Introduction

Chronic inflammatory bowel disease (IBD) is at high risk of thromboembolic events (TEA), which are a significant cause of morbidity and mortality.
They are attributed to a pre-thrombotic state caused by the inflammatory activity of this disease.
The objective of our study was to evaluate the prevalence and risk factors (FDR) of ATEs in patients with IBD, to determine their clinical and evolutionary particularities while specifying the existence or not of a gender effect.

Aims & Methods

This is a retrospective descriptive and analytical study carried out at the hepato-gastroenterology and proctology department "Médecine B" CHU Ibn Sina Rabat, between January 2001 and July 2023, including all patients who presented during their follow-up with an ATE confirmed by imagery (thoracic angioscanner/ cerebral angio MRI/ doppler ultrasound).
We collected demographic, clinical and paraclinical data.
The Chi-2 test was used to compare categorical variables.

Results

During the study period, among the 1643 IBD cases collected in the department, we recorded 21 cases of IBD complicated by ATE, a prevalence of 1.27%.
The mean age was 42.7 years (23-61 years), with a male predominance of 12 men (57%) and 9 women (43%), with a sex ratio of M/F : 1.3.
Among the 12 men, 7 (58%) had Crohn's disease and 5 (42%) UC, with a mean disease duration of 8 years and 4 months. Among the 9 women, 6 (67%) were being followed for Crohn's disease and 3 (33%) for UC.
The occurrence of a thrombo-embolic complication during hospitalization for a disease exacerbation was more frequent in men than in women (8 (67%) Vs 5 (55%); p=0.3).
Deep vein thrombosis (DVT) was more common in women than in men (6(67%) Vs 1(8%); p= 0.003).
Cerebral thrombophlebitis was found in 2 men (17%) and 2 women (22%).
Budd Chiari syndrome was found in 1 woman (11%).
Pulmonary embolism was found in 3 men (25%), portal thrombosis in 3 men (25%), renal artery thrombosis in 2 men (17%), superior mesenteric vein thrombosis in 1 man (8%). None of the women had these manifestations.
Thrombophilia testing revealed decreased anti-thrombin activity in women, associated with protein C deficiency in 2 patients (22%). In the men, we noted protein C deficiency in 1 patient (8%) and 1 case (8%) of protein S deficiency.
Hyperhomocysteinemia was positive in one patient (11%), with no cases in men.
All patients were treated with anti-coagulants for curative purposes.
The absence of thrombosis and good revascularization was confirmed by follow-up imaging after 6 months of treatment in 5 men (42%) and 3 women (33%); p= 0.4.
A complication in the form of extensive cerebral ischemic necrosis of thrombosed vessels was noted in 1 man (8%).
A single case of death was reported in 1 man (8%) following a severe pulmonary embolism.No cases of death were recorded in women.

Conclusion

Patients with chronic inflammatory bowel disease have a non-negligible risk of developing TEA, particularly during the active phase of the disease, underlining the importance of preventing thromboembolic disease when managing patients during relapses.

Introduction

Surgery represents an important part of the therapeutic armamentarium for the treatment of IBD, and has been associated with variable effects on the psychological profile of patients with inflammatory bowel disease. However, surgical treatment is often distressingly perceived by these patients as the failure of their therapies, and can be a trigger for anguish, anxiety or depression.

Aims & Methods

The aim of this study is to describe the psychological impact of surgery on operated IBD patients.
This is a prospective descriptive monocentric study, conducted at the Department of Hepato-Gastro-Enterology and Proctology "Medicine B" CHU Ibn Sina Rabat, which collected all patients followed for IBD (Crohn's + UC) and who were operated between August 2021 and August 2023, the psychological impact and apprehension regarding surgery will be addressed in this study. Patients of both sexes who agreed to answer the questionnaire were included, and patients who refused to answer the questionnaire and complicated patients who stayed in intensive care were excluded.

