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Mistakes in inflammatory bowel disease and reproduction and how to avoid them

C. Janneke van der Woude, Shannon Kanis

Summary

AI Generated

Disease activity during pregnancy is the most important risk factor for adverse pregnancy outcomes in patients with inflammatory bowel disease.

  • Inflammatory bowel disease is a chronic relapsing gastrointestinal disease that often affects young people during their fertile years and typically requires lifelong medical treatment.
  • Disease activity at the time of conception and during pregnancy is associated with negative pregnancy outcomes including spontaneous abortion, preterm delivery, and low birth weight.
  • Questions about fertility and pregnancy frequently arise in patients with IBD given the chronic nature of the disease and the age group it affects.
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Baird DD, Narendranathan M and Sandler RS. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology 1990; 99: 987–994. [Link]
2.
Hudson M, et al. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 1997; 58: 229–237. [Link]
3.
Riis L, et al. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2006; 101(7): 1539–1545. [Link]
4.
Kane SV. Inflammatory bowel disease, women, and pregnancy. Gastroenterol Hepatol (NY) 2013; 9: 741–743. [Link]
5.
Ørding OK, et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002; 122: 15–19. [Link]
6.
Waljee A, et al. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut 2006; 55: 1575–1580. [Link]
7.
Rajaratnam SG, et al. Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review. Int J Colorectal Dis 2011; 26: 1365–1374. [Link]
8.
Torres J, et al. European Crohn’s and colitis guidelines on sexuality, fertility, pregnancy and lactation. J Crohns Colitis 2023; 17: 1–27. [Link]
9.
Beyer-Berjot, L, et al. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 2013; 258: 275–282. [Link]
10.
Bartels SA, et al. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 2012; 256: 1045–1048. [Link]
11.
Druvefors E, et al. Female and male fertility after colectomy and reconstructive surgery in inflammatory bowel disease: a national cohort study from Sweden. J Crohns Colitis 2023; 17: 1631-1638. [Link]
12.
Marri SR, Ahn C and Buchman AL. Voluntary childlessness is increased in women with inflammatory bowel disease. Inflamm Bowel Dis 2007; 13: 591–599. [Link]
13.
Mountifield R, et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 2009; 15: 720–725. [Link]
14.
Manosa M, et al. Fecundity, pregnancy outcomes, and breastfeeding in patients with inflammatory bowel disease: a large cohort survey. Scand J Gastroenterol 2013; 48: 427–432. [Link]
15.
Selinger C, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis 2013; 7: e206–e213. [Link]
16.
Tavernier N, et al. Systematic review: fertility in non-surgically treated inflammatory bowel disease. Aliment Pharmacol Ther 2013; 8: 847–853. [Link]
17.
Grosen A, et al. Semen quality and sperm DNA integrity in patients with severe active inflammatory bowel disease and effects of tumour necrosis factor-alpha inhibitors. J Crohns Colitis 2019; 13: 564-571. [Link]
18.
Johnson E, et al. Morbidity and functional outcome after restorative proctocolectomy for ulcerative colitis. Eur J Surg 2001; 167: 40–45. [Link]
19.
Davies RJ, et al. A prospective evaluation of sexual function and quality of life after ileal pouch-anal anastomosis. Dis Colon Rectum 2008; 51: 1032–1035. [Link]
20.
Toth, A. Reversible toxic effect of salicylazosulfapyridine on semen quality. Fertil Steril 1979; 31: 538–540. [Link]
21.
Birnie GG, McLeod TI and Watkinson G. Incidence of sulphasalazine-induced male infertility. Gut 1981; 22: 452–455. [Link]
22.
Heetun ZS, et al. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther 2007; 26: 513–533. [Link]
23.
Narendranathan M, et al. Male infertility in inflammatory bowel disease. J Clin Gastroenterol 1989; 11: 403–406. [Link]
24.
Sussman A and Leonard JM. Psoriasis, methotrexate, and oligospermia. Arch Dermatol 1980; 116: 215–217. [Link]
25.
Food and Drug Administration access data. Methotrexate injection, USP. Lake Forest (IL): Hospira Inc; 2011. http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/011719s117lbl.pdf (accessed May 13, 2024). [Link]
26.
Mahadevan U and Matro R. Care of the pregnant patient with inflammatory bowel disease. Obstet Gynecol 2015; 126: 401–412. [Link]
27.
Grosen A, et al. The influence of methotrexate treatment on male fertility and pregnancy outcome after paternal exposure. Inflamm Bowel Dis. 2017; 23: 561-569. [Link]
28.
Dejaco C, et al. Azathioprine treatment and male fertility in inflammatory bowel disease. Gastroenterology 2001; 121: 1048–1053. [Link]
29.
Hoeltzenbein M, et al. Pregnancy outcome after paternal exposure to azathioprine/6-mercaptopurine. Reprod Toxicol 2012; 34: 364–369. [Link]
