ibd

IBD
  • 文章类型: Journal Article
    背景:研究发现,与健康个体相比,炎症性肠病(IBD)患者并发焦虑和抑郁的风险更高。如果不及时治疗,IBD患者并发抑郁和焦虑可导致较差的健康状况和增加的医疗保健利用率。这项工作的目标是制定共识声明,以开始解决患者和提供者与IBD患者抑郁和焦虑症状的筛查和治疗相关的需求和责任。
    方法:进行文献扫描以收集基于证据的背景信息和筛查建议,诊断,以及IBD患者焦虑和抑郁的治疗。随后,由IBD和心理健康专家和患者倡导者组成的小组使用改进的Delphi程序来综合文献并将信息提炼成一组核心陈述,以支持提供者的行动和护理提供。
    结果:从与一般管理相关的文献和共识过程中提取了六项陈述,筛选,以及IBD患者焦虑和抑郁的治疗。
    结论:对IBD患者的心理健康和支持至关重要;本文中包含的陈述代表了IBD医疗保健专业人员在解决提供者意识方面的关键问题时的实际考虑。知识和行为,筛查和治疗资源,和病人的教育。
    这项工作旨在就炎症性肠病患者的焦虑和抑郁的筛查和治疗达成共识。进行了文献扫描,专家小组制定了实用的声明,以指导炎症性肠病医疗保健专业人员。
    BACKGROUND: Studies have found a higher risk of comorbid anxiety and depression among patients with inflammatory bowel disease (IBD) compared with healthy individuals. If left untreated, comorbid depression and anxiety in patients with IBD can lead to poorer health outcomes and an increased healthcare utilization. The goal of this work was to develop a consensus statement to begin to address patient and provider needs and responsibilities related to screening and treatment of depression and anxiety symptoms among patients with IBD.
    METHODS: A literature scan was conducted to gather evidence-based background information and recommendations on the screening, diagnosis, and treatment of anxiety and depression in patients with IBD. This was followed by the engagement of a panel of IBD and mental health experts and patient advocates using a modified Delphi process to synthesize the literature and distill the information into a core set of statements to support provider actions and care delivery.
    RESULTS: Six statements were distilled from the literature and consensus process that link to the general management, screening, and treatment of anxiety and depression in patients with IBD.
    CONCLUSIONS: Mental healthcare and support for IBD patients is critical; the statements included in this article represent practical considerations for IBD healthcare professionals in addressing key issues on provider awareness, knowledge and behaviors, screening and treatment resources, and patient education.
    This work aimed to develop a consensus statement on screening and treatment of anxiety and depression in individuals with inflammatory bowel disease. A literature scan was conducted, and an expert panel developed practical statements to guide inflammatory bowel disease healthcare professionals.
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  • 文章类型: Systematic Review
    背景:克罗恩病(CD)回肠结肠切除术后的结果是异质的,术后复发的明确定义尚待确定。我们的国际炎症性肠病研究组织(IOIBD)终点工作组旨在标准化术后结果,讨论哪些终点应用于术后临床试验,并定义可用于试验或注册的终点。
    方法:在对文献进行系统回顾的基础上,起草了建议和声明,并发送给IOIBD所有成员进行第一轮投票。在向所有IOIBD成员开放的共识混合会议期间,根据选民的评论对建议和声明进行了修订。如果经过两轮投票仍未达成协议,声明被排除在外。
    结果:在系统综述中,筛选了3071份手稿,其中包括434。确定了16项建议,其中11人被认可。建议和声明包括内窥镜检查仍然是金标准,应在观察性队列和随机对照试验中用作短期主要终点。在这种特定情况下,腔CD临床试验中经典使用的临床症状并不可靠。出于这个原因,长期终点应基于通过成像技术评估的宏观炎症的证据,内窥镜检查或反映的并发症的存在。
    结论:机构建议使用临床评估,就像腔内CD一样,并且不能仅基于内窥镜检查识别主要终点。这种共识导致了对定义基于术后内窥镜和/或成像的终点的需求的共识。
    BACKGROUND: Outcomes after ileocolonic resection in Crohn\'s disease [CD] are heterogeneous, and a clear definition of postoperative recurrence remains to be determined. Our Endpoints Working Group of the International Organization for the study of Inflammatory Bowel Disease [IOIBD] aimed to standardise postoperative outcomes, to discuss which endpoints should be used for postoperative clinical trials, and to define those which could be used in trials or registries.
