68 research outputs found

    Development of Inflammatory Bowel Disease in HIV Patients:A Danish Cohort Study (1983-2018) With American Validation (1999-2018)

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    BACKGROUND AND AIMS: Human immunodeficiency virus (HIV) infection is associated with several immune-mediated disorders. However, the risk of inflammatory bowel disease (IBD) in people living with HIV (PLWH) remains unclear. We aimed to assess the risk of IBD among PLWH using a nationwide, population-based Danish cohort and to validate findings in a large American insurance-based database. METHODS: Using Danish registries (1983–2018), we identified 8995 PLWH and age- and sex-matched them to 449,750 HIV-negative individuals. Cox regression analysis was undertaken to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for IBD diagnosis. Results were stratified by sex, age, and year of HIV diagnosis. Using an American insurance-based cohort, Explorys (1999–2018), we assessed the prevalence odds ratio (OR) and 95% CI of IBD diagnosis in PLWH compared with HIV-negative individuals. RESULTS: IBD diagnosis among PLWH in Denmark was increased (HR: 2.25, 95% CI: 1.78–2.83) compared with matched HIV-negative individuals. This was seen for both Crohn’s disease (HR: 2.25, 95% CI: 1.47–3.44) and ulcerative colitis (HR: 2.24, 95% CI: 1.70–2.96) and in male (HR: 2.75, 95% CI: 2.15–3.52) but not female (HR: 0.93, 95% CI: 0.48–1.79) PLWH. Explorys analysis also showed an increased odds of IBD diagnoses among PLWH (OR: 1.41; 95% CI: 1.35–1.49). CONCLUSION: This study finds an increased risk of IBD diagnosis among PLWH in both a Danish and US cohort, highlighting a need to consider IBD in PLWH with new-onset gastrointestinal symptoms. Further research into the role of antiretroviral therapy in this relationship is required

    Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis

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    Background/Aims In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD). Methods Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity. Results Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%–95.4%; I2=0%), 81.5% (95% CI, 72.5%–88%; I2=43%), and 48.9% (95% CI, 32.1%–65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%–7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%–13%; I2=10%) and 5.3% (95% CI, 3.1%–8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%–18.2%; I2=55%) and 13% (95% CI, 8.5%–19.3%; I2=54%), respectively. Conclusions ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection

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    Association between vitamin D deficiency and anemia in inflammatory bowel disease patients with ileostomy

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    Background: Vitamin D deficiency is commonly seen in patients with inflammatory bowel disease (IBD). Vitamin D deficiency in IBD patients with ileostomy has not been systemically studied. The aim of the study was to assess the frequency and risk factors associated with low 25(OH) D3 levels in those patients. Methods: 112 eligible IBD patients with ileostomy were studied. Demographic, clinical, and endoscopic variables were analyzed. Vitamin D levels before and after ileostomy were compared when available. Levels of serum 25(OH)D3 <20 ng/mL were classed as being deficient. Results: 112 eligible ileostomy patients were included. The mean vitamin D level was 21.47 ± 1.08 ng/dl. Low levels of vitamin D (<30 ng/dl) were present in 92 patients (82%). Vitamin D deficiency (<20 ng/dL) was seen in 55 patients (49%). There was no difference between patients with or without vitamin D deficiency regarding demographic variables, medication use and duration of ileostomy. Neo-ileal inflammation on endoscopy was not associated with vitamin D deficiency (p = 0.155). Lower levels of phosphorus (p = 0.020) or hemoglobin (p = 0.019) and shorter duration of IBD (p = 0.047) were found in patients with vitamin D deficiency. In multivariate analysis, lower levels of phosphorus (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.16–2.89, p = 0.009) and hemoglobin (OR: 1.32, 95% CI: 1.08–1.60, p = 0.006) remained significantly associated with vitamin D deficiency. Conclusion: Vitamin D deficiency is common in IBD patients with ileostomy and is associated with low hemoglobin levels. Further studies are needed to evaluate vitamin D supplementation as a possible adjuvant in the treatment of anemia of chronic disease in IBD patients. Resumo: Introdução: A deficiência de vitamina D em pacientes com doença inflamatória intestinal submetidos a ileostomia não foi estudada sistematicamente. O objetivo desse estudo foi avaliar a frequência e os fatores de risco associados com a deficiência de vitamina D nesses pacientes. Resultados: 112 pacientes elegíveis foram incluídos. A média dos níveis de vitamina D na população estudada foi de 21.47 ± 1.08 ng/dl. Níveis de vitamina D abaixo do normal (<30 ng/dl) e deficiência de vitamina D (<20 ng/dL) foram encontrados em 92 pacientes (82%) e em 55 pacientes (49%) respectivamente. Encontrou-se uma associação entre deficiência de vitamina D e níveis mais baixos de fosforo (p = 0.020), hemoglobina (p = 0.019) e duração da doença inflamatória intestinal (p = 0.047). Na análise multivariada, níveis mais baixos de fósforo (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.16–2.89, p = 0.009) e hemoglobina (OR: 1.32, 95% CI: 1.08–1.60, p = 0.006) permaneceram associados com deficiência de vitamina D. Conclusão: A deficiência de vitamina D é comum em pacientes com doença inflamatória intestinal submetidos a ileostomia e está associada com níveis baixos de hemoglobina. Mais estudos são necessários para avaliar se a suplementação de vitamina D pode ser um adjuvante no tratamento de anemia da doença crônica nesses pacientes. Keywords: Anemia, Ileostomy, Vitamin D deficiency, Palavras-chave: Anemia, Ileostomia, Deficiência de Vitamina

    879 Post-ERCP Pancreatitis in Solid Organ Transplant Recipients

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