30.
Akbari M, et al. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis 2013; 19: 15–22. [Link]
31.
Mahadevan, U. et al. Infliximab and semen quality in men with inflammatory bowel disease. Inflamm Bowel Dis 2005; 14: 395-399. [Link]
32.
Villiger M, et al. Effects of TNF antagonists on sperm characteristics in patients with spondyloarthritis. Ann Rheum Dis 2010; 69: 1842–1844. [Link]
33.
Paschou S, et al. Fertility and reproduction in male patients with ankylosing spondylitis treated with infliximab. J Rheumatol 2009; 36: 351–354. [Link]
34.
Puchner R, et al. Impact of TNF-blocking agents on male sperm characteristics and pregnancy outcomes in fathers exposed to TNF-blocking agents at time of conception. Clin Exp Rheumatol 2012; 30: 765–767. [Link]
35.
Sands K, et al. Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive. Aliment Pharmacol Ther 2015; 41: 821–834. [Link]
36.
Grosen A, et al. Vedolizumab does not impair sperm DNA integrity in men with inflammatory bowel disease. Gastroenterology. 2019; 156: 2342-2344. [Link]
37.
Mahadevan U, et al. Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease. Aliment Pharmacol Ther. 2017; 45: 941-950. [Link]
38.
Mitrova K, et al. Safety of ustekinumab and vedolizumab during pregnancy – pregnancy, neonatal, and infant outcome: a prospective multicentre study. J Crohns Colitis. 2022; 16: 1808-1815. [Link]
39.
Grosen A, et al. Normal sperm DNA integrity in patients with inflammatory bowel disease on ustekinumab maintenance therapy. Inflamm Bowel Dis. 2022; 28: 1603-1606. [Link]
40.
Meserve J, et al. Paternal exposure to immunosuppressive and/or biologic agents and birth outcomes in patients with immune-mediated inflammatory diseases. Gastroenterology. 2021; 161: 107-115. [Link]
41.
XELJANZ / XELJANZ XR (tofacitinib) Nonclinical Toxicology | Pfizer Medical Information - US, https://www.pfizermedicalinformation.com/xeljanz/nonclinical-toxicology#S13.1 (accessed April 26, 2024). [Link]
42.
Rinvoq | European Medicines Agency, https://www.ema.europa.eu/en/documents/product-information/rinvoq-epar-product-information_en.pdf (accessed April 26, 2024) [Link]
43.
Reinisch W, et al. Effects of filgotinib on semen parameters and sex hormones in male patients with inflammatory diseases: results from the phase 2, randomized, double-blind, placebo-controlled MANTA and MANTA-RAy studies. Ann Rheum Dis. 2023; 0: 1-10. [Link]
44.
Zeposia, European Medicines Agency, https://www.ema.europa.eu/en/documents/product-information/zeposia-epar-product-information_en.pdf (accessed April 26, 2024). [Link]
45.
Cleary BJ and Kallen B, Early pregnancy azathioprine use and pregnancy outcomes. Birth Defects Res A Clin Mol Teratol 2009; 85: 647–654. [Link]
46.
Norgard B, et al. Azathioprine, mercaptopurine and birth outcome: a population-based cohort study. Aliment Pharmacol Ther 2003; 17: 827–834. [Link]
47.
McConnell RA and Mahadevan U. Use of Immunomodulators and Biologics Before, During, and After Pregnancy. Inflamm Bowel Dis 2016; 22: 213–223. [Link]
48.
Casanova MJ, et al. Safety of thiopurines and anti-TNF-alpha drugs during pregnancy in patients with inflammatory bowel disease. Am J Gastroenterol 2013; 108: 433–440. [Link]
49.
Coelho J, et al. Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME Study. Gut 2011; 60: 198–203. [Link]
50.
Shim L, et al. The effects of azathioprine on birth outcomes in women with inflammatory bowel disease (IBD). J Crohns Colitis 2011; 5: 234–238. [Link]
51.
Jharap B, de Boer NKH, Stokkers F, et al. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease. Gut 2014; 63: 451–457. [Link]
52.
Saarikoski S and Seppala M, Immunosuppression during pregnancy: transmission of azathioprine and its metabolites from the mother to the fetus. Am J Obstet Gynecol 1973; 115: 1100–1106. [Link]
53.
de Meij TG, et al. Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38: 38–43. [Link]
54.
Mahadevan U, et al. Pregnancy and neonatal outcomes after fetal exposure to biologics and thiopurines among women with inflammatory bowel disease. Gastroenterology 2021; 160: 1131-1139. [Link]
55.
Kane SV and Acquah LA, Placental transport of immunoglobulins: a clinical review for gastroenterologists who prescribe therapeutic monoclonal antibodies to women during conception and pregnancy. Am J Gastroenterol 2009; 104: 228–233. [Link]
56.
Zelinkova Z, et al. High intra-uterine exposure to infliximab following maternal anti-TNF treatment during pregnancy. Aliment Pharmacol Ther 2011; 33: 1053–1058. [Link]
57.
Zelinkova Z, et al. Effects of discontinuing anti-tumor necrosis factor therapy during pregnancy on the course of inflammatory bowel disease and neonatal exposure. Clin Gastroenterol Hepatol 2013; 11: 318–321. [Link]
58.
Lima A de, Zelinkova Z, Ent C van der, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261–1268. [Link]