Results

43 operated patients were included in our study, including 29 (67.4%) in the emergency setting and 14 (32.6%) scheduled. Mean age was 43 ± 16.17 years. The sex ratio was 1.26 (F/H=24/19). 35 patients (81.4%) were being followed for Crohn's disease and 8 patients (18.6%) for ulcerative colitis (UC), of whom 11 patients (25.5%) had a history of previous resection, and 1 patient (2.3%) was being followed for depression.
The surgical indications were GCA in 12 cases (27.9%), stenosis in 18 cases (41.8%), perforation in 1 case (2.3%), abscess in 8 cases (18.6%), and fistula in 4 cases (9.3%).
Our patients underwent ileo-caecal resection in 22 cases (51.2%), hemicolectomy in 6 patients (14%), coloproctectomy in 3 patients (7%), sub-total colectomy in 11 patients (25.6%), of whom 18 patients (41.9%) had an ostomy.
On the announcement of a possible surgical procedure, the thymic symptoms and feelings expressed by patients can be classified as follows: preoperative anxiety in 18 patients (41.9%), fear of death in 7 patients (16.3%), while 24 patients (55.8%) were indifferent.
The main anxiety-generating concern was postoperative pain in 7 patients (14%), potential complications in 7 patients (16.3%), failure of the procedure in 6 patients (14%), fear of dying in 7 patients (16.3%), and 25 patients (58.1%) expressed no anxiety.
The postoperative psychological experience was unremarkable in 37 patients (86%), 3 patients (7%) reported transient postoperative sadness and 3 patients (7%) developed postoperative depression, prompting consultation with a psychiatrist.

Conclusion

The impact of surgery in IBD patients not only concerns the body, but also has an effect on psychological well-being.
This study found that the pre-operative period induces a significant burden of anxiety in these patients, and depression in some.

Introduction

Anal fistulas are the most common clinical forms of ano-perineal suppurations. They are defined by the initial infection of an anal gland of Hermann and Desfosses opening in the middle part of the anal canal. A specific origin is possible. The treatment is surgical and has two objectives: to treat the suppuration definitively and to preserve fecal continence, but also to have histological evidence for specific fistulas.

Aims & Methods

The aim of our work is to collect epidemiological, clinical, paraclinical, therapeutic and evolutionary data of this condition.
This is a retrospective, descriptive study over a period of 6 years: January 2015-December 2021, including 640 patients with anal fistula collected at the proctology unit, all patients with anal fistula and who received surgical treatment or biopsy for diagnostic purposes were included in our study. This work allowed to collect epidemiological, clinical, paraclinical, therapeutic and evolutionary data of this condition.

Results

640 patients were included presenting with anal fistula. The average age was 39 years [25-59], with a male predominance of 570 patients (89%). Clinically, the predominant symptomatology was chronic purulent discharge in 416 cases (65%), 128 cases (20%) had an inaugural anal abscess, 77 cases (12%) had proctalgia, 19 cases (3%) had anal pruritus and 13 cases (2%) had diarrhea.
The proctological examination revealed: simple anal fistula in 575 patients (90%) and 65 patients had complex anal fistula (10%).
Out of 640 patients recruited for anal fistula, 45 patients (7%) had specific anal fistula and 595 patients (93%) had cryptoglandular anal fistula.
After a digestive, phtysiological and radiological assessment we concluded :
- 26 cases (58%) anal fistula occurring in patients followed for Crohn's disease or inaugural ano-perineal Crohn's disease having benefited from a seton drainage and put under combotherapy.
- 16 cases (36%) in favour of anal tuberculosis put on anti bacillary treatment.
- 2 cases (4%) of neoplastic fistulas that benefited from oncological management.
- 1 case (2%) in favor of anal sarcoidosis treated with corticotherapy.

Conclusion

Anal fistulas are a fairly common pathology. The diagnosis of anal fistulas is clinical. Cryptoglandular anal fistula remains the most frequent entity, requiring surgical treatment, while the management of specific anal fistula depends on the etiology.

Disclosure

No conflict of interest

Introduction

Acute severe colitis (ASC) is a medical-surgical emergency that can occur at any time during the course of chronic inflammatory bowel disease. It most commonly affects UC.

