No abstract

No abstract

No abstract

BackgroundThe safety of opiate use for patients with Crohn’s disease (CD) has long been a concern. The recent Crohn’s therapy, resource, evaluation, and assessment tool (TREAT) registry update has added to these concerns by demonstrating an association of opiate use with an increased risk of infection and death in CD. While the association is clear, the relationship of opiates to these negative outcomes is not. It is unknown whether opiates are a contributing factor to these negative outcomes or if their use is merely a marker of more severe disease. We hypothesized that opiate use is not harmful in CD but is a marker of disease severity and would be associated with commonly accepted clinical markers of severe CD such as early age at CD onset, disease duration, small intestinal involvement, a history of fistula or stricture, and lower quality of life (QOL) scores.MethodsData on CD history including pain medication usage were obtained from an interviewer directed survey of patients admitted to two tertiary care hospitals over a 2-year period. CD as the primary admitting diagnosis was not required. Active opiate use was defined by usage within the past month prior to admission.ResultsA total of 133 patients were approached to participate, of whom 108 consented to the survey, and 51 were active opiate users. Opiate using CD patients were more commonly smokers (22% vs. 3.45%, P < 0.010), had fistulas (40% vs. 22.4%, P < 0.048) and had a poorer quality of life score by short form inflammatory bowel disease questionnaire (mean 3.80 vs. 4.34, P < 0.036) than non-opiate users. No difference was found between opiate users and non-users for age of diagnosis, disease duration, or a history of strictures.ConclusionsThe study findings demonstrate that opiate use in CD is associated with markers of disease severity including fistulas, smoking, and lower QOL scores. The findings suggest that opiates may not be directly harmful to patients with CD, but may merely be another marker of disease severity. However, given opiates unproven benefits for long term CD pain control and risk of dependence, caution should still be exercised in their use.

INTRODUCTION: The Baveno VI criteria states that patients with a platelet count greater than 150,000/µl and liver stiffness less than 20 kPa on transient elastography (TE) are at low risk for gastroesophageal varices in compensated cirrhosis and can safely forego screening endoscopy (EGD). Despite being validated in multiple studies, the familiarity with this criteria and degree of utilization is unclear among gastroenterologists. METHODS: An 11-question multiple choice survey was distributed to gastroenterologists including fellows in training. Questions pertained to clinicians’ approach to compensated cirrhotic patients. Baseline data was obtained from all respondents regarding years in practice, practice setting, state of practice, volume of EGDs performed annually for screening varices, rates of diagnosis of varices, and frequency of ordering TE in compensated cirrhotics. Respondents were then asked about their familiarity and use of the Baveno VI criteria, their willingness to adopt it in their practice, and their reservations with the criteria. Responses were anonymous and recorded from 4/24/19 to 6/9/19. RESULTS: One hundred twenty-two completed surveys were analyzed. The experience of the respondents ranged from being in fellowship to being in practice over 20 years, Graph 1. The most common practice setting was within an academic teaching hospital (n = 77, 63.1%), and 115 respondents (94.3%) reported adherence to screening EGD at time of diagnosis of cirrhosis at least 75% of the time. Most respondents (n = 75, 61.5%) endorsed ordering TE less than 25% of the time. Furthermore, the majority of respondents (n = 106, 86.9%) either were unfamiliar with the criteria or did not use them in clinical practice despite familiarity, Graph 2. Reservations about adopting the criteria centered on a perceived lack of substantiated data regarding TE (n = 44, 36.1%) and its absence from guidelines by predominant GI societies (n = 27, 22.1%), Table 1. CONCLUSION: Our survey showed that a majority of gastroenterologists are unaware of the existence and potential use of the Baveno VI criteria. As in any invasive procedure, EGD has an inherent risk of complications. Additionally, the costs associated with screening EGDs may pose an unnecessary economic burden to the healthcare system. Provision of validated data, education of the criteria, availability of non-invasive TE, and incorporation of the criteria into GI societies’ guidelines may increase the awareness and implementation of the criteria into clinical practice.

No abstract

No abstract

No abstract