    METHODS: Based on a systematic review of the literature, recommendations and statements were drafted and sent to all IOIBD members for a first round of voting. Recommendations and statements were revised based on the voters\' comments during a consensus hybrid conference open to all IOIBD members. If no agreement was reached after two rounds of voting, the statement was excluded.
    RESULTS: In the systematic review, 3071 manuscripts were screened of which 434 were included. Sixteen recommendations were identified, of which 11 were endorsed. Recommendations and statements include that endoscopy remains the gold standard and should be used as a short-term primary endpoint in both observational cohorts and randomised controlled trials. Clinical symptoms classically used in clinical trials for luminal CD are not reliable in this specific situation. For that reason, longer-term endpoints should be based on the evidence of macroscopic inflammation assessed by imaging techniques, endoscopy, or as reflected by the presence of complications.
    CONCLUSIONS: Agencies recommend the use of clinical evaluations, as in the case of luminal CD, and do not recognise primary endpoints based solely on endoscopy. This consensus has led to agreement on the need to define postoperative endoscopy-based and/or imaging-based endpoints.
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  • 文章类型: Journal Article
    目的:与普通人群相比,炎症性肠病患者发生结直肠癌的风险增加。一些已发布的临床指南建议进行内窥镜监测以检测早期的发育不良变化。提供有关监视程序的时间和执行的建议。在临床实践中,缺乏遵守这些指南的数据。
    方法:2005年1月至2014年6月,在澳大利亚医院的服务网络中,对所有新诊断为炎症性肠病的患者进行了纵向初始队列研究,并在胃肠病诊所进行了连续随访,直至2022年12月31日。如果患者需要根据澳大利亚指南进行监测,则将其包括在内。报告了遵守准则以及技术和质量措施的情况。
    结果:共纳入136例患者,共进行了263次监测程序.95例患者(70%)在正确的时间间隔内进行了首次结肠镜检查。50名患者(37%)在所有监视程序的时间安排方面完全遵守指南。监测程序的总体异型增生检出率为10%。仅在16%的程序中进行了彩色内窥镜检查。
    结论:在手术时机和色素内镜的使用方面,对内镜监测指南的依从性较差。进一步的临床医生教育,在国家结肠镜检查培训计划中推广监测指南和纳入色素内镜检查培训可能会提高对指南的依从性.
    OBJECTIVE: Patients with inflammatory bowel disease have an increased risk of developing colorectal cancer as compared with the general population. Endoscopic surveillance to detect early dysplastic changes is advised by several published clinical guidelines, which provide recommendations as to the timing and performance of surveillance procedures. There is a paucity of data as to adherence with these guidelines in clinical practice.
    METHODS: A longitudinal inception cohort study of all new patients diagnosed with inflammatory bowel disease across a service network of Australian hospitals between January 2005 and June 2014, with continuous follow-up in a gastroenterology clinic until December 31, 2022. Patients were included if they warranted surveillance according to the Australian guidelines. Adherence to guidelines and technical and quality measures were reported.
    RESULTS: A total of 136 patients were included, and a total of 263 surveillance procedures were performed. Ninety-five patients (70%) had their first surveillance colonoscopy within the correct time interval. Fifty patients (37%) were completely adherent to guidelines with respect to timing of all surveillance procedure. The overall dysplasia detection rate for surveillance procedures was 10%. Chromoendoscopy was only performed in 16% of procedures.
    CONCLUSIONS: Adherence to endoscopic surveillance guidelines with regard to timing of procedures and the utilization of chromoendoscopy is poor. Further clinician education, promotion of the surveillance guidelines and incorporation of chromoendoscopy training as part of the national colonoscopy training program may improve adherence to guidelines.