59.
Narula N, et al. Anti-TNFalpha Therapies Are Safe During Pregnancy in Women with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2014; 20: 1862–1869. [Link]
60.
Kanis S, et al. Health outcomes of 1000 children born to mothers with inflammatory bowel disease in their first 5 years of life. Gut 2021; 70: 1266-1274. [Link]
61.
De Lima, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261-1268. [Link]
62.
Malhi G, et al. Risk factors for postpartum disease activity in women with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2022; 28: 1090-1099. [Link]
63.
Luu M, et al. Continuous anti-TNFalpha use throughout pregnancy: possible complications for the mother but not for the fetus. A retrospective cohort on the French National Health Insurance Database (EVASION). Am J Gastroenterol 2018; 113: 1669-1677. [Link]
64.
Clowse ME, et al. Pregnancy outcomes in subjects exposed to certolizumab pegol. J Rheumatol 2015; 42: 2270–2278. [Link]
65.
Moens A, et al. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther 2020; 51: 129-138. [Link]
66.
Avni-Biron I, et al. Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2022; 56: 1361-1369. [Link]
67.
Chugh R, Long MD, Jiang Y, et al. Maternal and Neonatal Outcomes in Vedolizumab- and Ustekinumab-Exposed Pregnancies: Results From the PIANO Registry. Official journal of the American College of Gastroenterology | ACG 2024; 119: 468. [Link]
68.
Wils P, et al. Safety of ustekinumab or vedolizumab in pregnant inflammatory bowel disease: a multicentre cohort study. Aliment Pharmacol Ther 2021; 53: 460-470. [Link]
69.
Aratari A, et al. Intentional infliximab use during pregnancy for severe steroid-refractory ulcerative colitis. J Crohns Colitis 2011; 5: 262. [Link]
70.
Schnitzler F, et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis 2011; 17: 1846–1854. [Link]
71.
ASGE Standard of Practice Committee, et al: Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2012, 76: 18–24. [Link]
72.
De Lima A, et al. Does lower gastrointestinal endoscopy during pregnancy pose a risk for mother and child? A systematic review. BMC Gastroenterol 2015; 15: 15. [Link]
73.
De Lima A, Zelinkova Z and van der Woude CJ. A prospective study of the safety of lower gastrointestinal endoscopy during pregnancy in patients with inflammatory bowel disease. J Crohns Colitis 2015; 9: 519–524. [Link]
74.
Hahnloser D, et al. Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes. Dis Colon Rectum 2004; 47: 1127–1135. [Link]
75.
Polle SW et al. Effect of vaginal delivery on long-term pouch function. Br J Surg 2006; 93: 1394–1401. [Link]
76.
Cornish JA, et al. The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum 2007 Aug; 50: 1128–1138. [Link]
77.
Seligman NS, Sbar W and Berghella V. Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomosis. J Matern Fetal Neonatal Med 2011; 24: 525–530. [Link]
78.
Remzi FH, et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum 2005; 48: 1691–1699. [Link]
79.
Castiglione F, et al. Effect of pregnancy on the clinical course of a cohort of women with inflammatory bowel disease. Ital J Gastroenterol 1996; 28: 199–204. [Link]
80.
Moffatt DC, Ilnyckyj A and Bernstein CN. A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period. Am J Gastroenterol 2009; 104: 2517–2523. [Link]
81.
Moretti ME, et al. Breast-feeding during maternal use of azathioprine. Ann Pharmacother 2006; 40: 2269–2272. [Link]
82.
Julsgaard M, et al. Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn’s disease. Scand J Gastroenterol. 2014; 49: 958-966. [Link]
83.
Christensen LA, et al. Azathioprine treatment during lactation. Aliment Pharmacol Ther 2008; 28: 1209–1213. [Link]
84.
Angelberger S, et al. Long-term follow–up of babies exposed to azathioprine in utero and via breastfeeding. J Crohns Colitis 2011; 5: 95–100. [Link]
85.
Matro R, et al. Detection of biologic agents in breast milk and implication for infection, growth and development in infants born to women with inflammatory bowel disease: results from the PIANO Registry [abstract 747]. Gastroenterology 2015; 148 (issue 4 suppl 1): S-141. [Link]
86.
Nguyen GC, et al. The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology 2016; 150: 734–757. [Link]
87.
Ben-Horin S, et al. Adalimumab level in breast milk of a nursing mother. Clin Gastroenterol Hepatol 2010; 8: 475–476. [Link]
88.
Ben-Horin S, et al. Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis 2011; 5: 555–558. [Link]
89.
Matro R, et al. Exposure concentrations of infants breastfed by women receiving biological therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology 2018; 155: 696-704. (q, 89) [Link]
90.
Julsgaard M, et al. Vedolizumab clearance in neonates, susceptibility to infections and developmental milestones: a prospective multicentre population-based cohort study. Aliment Pharmacol Ther 2021; 54: 1320-1329. [Link]

