Abstract:BackgroundCrohn's disease (CD) and ulcerative colitis (UC) are the most frequent inflammatory bowel disorders (IBD). IBD cause a significant burden to society due to extensive health care utilization from the first clinical symptoms until diagnosis and thereafter due to direct and indirect costs. Besides the socio-economic impact of CD and UC, gastrointestinal and extraintestinal symptoms affect quality of life, but there is remarkably little data about the quality of treatment as assessed by patient satisfact… Show more
“…In IBD prodromes of between 4 and 4.5 years have been reported: n = 66, median 7.7 years ± 10.7 years in Crohn's disease; median 1.2 ± 1.8 years in ulcerative colitis [3]; n = 86 of which 19% had a mean prodrome of 4 years or greater [4]. Furthermore, prodromes of 11-year duration were recently reported in The Manitoba IBD Cohort Study (n = 112, mean duration 11 years, ranging from 3 to 48 years) [5].…”
This is the first study to make direct comparisons of prodrome periods between celiac disease and IBD. Prodrome duration in celiac disease is significantly longer and more often characterized by P-IBS than IBD. In celiac disease and CD, P-IBS increases prodrome duration. This may represent a failure to understand the overlap between IBS and celiac disease/IBD.
“…In IBD prodromes of between 4 and 4.5 years have been reported: n = 66, median 7.7 years ± 10.7 years in Crohn's disease; median 1.2 ± 1.8 years in ulcerative colitis [3]; n = 86 of which 19% had a mean prodrome of 4 years or greater [4]. Furthermore, prodromes of 11-year duration were recently reported in The Manitoba IBD Cohort Study (n = 112, mean duration 11 years, ranging from 3 to 48 years) [5].…”
This is the first study to make direct comparisons of prodrome periods between celiac disease and IBD. Prodrome duration in celiac disease is significantly longer and more often characterized by P-IBS than IBD. In celiac disease and CD, P-IBS increases prodrome duration. This may represent a failure to understand the overlap between IBS and celiac disease/IBD.
“…The few studies having looked at adherence to guidelines among gastroenterologists have revealed equivocal results 30,31 . However, the treatment of CD appeared to be appropriate in most patients according to cohort studies from Switzerland and Europe 32,33 .…”
BACKGROUND: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation. AIMS: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics. METHODS: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318). RESULTS: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%). CONCLUSIONS: Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.
“…Quality-of-life studies were performed in inflammatory bowel diseases,8,14–17 in clinical trials, HRQL was used as a secondary endpoint 12. However, no study has assessed patients’ satisfaction in CD 10. A recent prospective study showed that despite the preference of CD patients for adalimumab versus infliximab for maintenance, a proportion of patients returned to infliximab due to intolerance, supporting the importance of patients’ outcomes in patients’ behavior towards CD’s therapeutics and their efficacy 18…”
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