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  • 文章类型: Journal Article
    原发性硬化性胆管炎(PSC)是炎症性肠病(IBD)的经典肝胆表现,是西方世界肝移植(LT)的主要指征。在这篇文章中,我们就LT实践发表共识声明,由欧洲器官移植学会(ESOT)的专门指南工作组开发。首要目标是就普遍辩论的主题提供实际指导,包括LT的指示和时间,移植等待名单上患者胆管狭窄的处理,移植的技术方面,移植后的免疫抑制策略,肠切除的时机和延长以及再次移植的无效标准。
    Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of inflammatory bowel disease (IBD) and a lead indication for liver transplantation (LT) in the western world. In this article, we present a Consensus Statement on LT practice, developed by a dedicated Guidelines\' Taskforce of the European Society of Organ Transplantation (ESOT). The overarching goal is to provide practical guidance on commonly debated topics, including indications and timing of LT, management of bile duct stenosis in patients on the transplant waiting list, technical aspects of transplantation, immunosuppressive strategies post-transplant, timing and extension of intestinal resection and futility criteria for re-transplantation.
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  • 文章类型: Journal Article
    随着生物起源药物的专利到期,生物仿制药正在成为医疗保健系统中具有成本效益的替代品。解决炎症性肠病(IBD)临床管理中的各种挑战仍然至关重要。为了阐明医生当前的知识,信仰,实用的方法,以及与生物仿制药采用相关的担忧-是否启动生物仿制药,从创始人过渡到生物仿制药,或在生物仿制药之间切换(包括多个切换和反向切换)-进行了全球调查。来自13个国家的15名在IBD领域具有专业知识的医生参加了一次虚拟的国际共识会议,以制定有关全球生物仿制药采用的实用指南,考虑到调查结果。这一共识集中在涉及生物仿制药有效性的10项关键声明上,安全,适应症,理由,多个开关,生物仿制药的治疗药物监测,非医疗转换,和未来的前景。最终,共识确认,与原始药物相比,生物仿制药同样有效和安全。它们被认为适用于未接受生物治疗的患者和以前接受过原始药物治疗的患者,降低成本是从原始药物过渡到生物仿制药的主要动机。
    As the patents for biologic originator drugs expire, biosimilars are emerging as cost-effective alternatives within healthcare systems. Addressing various challenges in the clinical management of inflammatory bowel disease (IBD) remains crucial. To shed light on physicians\' current knowledge, beliefs, practical approaches, and concerns related to biosimilar adoption-whether initiating a biosimilar, transitioning from an originator to a biosimilar, or switching between biosimilars (including multiple switches and reverse switching)-a global survey was conducted. Fifteen physicians with expertise in the field of IBD from 13 countries attended a virtual international consensus meeting to develop practical guidance regarding biosimilar adoption worldwide, considering the survey results. This consensus centered on 10 key statements covering biosimilar effectiveness, safety, indications, rationale, multiple switches, therapeutic drug monitoring of biosimilars, non-medical switching, and future perspectives. Ultimately, the consensus affirmed that biosimilars are equally effective and safe when compared to originator drugs. They are considered suitable for both biologic-naïve patients and those who have previously been treated with originator drugs, with cost reduction being the primary motivation for transitioning from an originator drug to a biosimilar.