Abstract

Inflammatory bowel disease (IBD) is a chronic relapsing gastrointestinal disease, often affecting young people during their fertile years. The chronic character of IBD means that lifelong medical treatment is often required. As such, it is not surprising that questions often arise about fertility and pregnancy in patients with IBD. The most important risk factor for adverse pregnancy outcomes in IBD patients is the presence of disease activity during pregnancy. Indeed, negative pregnancy outcomes (e.g. spontaneous abortion, preterm delivery and low birth weight) are associated with disease activity at the time of conception and during pregnancy.

Topics

IBD Primary Care

Citation

 Cite this article as: Kanis SL and van der Woude CJ. Mistakes in inflammatory bowel disease and reproduction and how to avoid them. UEG Education 2016: 16: 20–23.

Published

2024

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Manik Gemilyan, Gagik Hakobyan

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Baird DD, Narendranathan M and Sandler RS. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology 1990; 99: 987–994. [Link]
2.
Hudson M, et al. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 1997; 58: 229–237. [Link]
3.
Riis L, et al. Does pregnancy change the disease course? A study in a European cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2006; 101(7): 1539–1545. [Link]
4.
Kane SV. Inflammatory bowel disease, women, and pregnancy. Gastroenterol Hepatol (NY) 2013; 9: 741–743. [Link]
5.
Ørding OK, et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002; 122: 15–19. [Link]
6.
Waljee A, et al. Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut 2006; 55: 1575–1580. [Link]
7.
Rajaratnam SG, et al. Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review. Int J Colorectal Dis 2011; 26: 1365–1374. [Link]
8.
Torres J, et al. European Crohn’s and colitis guidelines on sexuality, fertility, pregnancy and lactation. J Crohns Colitis 2023; 17: 1–27. [Link]
9.
Beyer-Berjot, L, et al. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 2013; 258: 275–282. [Link]
10.
Bartels SA, et al. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 2012; 256: 1045–1048. [Link]
11.
Druvefors E, et al. Female and male fertility after colectomy and reconstructive surgery in inflammatory bowel disease: a national cohort study from Sweden. J Crohns Colitis 2023; 17: 1631-1638. [Link]
12.
Marri SR, Ahn C and Buchman AL. Voluntary childlessness is increased in women with inflammatory bowel disease. Inflamm Bowel Dis 2007; 13: 591–599. [Link]
13.
Mountifield R, et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 2009; 15: 720–725. [Link]
14.
Manosa M, et al. Fecundity, pregnancy outcomes, and breastfeeding in patients with inflammatory bowel disease: a large cohort survey. Scand J Gastroenterol 2013; 48: 427–432. [Link]
15.
Selinger C, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis 2013; 7: e206–e213. [Link]
16.
Tavernier N, et al. Systematic review: fertility in non-surgically treated inflammatory bowel disease. Aliment Pharmacol Ther 2013; 8: 847–853. [Link]
17.
Grosen A, et al. Semen quality and sperm DNA integrity in patients with severe active inflammatory bowel disease and effects of tumour necrosis factor-alpha inhibitors. J Crohns Colitis 2019; 13: 564-571. [Link]
18.
Johnson E, et al. Morbidity and functional outcome after restorative proctocolectomy for ulcerative colitis. Eur J Surg 2001; 167: 40–45. [Link]
19.
Davies RJ, et al. A prospective evaluation of sexual function and quality of life after ileal pouch-anal anastomosis. Dis Colon Rectum 2008; 51: 1032–1035. [Link]
20.
Toth, A. Reversible toxic effect of salicylazosulfapyridine on semen quality. Fertil Steril 1979; 31: 538–540. [Link]
21.
Birnie GG, McLeod TI and Watkinson G. Incidence of sulphasalazine-induced male infertility. Gut 1981; 22: 452–455. [Link]
22.
Heetun ZS, et al. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther 2007; 26: 513–533. [Link]
23.
Narendranathan M, et al. Male infertility in inflammatory bowel disease. J Clin Gastroenterol 1989; 11: 403–406. [Link]
24.
Sussman A and Leonard JM. Psoriasis, methotrexate, and oligospermia. Arch Dermatol 1980; 116: 215–217. [Link]
25.
Food and Drug Administration access data. Methotrexate injection, USP. Lake Forest (IL): Hospira Inc; 2011. http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/011719s117lbl.pdf (accessed May 13, 2024). [Link]
26.
Mahadevan U and Matro R. Care of the pregnant patient with inflammatory bowel disease. Obstet Gynecol 2015; 126: 401–412. [Link]
27.
Grosen A, et al. The influence of methotrexate treatment on male fertility and pregnancy outcome after paternal exposure. Inflamm Bowel Dis. 2017; 23: 561-569. [Link]
28.
Dejaco C, et al. Azathioprine treatment and male fertility in inflammatory bowel disease. Gastroenterology 2001; 121: 1048–1053. [Link]
29.
Hoeltzenbein M, et al. Pregnancy outcome after paternal exposure to azathioprine/6-mercaptopurine. Reprod Toxicol 2012; 34: 364–369. [Link]
30.
Akbari M, et al. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis 2013; 19: 15–22. [Link]
31.
Mahadevan, U. et al. Infliximab and semen quality in men with inflammatory bowel disease. Inflamm Bowel Dis 2005; 14: 395-399. [Link]
32.
Villiger M, et al. Effects of TNF antagonists on sperm characteristics in patients with spondyloarthritis. Ann Rheum Dis 2010; 69: 1842–1844. [Link]
33.
Paschou S, et al. Fertility and reproduction in male patients with ankylosing spondylitis treated with infliximab. J Rheumatol 2009; 36: 351–354. [Link]
34.
Puchner R, et al. Impact of TNF-blocking agents on male sperm characteristics and pregnancy outcomes in fathers exposed to TNF-blocking agents at time of conception. Clin Exp Rheumatol 2012; 30: 765–767. [Link]
35.
Sands K, et al. Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive. Aliment Pharmacol Ther 2015; 41: 821–834. [Link]
36.
Grosen A, et al. Vedolizumab does not impair sperm DNA integrity in men with inflammatory bowel disease. Gastroenterology. 2019; 156: 2342-2344. [Link]
37.
Mahadevan U, et al. Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease. Aliment Pharmacol Ther. 2017; 45: 941-950. [Link]
38.
Mitrova K, et al. Safety of ustekinumab and vedolizumab during pregnancy – pregnancy, neonatal, and infant outcome: a prospective multicentre study. J Crohns Colitis. 2022; 16: 1808-1815. [Link]
39.
Grosen A, et al. Normal sperm DNA integrity in patients with inflammatory bowel disease on ustekinumab maintenance therapy. Inflamm Bowel Dis. 2022; 28: 1603-1606. [Link]
40.
Meserve J, et al. Paternal exposure to immunosuppressive and/or biologic agents and birth outcomes in patients with immune-mediated inflammatory diseases. Gastroenterology. 2021; 161: 107-115. [Link]
41.
XELJANZ / XELJANZ XR (tofacitinib) Nonclinical Toxicology | Pfizer Medical Information - US, https://www.pfizermedicalinformation.com/xeljanz/nonclinical-toxicology#S13.1 (accessed April 26, 2024). [Link]
42.
Rinvoq | European Medicines Agency, https://www.ema.europa.eu/en/documents/product-information/rinvoq-epar-product-information_en.pdf (accessed April 26, 2024) [Link]
43.
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Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.1 Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.2 Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.3

