis that breastfeeding is associated with lower risks of Crohn disease and ulcerative colitis. However, because only a few studies were graded to be of high quality, we suggest that further research, conducted with good methodology and large sample sizes, should be carried out to strengthen the validity of these observations.     

Role of diet and nutrition in inflammatory bowel disease

Inflammatory bowel diseases (IBDs) are closely linked to nutrition. The latest research indicates that diet and nutrition are significantly involved in the etiopathogenesis of the disease, although their specific role throughout its clinical course still remains unclear. This study reviewed how diet and nutrition are associated with IBD development and management. Even though specific diets have been shown to bring about positive outcomes, there is currently no scientific consensus regarding an appropriate diet that would benefit all IBD patients. We suggest that individualized dietary recommendations are of the greatest importance and that diets should be planned to provide individual IBD patients with specific nutrient requirements while keeping all the clinical aspects of the patients in mind. Further research is clearly necessary to investigate nutritional factors involved in IBD development and, especially, to evaluate the applications of the diets during the course of the disease.     

益生菌改善炎症性肠病患者的临床效果观察

目的探讨益生菌在炎症性肠病患者中的应用效果。方法选取2015年8月-2016年4月中山市博爱医院收治的炎症性肠病患者60例,以随机数字表法分为对照组和观察组各30例。对照组给予美沙拉嗪肠溶片治疗,观察组在对照组基础上加用益生菌治疗,比较两组的治疗效果以及炎症因子水平。结果观察组总有效率为96.67%,明显高于对照组80.00%,治疗后两组CRP、IL-6、ESR水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。结论益生菌在炎症性肠病临床治疗中的应用有助于促进炎症反应消退,使患者早日康复,值得临床推广应用。     

内质网应激、肠黏膜屏障与炎症性肠病

未折叠蛋白在内质网中大量蓄积引起的内质网应激(ERS),可能是引起炎症性肠病(IBD)的关键机制,受到人们广泛的关注.肠上皮细胞分泌功能高,极易受ERS的影响.上皮细胞未折叠蛋白反应(UPR)途径的自身缺陷或细胞内错误折叠蛋白产生过多,都可引起ERS,导致肠黏膜屏障损伤和肠黏膜炎症.而肠腔共生菌群和黏膜炎性因子等,都可...     

炎症性肠病122例临床分析

目的 探讨炎症性肠病（IBD）患者的临床治疗现状.方法 调查122例IBD患者的临床特点及诊疗特征.结果 122例IBD患者中,54例为溃疡性结肠炎（UC）,病变范围以广泛结肠为主,就诊医院中位数3家,使用氨基水杨酸制剂、糖皮质激素、免疫抑制剂、生物制剂和抗生素分别为100.0％（54/54）,55.6％（30/54）,24.1％（13/54）,7.4％ （4/54）,75.9％（41/54）;68例为克罗恩病（CD）,病变范围以空回肠＋结肠为主,就诊医院中位数4家,使用过氨基水杨酸制剂、糖皮质激素、免疫抑制剂、生物制剂和抗生素分别为95.6％（65/68）,58.8％（40/68）,47.1％（32/68）,11.8％ （8/68）,79.4％（54/68）.CD患者使用免疫抑制剂、喹诺酮类抗生素均高于UC患者,使用中草药治疗的低于UC患者,差异有统计学意义（P＜0.05）.结论 目前治疗IBD的主要药物有氨基水杨酸制剂、糖皮质激素、免疫抑制剂、生物制剂.     

Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease

Alcohol consumption is a potential trigger for flare in inflammatory bowel disease (IBD) flare because of alcohol's pro-oxidant effects and its deleterious effects on gut barrier function. The association with alcohol consumption and IBD flare is unclear. To test this hypothesis, we evaluated the pattern of alcohol consumption and its self-reported effect on gastrointestinal (GI) symptoms in patients with IBD. We recruited 129 consecutive patients: 52 patients with Crohn's disease, 38 patients with ulcerative colitis, and 39 patients with irritable bowel syndrome (IBS). All the participants completed a validated questionnaire on disease activity (the Crohn's disease activity index or ulcerative colitis clinical activity index, respectively) validated questionnaires to quantify alcohol consumption by National Institute of Alcohol Abuse and Alcoholism criteria, and two structured questionnaires we designed to access patients' perception of the effect of alcohol on their GI symptoms and on overall GI symptom severity. The pattern of current, light, moderate, and heavy alcohol consumption in inactive IBD was similar to the general U.S. population. Specifically, of the 90 inactive IBD patients, 56 (62%) were current drinkers, compared with 61% in the general U.S. population. Of current drinkers, 75% of IBD (N = 42) and 43% of IBS (N = 9) reported a worsening of GI symptoms with alcohol consumption (P = .01); however, overall GI symptom severity did not differ when compared with quantity of alcohol consumed. Patients with inactive IBD drink alcohol in quantities similar to the general population. Current drinkers with inactive IBD are more likely to report worsening of GI symptoms with alcohol than current drinkers with IBS.     

限制性液体治疗对炎症性肠病术后并发症和预后的影响

目的:探讨限制性液体治疗对炎症性肠病(IBD)病人术后并发症和预后的影响. 方法:将87例IBD病人随机分为限制输液组(n=44)和标准输液组(n=43).限制输液组病人术后连续3d输注液体,20 ml/( kg·d),依据体重、碱缺失、血清乳酸水平、血氧合指标及其额外丢失量;标准输液组术后连续3d输注液体,按照生理需...     

活动性炎症性肠病与血小板参数的相关性及其临床意义

目的研究炎症性肠病(IBD)患者血液中血小板计数和平均血小板体积是否可以作为评价IBD活动性的参考指标。方法选取IBD病例160例,其中溃疡性结肠炎(UC)85例,克隆病(CD)75例;非IBD病例121例。摘录病例中的血小板计数和平均血小板体积。结果UC和CD病例中的血小板计数均比非IBD病例高,而平均血小板体积均比非IBD病例低,差异有统计学意义。血小板计数和平均血小板体积均与UC的炎症程度分级有相关关系,与CD的简易CD活性指数评分也有相关关系。结论血小板计数和平均血小板体积可作为评价IBD活动性的参考指标。     

活动性炎症性肠病与血小板参数的相关性及其临床意义

目的研究炎症性肠病（IBD）患者血液中血小板计数和平均血小板体积是否可以作为评价IBD活动性的参考指标。方法选取IBD病例160例，其中溃疡性结肠炎（UC）85例，克隆病（CD）75例；非IBD病例121例。摘录病例中的血小板计数和平均血小板体积。结果UC和CD病例中的血小板计数均比非IBD病例高，而平均血小板体积均比非IBD病例低，差异有统计学意义。血小板计数和平均血小板体积均与UC的炎症程度分级有相关关系，与CD的简易CD活性指数评分也有相关关系。结论血小板计数和平均血小板体积可作为评价IBD活动性的参考指标。