Anemia in inflammatory bowel diseases: the approaches to its diagnosis, treatment and prevention

Anemia is a frequent systemic complication and extra-intestinal manifestation of inflammatory bowel diseases (IBD). Despite significant progress in IBD treatment, late diagnosis and insufficient correction of concomitant anemia remain a problem in routine clinical practice. The review describes the main pathophysiological mechanisms of IBD-associated anemia, such as iron deficiency, chronic inflammation (anemia of chronic disease) and B9 and B12 deficiencies. The authors highlight the main diagnostic principles of these conditions, present the strategy for their differential diagnosis, describe the state-of-theart approaches to the correction of iron-deficient anemia in IBD, and delineate the role of oral and parenteral medications for replacement therapy. Optimal treatment goals and prevention methods of an iron-deficient condition are given. Special attention is focused on the principles on red cell mass transfusions in acute massive blood loss. The authors describe the main differentiating features of anemia of chronic disease and its treatment in IBD patients with various grades of the inflammation. The paper contains the indications and treatment regimens for B12 and foliate-deficient anemia with consideration of the IBD course. The authors of the article are members of the Working Group of the Russian Society on the study of IBD and believe that the literature analysis performed would allow for its use to issue the Russian clinical guidelines on the management of patients with anemia in ulcerative colitis and Crohn's disease

Management of patients with comorbidity during novel coronavirus (COVID-19) pandemic. National Consensus Statement 2020

The pandemic of the novel coronavirus infection (COVID-19), caused by SARS‑CoV‑2, has become a challenge to healthcare systems in all countries of the world. Patients with comorbidity are the most vulnerable group with the high risk of adverse outcomes. The problem of managing these patients in context of a pandemic requires a comprehensive approach aimed both at the optimal management in self-isolated patients not visiting medical facilities, and management of comorbidities in patients with COVID-19. The presented consensus covers these two aspects of managing patients with cardiovascular disease, diabetes, chronic obstructive pulmonary disease, gastrointestinal disease, and also pay attention to the multiple organ complications of COVID-19

Endoscopic and deep remission at 1 year prevents disease progression in early Crohn’s disease: long-term data from CALM

Background We aimed to describe the long-term impact of achieving endoscopic and deep remission among participants in the effect of tight control management on CD (CALM) trial. Methods We analysed medical records from patients with follow-up data since end of CALM. Patients were stratified by outcomes in CALM at 1 year: clinical remission (Crohn’s disease activity index, CDAI &lt;150), endoscopic remission (Crohn’s disease endoscopic index of severity, CDEIS &lt;4 with no deep ulcerations), and deep remission (CDAI &lt;150, CDEIS &lt;4 with no deep ulcerations, and no steroids for ≥8 weeks). The primary outcome was a composite of major adverse outcomes reflecting CD progression: new internal fistula/abscess, stricture, perianal fistula/abscess, CD hospitalisation, or CD surgery since end of CALM. Kaplan–Meier and Cox regression methods were used to compare composite rates between patients who achieved or did not achieve remission at 1 year. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) are reported, controlling for randomisation arm and baseline variables significant at p &lt; 0.2 level. Results One hundred twenty-two patients with median age 29 years (IQR 22.5–37) and median disease duration 0.2 years (IQR 0.1–0.8) were included. Median follow-up time from end of CALM was 3.02 years (range 0.05–6.26 years). Fifty per cent were randomised to the tight control arm. There were no significant differences in baseline characteristics in patients with follow-up data and those lost to follow-up with the exception of a slightly higher CDEIS score in patients lost to follow-up (14.6 vs. 12.9, p = 0.04). Thirty-four patients (27.9%) had a major adverse outcome during follow-up. Patients in clinical remission at 1 year did not have significantly lower rates of the composite endpoint (log-rank p = 0.15). Patients in endoscopic and deep remission at the end of CALM were significantly less likely to have a major adverse event over time (Figures 1 and 2). After adjusting for age, disease duration, prior surgery, prior stricture, and randomisation arm, endoscopic remission (aHR 0.44, 95% CI 0.20–0.96, p = 0.038) and deep remission (aHR 0.25, 95% CI 0.09–0.72, p = 0.01) were significantly associated with lower risk of major adverse events. Conclusions Early CD patients who achieve endoscopic or deep remission after 1 year of intensive treatment are less likely to have disease progression over a median of 3 years.</p