Topics

Primary Care

Published

2025

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ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

Henit Yanai

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Guideline

Introduction

The therapeutic landscape of inflammatory bowel disease [IBD] has undergone a profound transformation with the advent of novel immunosuppressive and biologic agents. These advancements have revolutionised the management of Crohn’s disease [CD] and ulcerative colitis [UC], enabling tighter control of inflammation and significantly improved patient outcomes. However, while older treatment strategies, including prolonged corticosteroids, purine analogues, and anti-tumour necrosis factor [TNF]/thiopurine combination therapy, carried a substantial immunosuppressive burden, the expanding therapeutic armamentarium introduces new agents with distinct infection risk profiles that require updated, evidence-based guidance. By definition, opportunistic infections are infections caused by organisms that infrequently induce disease in immunocompetent hosts but can result in significant morbidity or mortality in immunocompromised individuals. As treatment strategies increasingly rely on potent modulation of the immune system, ranging from traditional thiopurines to advanced small molecules, a structured, evidence-based approach to infection prevention, diagnosis, and management has become indispensable for the clinician. The European Crohn’s and Colitis Organisation [ECCO] has long recognised this clinical imperative, previously publishing consensus statements in 2009 and 2014, followed by a comprehensive guideline in 2021. This 2026 update is warranted by the rapid expansion of the therapeutic armamentarium, specifically the introduction of newer small molecules, advanced biologics, and evolving vaccination strategies. This update integrates the most recent data on risk stratification, viral, bacterial, mycobacterial, and vaccine-preventable infections, emphasising a preventative strategy tailored to the contemporary IBD treatment paradigm.

Publisher

European Crohn’s and Colitis Organisation logo
European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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Abstract