Aims & Methods

Aims: The aim of our work is to describe the particularities of GCA management during Crohn's disease (CD).
Materials and methods: This is a retrospective descriptive and analytical study spread over a 5-year period from January 2018 to January 2023. All patients who developed GAC during the course of Crohn's disease, whether inaugural or progressive, were included in our study.Data collected included age, sex, Crohn's disease location and phenotype, Lichtiger score before and after coticotherapy, second-line treatment, and use of surgery. SPSS 2.0 software was used for the statistical study. A binary logistic regression model was used for univariate analysis.

Results

Of the 424 IBD cases, 267 were being followed for Crohn's disease, of whom 38 (14.2%) patients presented with GAC. Mean age was 44.21 ±12.7 years (range 19-72 years). The F/H sex ratio was 1.9 (25 women to 13 men).The location of Crohn's disease was pancolic in 28 patients, ileocolic in 9, and ileocolic with high involvement in 1 patient. GCA was inaugural in 10 patients (26.3%), and complicated known Crohn's disease in 28 patients (73.7%). The mean Lichtiger score calculated at D0 was 11.84±1.8. The mean CRP value on admission was 89.8±47. Mean albumin was 27.9±3.6. Emergency abdomino-pelvic CT scans showed no complications such as colectasis, perforation or abscess in our series. All patients received IV methylprednisolone corticosteroids at a dose of 0.8 mg/kg/d, not to exceed 40 mg/d, with close clinico-biological monitoring. 21 patients (55.2%) were corticosensitive. The mean Lichtiger score calculated at D5 in corticosensitive patients was 8.7, with a mean CRP value at D3 of 36.8±12.

In univariate analysis, CRP >45 (on admission) and hypoalbuminemia were predictive factors for failure of IV corticosteroid therapy, with [OR=3.2 [1.3-5.2]; p=0.0005] and [OR = 1.31 [1.015-7,] p=0.002] respectively.Of the 17 (44.8%) cortico-resistant patients, 3 (7.9%) received emergency second-line treatment with Infliximab, and 15 (39.47%) underwent subtotal colectomy with ileostomy. Of these patients, one was scheduled after failure of second-line treatment. Good outcome was noted in 36 patients (94.7%). 2 cases of death (5.3%) were reported postoperatively. On discharge, 23 patients (63.9%) were treated with immunosuppressive agents or 13 (36.1%) with biotherapy.

Conclusion

Acute severe colitis can reveal or complicate Crohn's disease at any stage of its evolution. Management must be urgent, and requires medical-surgical coordination. The first-line medical treatment is intravenous corticosteroid therapy. Colectomy should be discussed at every stage of management.

Introduction

Patients (pts) with inflammatory bowel disease (IBD) have a significantly higher risk of venous thromboembolic events (VTEs) compared to the general population [1]. Thromboprophylaxis (TP) is recommended for patients with IBD during all-cause hospitalization [2]. Evidence supporting this practice in the clinical context of IBD is scarce. This retrospective, real-world, single-center study aims to evaluate the effectiveness and safety of TP in preventing VTEs in a large cohort of hospitalized patients with IBD. The secondary endpoint of the study was to measure adherence to the TP prescription.

Aims & Methods

Disease-related real-world data were retrospectively collected from the Hospital Information System using automated data extraction strategies and through the implementation of a patient-centred data repository (the IBD Data Mart) [3]. The study population was identified from the medical records of patients who met the following inclusion criteria during 2020-2023: hospitalized adult patients (aged ≥18 years) diagnosed with Crohn's disease (CD) (ICD9-CM diagnosis codes 555) or ulcerative colitis (UC) (ICD9-CM diagnosis codes 556). Variables of interest, including demographics, comorbidities, surgery procedures, and treatment information, were collected using data extraction strategies. Specific ETL (Extract, Transform, Load) procedures were implemented to automatically retrieve data from heterogeneous data sources: data were acquired from a structured data source or extracted using clinically-validated text mining techniques from an unstructured data source. We assessed the use of anticoagulant treatments in this setting and during hospitalization. The TP included one of the following therapeutic protocols: low-molecular-weight heparin (LMWH) at a variable dose of 4000 to 8000 IU once daily, fondaparinux 2.5-3.5 mg/day, or calciparin at a dosage of up to 5000 IU twice daily. Patients were divided into two groups: patients with or without TP. Incidence of VTEs was assessed, also based on IBD type and hospitalization.