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  • 文章类型: Systematic Review
    背景:许多研究已经检查了克罗恩病(CD)和溃疡性结肠炎患者的肠道微生物生态学,但炎症性肠病相关分类群和生态效应大小在研究之间并不一致。
    方法:我们系统地搜索了PubMed和GoogleScholar,并对13项研究进行了荟萃分析,以分析样本类型(粪便,活检,和灌洗)影响炎症性肠病肠道微生物组研究的结果,对所有主要数据使用统一的生物信息学方法。
    结果:α多样性降低是CD和溃疡性结肠炎的一致特征,但在CD中更为明显。在大多数研究中,疾病对β多样性的影响很大,但是效果大小不同,样品类型的影响大于疾病的影响。梭杆菌是与CD最相关的属,但疾病相关属在研究之间大多不一致.粪便研究的异质性低于活检研究,尤其是CD。
    结论:我们的结果表明,样本类型变异是研究变异性的重要因素,在研究设计过程中应仔细考虑,由于其异质性较低,粪便在CD研究中可能优于活检。
    为了评估炎症性肠病微生物组研究的可重复性,我们对13项炎症性肠病研究进行了荟萃分析,测量疾病和样本类型的影响。克罗恩病研究比溃疡性结肠炎研究更异质性,样本类型变异是导致不一致的主要原因。
    Numerous studies have examined the gut microbial ecology of patients with Crohn\'s disease (CD) and ulcerative colitis, but inflammatory bowel disease-associated taxa and ecological effect sizes are not consistent between studies.
    We systematically searched PubMed and Google Scholar and performed a meta-analysis of 13 studies to analyze how variables such as sample type (stool, biopsy, and lavage) affect results in inflammatory bowel disease gut microbiome studies, using uniform bioinformatic methods for all primary data.
    Reduced alpha diversity was a consistent feature of both CD and ulcerative colitis but was more pronounced in CD. Disease contributed significantly variation in beta diversity in most studies, but effect size varied, and the effect of sample type was greater than the effect of disease. Fusobacterium was the genus most consistently associated with CD, but disease-associated genera were mostly inconsistent between studies. Stool studies had lower heterogeneity than biopsy studies, especially for CD.
    Our results indicate that sample type variation is an important contributor to study variability that should be carefully considered during study design, and stool is likely superior to biopsy for CD studies due to its lower heterogeneity.
    To assess reproducibility in inflammatory bowel disease microbiome research, we performed a meta-analysis of 13 inflammatory bowel disease studies, measuring effects of disease and sample type. Crohn’s disease studies were more heterogeneous than ulcerative colitis studies, and sample type variation was a major contributor to inconsistency.
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  • 文章类型: Journal Article
    炎症性肠病(IBD)是一种慢性全身性炎症性疾病,可能会对接受选择性眼科手术的患者的手术结果产生不利影响。在这个系列中,11例溃疡性结肠炎或克罗恩病患者的21只眼行激光原位角膜磨镶术(LASIK),屈光性角膜切除术(PRK),或小切口微透镜提取(SMILE)。术后随访平均8.9±4.6个月。这项研究中的所有患者都做得很好,到术后3个月,100%的眼睛矫正远距视力达到未矫正的远距视力20/20。术后期间注意到的常见症状包括干眼症,刺激,异物感,和模糊的视力,所有这些在随访期间的患病率和严重程度都有所改善,没有一个病人经历了他们的疾病发作。尽管这些患者取得了成功的结果,作者认识到IBD患者手术的固有风险.目前,临床医生没有一致的指导方针,以确保他们充分筛查这些患者的资格,所以作者建议一个相关的,集中审查系统,一份简短的IBD病史相关问卷,以及用于手术评估的初步手术决策流程图。
    Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition that can potentially adversely affect surgical outcomes in patients receiving elective ophthalmic procedures. In this case series, 21 eyes of 11 patients with ulcerative colitis or Crohn\'s disease underwent laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). Their surgical outcomes were followed up for an average of 8.9 ± 4.6 months. All the patients in this study did well, with 100% of eyes corrected for distance vision achieving uncorrected distance visual acuity 20/20 by postoperative month three. Common symptoms noted during the postoperative period included dry eyes, irritation, foreign body sensation, and blurry vision, all of which improved in prevalence and severity over the follow-up period, and none of the patients experienced a flare-up of their disease. Despite the successful outcomes in these patients, the authors recognize the inherent risks of operating on patients with IBD. Currently, there are no consensus guidelines for clinicians to follow to ensure that they are adequately screening these patients for eligibility, so the authors are suggesting a relevant, focused review of systems, a brief IBD history-related questionnaire, and a preliminary surgical decision-making flowchart for use in surgical evaluation.