Topics

Stomach & H. Pylori

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2025

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Abstract

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References

Mistakes
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Coelho J, et al. Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME Study. Gut 2011; 60: 198–203. [Link]
50.
Shim L, et al. The effects of azathioprine on birth outcomes in women with inflammatory bowel disease (IBD). J Crohns Colitis 2011; 5: 234–238. [Link]
51.
Jharap B, de Boer NKH, Stokkers F, et al. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease. Gut 2014; 63: 451–457. [Link]
52.
Saarikoski S and Seppala M, Immunosuppression during pregnancy: transmission of azathioprine and its metabolites from the mother to the fetus. Am J Obstet Gynecol 1973; 115: 1100–1106. [Link]
53.
de Meij TG, et al. Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38: 38–43. [Link]
54.
Mahadevan U, et al. Pregnancy and neonatal outcomes after fetal exposure to biologics and thiopurines among women with inflammatory bowel disease. Gastroenterology 2021; 160: 1131-1139. [Link]
55.
Kane SV and Acquah LA, Placental transport of immunoglobulins: a clinical review for gastroenterologists who prescribe therapeutic monoclonal antibodies to women during conception and pregnancy. Am J Gastroenterol 2009; 104: 228–233. [Link]
56.
Zelinkova Z, et al. High intra-uterine exposure to infliximab following maternal anti-TNF treatment during pregnancy. Aliment Pharmacol Ther 2011; 33: 1053–1058. [Link]
57.
Zelinkova Z, et al. Effects of discontinuing anti-tumor necrosis factor therapy during pregnancy on the course of inflammatory bowel disease and neonatal exposure. Clin Gastroenterol Hepatol 2013; 11: 318–321. [Link]
58.
Lima A de, Zelinkova Z, Ent C van der, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261–1268. [Link]
59.
Narula N, et al. Anti-TNFalpha Therapies Are Safe During Pregnancy in Women with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2014; 20: 1862–1869. [Link]
60.
Kanis S, et al. Health outcomes of 1000 children born to mothers with inflammatory bowel disease in their first 5 years of life. Gut 2021; 70: 1266-1274. [Link]
61.
De Lima, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261-1268. [Link]
62.
Malhi G, et al. Risk factors for postpartum disease activity in women with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2022; 28: 1090-1099. [Link]
63.
Luu M, et al. Continuous anti-TNFalpha use throughout pregnancy: possible complications for the mother but not for the fetus. A retrospective cohort on the French National Health Insurance Database (EVASION). Am J Gastroenterol 2018; 113: 1669-1677. [Link]
64.
Clowse ME, et al. Pregnancy outcomes in subjects exposed to certolizumab pegol. J Rheumatol 2015; 42: 2270–2278. [Link]
65.
Moens A, et al. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther 2020; 51: 129-138. [Link]
66.
Avni-Biron I, et al. Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2022; 56: 1361-1369. [Link]
67.
Chugh R, Long MD, Jiang Y, et al. Maternal and Neonatal Outcomes in Vedolizumab- and Ustekinumab-Exposed Pregnancies: Results From the PIANO Registry. Official journal of the American College of Gastroenterology | ACG 2024; 119: 468. [Link]
68.
Wils P, et al. Safety of ustekinumab or vedolizumab in pregnant inflammatory bowel disease: a multicentre cohort study. Aliment Pharmacol Ther 2021; 53: 460-470. [Link]
69.
Aratari A, et al. Intentional infliximab use during pregnancy for severe steroid-refractory ulcerative colitis. J Crohns Colitis 2011; 5: 262. [Link]
70.
Schnitzler F, et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis 2011; 17: 1846–1854. [Link]
71.
ASGE Standard of Practice Committee, et al: Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2012, 76: 18–24. [Link]
72.
De Lima A, et al. Does lower gastrointestinal endoscopy during pregnancy pose a risk for mother and child? A systematic review. BMC Gastroenterol 2015; 15: 15. [Link]
73.
De Lima A, Zelinkova Z and van der Woude CJ. A prospective study of the safety of lower gastrointestinal endoscopy during pregnancy in patients with inflammatory bowel disease. J Crohns Colitis 2015; 9: 519–524. [Link]
74.
Hahnloser D, et al. Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes. Dis Colon Rectum 2004; 47: 1127–1135. [Link]
75.
Polle SW et al. Effect of vaginal delivery on long-term pouch function. Br J Surg 2006; 93: 1394–1401. [Link]
76.
Cornish JA, et al. The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum 2007 Aug; 50: 1128–1138. [Link]
77.
Seligman NS, Sbar W and Berghella V. Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomosis. J Matern Fetal Neonatal Med 2011; 24: 525–530. [Link]
78.
Remzi FH, et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum 2005; 48: 1691–1699. [Link]
79.
Castiglione F, et al. Effect of pregnancy on the clinical course of a cohort of women with inflammatory bowel disease. Ital J Gastroenterol 1996; 28: 199–204. [Link]
80.
Moffatt DC, Ilnyckyj A and Bernstein CN. A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period. Am J Gastroenterol 2009; 104: 2517–2523. [Link]
81.
Moretti ME, et al. Breast-feeding during maternal use of azathioprine. Ann Pharmacother 2006; 40: 2269–2272. [Link]
82.
Julsgaard M, et al. Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn’s disease. Scand J Gastroenterol. 2014; 49: 958-966. [Link]
83.
Christensen LA, et al. Azathioprine treatment during lactation. Aliment Pharmacol Ther 2008; 28: 1209–1213. [Link]
84.
Angelberger S, et al. Long-term follow–up of babies exposed to azathioprine in utero and via breastfeeding. J Crohns Colitis 2011; 5: 95–100. [Link]
85.
Matro R, et al. Detection of biologic agents in breast milk and implication for infection, growth and development in infants born to women with inflammatory bowel disease: results from the PIANO Registry [abstract 747]. Gastroenterology 2015; 148 (issue 4 suppl 1): S-141. [Link]
86.
Nguyen GC, et al. The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology 2016; 150: 734–757. [Link]
87.
Ben-Horin S, et al. Adalimumab level in breast milk of a nursing mother. Clin Gastroenterol Hepatol 2010; 8: 475–476. [Link]
88.
Ben-Horin S, et al. Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis 2011; 5: 555–558. [Link]
89.
Matro R, et al. Exposure concentrations of infants breastfed by women receiving biological therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology 2018; 155: 696-704. (q, 89) [Link]
90.
Julsgaard M, et al. Vedolizumab clearance in neonates, susceptibility to infections and developmental milestones: a prospective multicentre population-based cohort study. Aliment Pharmacol Ther 2021; 54: 1320-1329. [Link]

Abstract

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition that is confined to the oesophagus. Clinically, EoE is characterized by symptoms of oesophageal dysfunction; histologically, by eosinophil-predominant inflammation.1,2 At present, EoE is the second-most frequent cause of chronic oesophagitis (gastro-oesophageal reflux disease [GORD] is the primary cause) and the foremost cause of dysphagia and food impaction in young adults and children.

Topics

Oesophagus

Citation

Molina-Infante J and Lucendo AJ. Mistakes in eosinophilic oesophagitis and how to avoid them. UEG Education 2017: 17; 6–9.