Results

Of the 1359 identified pts (42% with UC), 724 (53.3%) were treated with anticoagulant therapy during hospitalization. 79 pts (5.8%) presented a VTE. 259 pts were already in treatment with anticoagulant or antiplatelet therapy before hospitalization. 472 pts started anticoagulant treatment during hospitalization (472/1101, 42.9%). Among them, 431 (91.3%) began TP immediately after hospitalization, and 34 (7.2%) were excluded from the analysis because they were treated with a therapeutic dose of anticoagulant immediately after hospitalization, meaning they already had a VTE. Therefore, 1067 patients were evaluated for the efficacy of TP in preventing VTEs during hospitalization. Our results showed that TP is almost significantly effective in reducing VTE episodes (p=0.053). Regarding safety, we did not observe significant differences in the need for blood transfusions between patients treated or not treated with TP (p=0.37). Furthermore, TP interruption was rare, as only 28 patients (6.5%) discontinued treatment.

Conclusion

TP is effective in a real-world cohort of hospitalized patients with IBD in reducing VTEs. It is also a safe procedure as it does not increase the risk of severe bleeding requiring blood transfusions, and treatment discontinuation is an infrequent event. However, the rate of TP in our cohort is still suboptimal, and strategies to significantly implement this practice are recommended to reduce the occurrence of VTEs further.

References

[1] Papa A, et al. Prevention and treatment of venous thromboembolism in patients with IBD: a trail still climbing. Inflamm Bowel Dis. 2015 May;21(5):1204-13.
[2] Olivera PA et al. International consensus on preventing venous and arterial thrombotic events in patients with inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021 Dec;18(12):857-873.
[3] Damiani A, et al. Building an artificial intelligence laboratory based on real-world data: the experience of Gemelli generator. Front Comput Sci. 2021;3.

Introduction

The distinction between intestinal tuberculosis (IT) and Crohn's disease (CD) is difficult because of the numerous clinical, endoscopic and histological similarities between these two diseases, essentially in the ileo-cecal localization, which poses a problem of positive diagnosis and therefore of therapeutic management of these patients. The diagnosis of IT can be easy when it is associated with a pulmonary or peritoneal localization, more difficult when it is isolated.
The aim of our work is to show the interest of quantiferon in the differential diagnosis between these two pathologies.

Aims & Methods

This is a retrospective, descriptive monocentric study conducted over a period of 15 years from January 2007 to July 2022. 666 cases of CD were identified including 189 patients with ileocecal localization and during the same period 53 cases of TI were included. All our patients had an endoscopic evaluation with biopsies, an entero-CT scan and a phthisiological check-up. We included all patients with ileocolitis having chronic transit disorders.

Results

The average age of our patients was 39 years for IT and 32 years for CD. The sex ratio F/H=1.4 for IT and F/H=1.2 for CD.
The circumstances of discovery were dominated by chronic abdominal pain, then diarrhea and finally subocclusive syndrome in 46.5% (n=88), 38.6% (n=73) and 15.8% (n=30) respectively in patients with a retained diagnosis of CD, and by abdominal pain, chronic diarrhea and finally constipation and/or subocclusive syndrome in 41.5% (n=22), 39.6% (n=21) and 22.6% (n=12) of the patients diagnosed with IT respectively.
Quantiferon was performed in 79 patients and was positive in 35.4% of patients (n=28) with CD and 64.5% of those with TI (n=51). ASCA was performed in 63 patients and was positive in 60% (n=38) and negative in 40% (n=25) of patients.
In cases where ASCA was positive/Qantiferon negative, the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of CD were 80%, 98%, 93% and 50%, respectively.

Conclusion

Quantiferon has an important contribution in the differential diagnosis between IT and CD, the association with ASCA allows to refine the diagnosis between these two entities for a better therapeutic management.