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  • 文章类型: Journal Article
    背景:炎症性肠病(IBD)是缓解和复发的疾病,主要关注胃肠道。IBD与心理社会不适的状况有关,这严重损害了患者的生活质量和充分参与自我管理的能力。因此,IBD患者的有效护理不仅应包括医疗支持,还应包括心理支持,以改善患者的健康。虽然这,迄今为止,还没有标准化的方法来促进IBD患者的心理健康,以提高对护理质量的认识。为了填补这个空白,我们组织了一次共识会议,以确定IBD患者的社会心理需求,并促进他们参与日常临床实践.本文描述了实施的过程,并说明了从中得出的建议,其中重点介绍了多学科方法在IBD管理中的重要性。
    结果:共识会议分为三个阶段:(1)有关生活经历的文献综述,订婚,和IBD患者的心理社会需求;(2)与IBD专家和患者代表的研讨会;(3)起草声明和投票。七十三名与会者参与了共识会议,在协商一致过程中,已经表决并批准了16项声明。
    结论:主要结论是早期检测的必要性,在需要的情况下,干预患者的心理社会需求,以实现患者参与IBD护理。
    BACKGROUND: Inflammatory bowel diseases (IBD) are remitting and relapsing diseases that mainly interest the gastrointestinal tract. IBD is associated with a condition of psycho-social discomfort that deeply compromises the quality of life and the competence of patient to be fully engaged in their self-management. As a consequence, effective care of IBD patients should include not only medical but also psychological support in order to improve patients\' wellbeing. Although this, to date there is no standardized approach to promote psychological wellbeing of IBD patients in order to improve the perception of the quality of the care. To fill this gap, a consensus conference has been organized in order to define the psychosocial needs of IBD patients and to promote their engagement in daily clinical practice. This paper describes the process implemented and illustrates the recommendations deriving from it, which focus on the importance of a multidisciplinary approach in IBD management.
    RESULTS: The consensus conference has been organized in three phases: (1) literature review about life experiences, engagement, and psychosocial needs of IBD patients; (2) workshops with IBD experts and patients\' representatives; (3) drafting of statements and voting. Seventy-three participants were involved in the consensus conference, and sixteen statements have been voted and approved during the consensus process.
    CONCLUSIONS: The main conclusion is the necessity of the early detection of - and, in case of need, intervention on- psycho-social needs of patients in order to achieve patient involvement in IBD care.
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  • 文章类型: Consensus Development Conference
    暂无摘要。
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  • 文章类型: Journal Article
    炎性肠病(IBD)的症状和临床过程因个体而异。因此,个性化护理对于有效管理至关重要,由强大的以患者为中心的多学科团队提供,在精心设计的服务中工作。这项研究旨在完全重写英国成人和儿童IBD医疗保健标准,并开发IBD服务基准测试工具,以支持当前和未来的个性化护理模式。
    由英国IBD领导,由患者组成的全国多学科联盟,并提名了IBD护理所有主要利益相关者的代表,标准要求由689名患者和151名医疗保健专业人员的调查数据确定。在三轮修改的electronic-Delphi上起草和完善了标准。
    就涵盖七个临床领域的59项标准达成共识;(1)多学科IBD服务的设计和交付;(2)诊断前转诊途径,协议和时间表;(3)新诊断患者的整体护理;(4)支持患者赋权的耀斑管理,自我管理,并在需要时接触专家;(5)手术,包括适当的专业知识,术前信息,心理支持和术后护理;(6)住院医疗服务提供(7)以及门诊和初级护理环境中的持续长期护理,包括共享护理。使用这些以患者为中心的标准,并由IBD质量改善项目(IBDQIP)提供信息,本文提出了一个国家基准框架。
    标准和基准测试工具为医疗保健提供者和患者提供了一个评估其服务质量的框架。这将承认优秀的护理,促进质量改进,IBD的审计和服务开发。
    UNASSIGNED: Symptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models.
    UNASSIGNED: Led by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi.
    UNASSIGNED: Consensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework.
    UNASSIGNED: The Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.
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