Published

2024

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UEG Mistakes In Articles
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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
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20.
Toth, A. Reversible toxic effect of salicylazosulfapyridine on semen quality. Fertil Steril 1979; 31: 538–540. [Link]
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23.
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Grosen A, et al. The influence of methotrexate treatment on male fertility and pregnancy outcome after paternal exposure. Inflamm Bowel Dis. 2017; 23: 561-569. [Link]
28.
Dejaco C, et al. Azathioprine treatment and male fertility in inflammatory bowel disease. Gastroenterology 2001; 121: 1048–1053. [Link]
29.
Hoeltzenbein M, et al. Pregnancy outcome after paternal exposure to azathioprine/6-mercaptopurine. Reprod Toxicol 2012; 34: 364–369. [Link]
30.
Akbari M, et al. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis 2013; 19: 15–22. [Link]
31.
Mahadevan, U. et al. Infliximab and semen quality in men with inflammatory bowel disease. Inflamm Bowel Dis 2005; 14: 395-399. [Link]
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Villiger M, et al. Effects of TNF antagonists on sperm characteristics in patients with spondyloarthritis. Ann Rheum Dis 2010; 69: 1842–1844. [Link]
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Paschou S, et al. Fertility and reproduction in male patients with ankylosing spondylitis treated with infliximab. J Rheumatol 2009; 36: 351–354. [Link]
34.
Puchner R, et al. Impact of TNF-blocking agents on male sperm characteristics and pregnancy outcomes in fathers exposed to TNF-blocking agents at time of conception. Clin Exp Rheumatol 2012; 30: 765–767. [Link]
35.
Sands K, et al. Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive. Aliment Pharmacol Ther 2015; 41: 821–834. [Link]
36.
Grosen A, et al. Vedolizumab does not impair sperm DNA integrity in men with inflammatory bowel disease. Gastroenterology. 2019; 156: 2342-2344. [Link]
37.
Mahadevan U, et al. Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease. Aliment Pharmacol Ther. 2017; 45: 941-950. [Link]
38.
Mitrova K, et al. Safety of ustekinumab and vedolizumab during pregnancy – pregnancy, neonatal, and infant outcome: a prospective multicentre study. J Crohns Colitis. 2022; 16: 1808-1815. [Link]
39.
Grosen A, et al. Normal sperm DNA integrity in patients with inflammatory bowel disease on ustekinumab maintenance therapy. Inflamm Bowel Dis. 2022; 28: 1603-1606. [Link]
40.
Meserve J, et al. Paternal exposure to immunosuppressive and/or biologic agents and birth outcomes in patients with immune-mediated inflammatory diseases. Gastroenterology. 2021; 161: 107-115. [Link]
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Reinisch W, et al. Effects of filgotinib on semen parameters and sex hormones in male patients with inflammatory diseases: results from the phase 2, randomized, double-blind, placebo-controlled MANTA and MANTA-RAy studies. Ann Rheum Dis. 2023; 0: 1-10. [Link]
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45.
Cleary BJ and Kallen B, Early pregnancy azathioprine use and pregnancy outcomes. Birth Defects Res A Clin Mol Teratol 2009; 85: 647–654. [Link]
46.
Norgard B, et al. Azathioprine, mercaptopurine and birth outcome: a population-based cohort study. Aliment Pharmacol Ther 2003; 17: 827–834. [Link]
47.
McConnell RA and Mahadevan U. Use of Immunomodulators and Biologics Before, During, and After Pregnancy. Inflamm Bowel Dis 2016; 22: 213–223. [Link]
48.
Casanova MJ, et al. Safety of thiopurines and anti-TNF-alpha drugs during pregnancy in patients with inflammatory bowel disease. Am J Gastroenterol 2013; 108: 433–440. [Link]
49.
Coelho J, et al. Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME Study. Gut 2011; 60: 198–203. [Link]
50.
Shim L, et al. The effects of azathioprine on birth outcomes in women with inflammatory bowel disease (IBD). J Crohns Colitis 2011; 5: 234–238. [Link]
51.
Jharap B, de Boer NKH, Stokkers F, et al. Intrauterine exposure and pharmacology of conventional thiopurine therapy in pregnant patients with inflammatory bowel disease. Gut 2014; 63: 451–457. [Link]
52.
Saarikoski S and Seppala M, Immunosuppression during pregnancy: transmission of azathioprine and its metabolites from the mother to the fetus. Am J Obstet Gynecol 1973; 115: 1100–1106. [Link]
53.
de Meij TG, et al. Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38: 38–43. [Link]
54.
Mahadevan U, et al. Pregnancy and neonatal outcomes after fetal exposure to biologics and thiopurines among women with inflammatory bowel disease. Gastroenterology 2021; 160: 1131-1139. [Link]
55.
Kane SV and Acquah LA, Placental transport of immunoglobulins: a clinical review for gastroenterologists who prescribe therapeutic monoclonal antibodies to women during conception and pregnancy. Am J Gastroenterol 2009; 104: 228–233. [Link]
56.
Zelinkova Z, et al. High intra-uterine exposure to infliximab following maternal anti-TNF treatment during pregnancy. Aliment Pharmacol Ther 2011; 33: 1053–1058. [Link]
57.
Zelinkova Z, et al. Effects of discontinuing anti-tumor necrosis factor therapy during pregnancy on the course of inflammatory bowel disease and neonatal exposure. Clin Gastroenterol Hepatol 2013; 11: 318–321. [Link]
58.
Lima A de, Zelinkova Z, Ent C van der, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261–1268. [Link]
59.
Narula N, et al. Anti-TNFalpha Therapies Are Safe During Pregnancy in Women with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2014; 20: 1862–1869. [Link]
60.
Kanis S, et al. Health outcomes of 1000 children born to mothers with inflammatory bowel disease in their first 5 years of life. Gut 2021; 70: 1266-1274. [Link]
61.
De Lima, et al. Tailored anti-TNF therapy during pregnancy in patients with IBD: maternal and fetal safety. Gut 2016; 65: 1261-1268. [Link]
62.
Malhi G, et al. Risk factors for postpartum disease activity in women with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2022; 28: 1090-1099. [Link]
63.
Luu M, et al. Continuous anti-TNFalpha use throughout pregnancy: possible complications for the mother but not for the fetus. A retrospective cohort on the French National Health Insurance Database (EVASION). Am J Gastroenterol 2018; 113: 1669-1677. [Link]
64.
Clowse ME, et al. Pregnancy outcomes in subjects exposed to certolizumab pegol. J Rheumatol 2015; 42: 2270–2278. [Link]
65.
Moens A, et al. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther 2020; 51: 129-138. [Link]
66.
Avni-Biron I, et al. Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2022; 56: 1361-1369. [Link]
67.
Chugh R, Long MD, Jiang Y, et al. Maternal and Neonatal Outcomes in Vedolizumab- and Ustekinumab-Exposed Pregnancies: Results From the PIANO Registry. Official journal of the American College of Gastroenterology | ACG 2024; 119: 468. [Link]
68.
Wils P, et al. Safety of ustekinumab or vedolizumab in pregnant inflammatory bowel disease: a multicentre cohort study. Aliment Pharmacol Ther 2021; 53: 460-470. [Link]
69.
Aratari A, et al. Intentional infliximab use during pregnancy for severe steroid-refractory ulcerative colitis. J Crohns Colitis 2011; 5: 262. [Link]
70.
Schnitzler F, et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis 2011; 17: 1846–1854. [Link]
71.
ASGE Standard of Practice Committee, et al: Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2012, 76: 18–24. [Link]
72.
De Lima A, et al. Does lower gastrointestinal endoscopy during pregnancy pose a risk for mother and child? A systematic review. BMC Gastroenterol 2015; 15: 15. [Link]
73.
De Lima A, Zelinkova Z and van der Woude CJ. A prospective study of the safety of lower gastrointestinal endoscopy during pregnancy in patients with inflammatory bowel disease. J Crohns Colitis 2015; 9: 519–524. [Link]
74.
Hahnloser D, et al. Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes. Dis Colon Rectum 2004; 47: 1127–1135. [Link]
75.
Polle SW et al. Effect of vaginal delivery on long-term pouch function. Br J Surg 2006; 93: 1394–1401. [Link]
76.
Cornish JA, et al. The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum 2007 Aug; 50: 1128–1138. [Link]
77.
Seligman NS, Sbar W and Berghella V. Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomosis. J Matern Fetal Neonatal Med 2011; 24: 525–530. [Link]
78.
Remzi FH, et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum 2005; 48: 1691–1699. [Link]
79.
Castiglione F, et al. Effect of pregnancy on the clinical course of a cohort of women with inflammatory bowel disease. Ital J Gastroenterol 1996; 28: 199–204. [Link]
80.
Moffatt DC, Ilnyckyj A and Bernstein CN. A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period. Am J Gastroenterol 2009; 104: 2517–2523. [Link]
81.
Moretti ME, et al. Breast-feeding during maternal use of azathioprine. Ann Pharmacother 2006; 40: 2269–2272. [Link]
82.
Julsgaard M, et al. Self-reported adherence to medical treatment, breastfeeding behaviour, and disease activity during the postpartum period in women with Crohn’s disease. Scand J Gastroenterol. 2014; 49: 958-966. [Link]
83.
Christensen LA, et al. Azathioprine treatment during lactation. Aliment Pharmacol Ther 2008; 28: 1209–1213. [Link]
84.
Angelberger S, et al. Long-term follow–up of babies exposed to azathioprine in utero and via breastfeeding. J Crohns Colitis 2011; 5: 95–100. [Link]
85.
Matro R, et al. Detection of biologic agents in breast milk and implication for infection, growth and development in infants born to women with inflammatory bowel disease: results from the PIANO Registry [abstract 747]. Gastroenterology 2015; 148 (issue 4 suppl 1): S-141. [Link]
86.
Nguyen GC, et al. The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology 2016; 150: 734–757. [Link]
87.
Ben-Horin S, et al. Adalimumab level in breast milk of a nursing mother. Clin Gastroenterol Hepatol 2010; 8: 475–476. [Link]
88.
Ben-Horin S, et al. Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis 2011; 5: 555–558. [Link]
89.
Matro R, et al. Exposure concentrations of infants breastfed by women receiving biological therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology 2018; 155: 696-704. (q, 89) [Link]
90.
Julsgaard M, et al. Vedolizumab clearance in neonates, susceptibility to infections and developmental milestones: a prospective multicentre population-based cohort study. Aliment Pharmacol Ther 2021; 54: 1320-1329. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

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Oesophageal cancer with Massimiliano di Pietro (Part 1)

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Mistakes in eosinophilic oesophagitis and how to avoid them

Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo Alfredo J. Lucendo, Javier Molina-Infante

Mistakes in hepatitis C and how to avoid them

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