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When lifestyle intervention doesn't help: Recommendations for medical treatment of obesity
1 Universitätsklinikum des Saarlandes, None, Germany
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Best of UEG Week 2024 with Thomas Seufferlein on "Oncology for Gastroenterologists"
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ENDOSCOPIC SPHINCTEROTOMY FOR RECURRENT BILIARY PANCREATITIS IN PATIENTS UNFIT FOR SURGERY
Sara Ramos Lopes 1, Madalena Teixeira 1, David Ferro Tomás 1, António Bastos 1, João Mangualde 1, Ricardo Freire 1, Elia Gamito 1, Ana Luísa Alves 1
1 Unidade Local de Saúde da Arrábida, Setúbal, Portugal
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Introduction
As a chronic disease, patients’ perspectives on their disease status and quality of life is an essential part of inflammatory bowel disease (IBD) management1. Patient-reported outcomes should be the standard of measure for signs and symptoms evaluation2.
Aims & Methods
We aimed to evaluate the correlation between patients’ self-assessment of disease activity, activity scores and the physician’s global assessment.
A unicentric cross-sectional study was conducted. The Short Inflammatory Bowel Disease Questionnaire (SIBDQ)3 was administered to consecutively evaluated IBD patients in the outpatient setting. Additionally, a pilot questionnaire addressing perceived disease activity was completed by both patients and their attending physician.
Disease activity was categorized as remission, mild, moderate, or severe. Remission was defined as Harvey Bradshaw Index (HBI) ≤ 4 for Crohn's disease or Mayo Clinic Subscore (MCS) ≤ 2 for ulcerative colitis.
Spearman’s rank correlation coefficient was used to assess correlations between patient-reported disease activity, physician global assessment, disease activity scores, and quality of life.
Results
A total of 105 patients were included (female: 52%; mean age: 44±15 years), of whom 68% had Crohn's disease. 71% percent of patients were receiving advanced therapy (table 1).
A quarter of the patients (27%, n=28) perceived their disease to be in remission, of whom 56% were indeed in deep remission and 19% in endoscopic remission (table 1). A statistically significant positive correlation was observed between patient self-assessment and HBI scores (mean=2.5±6.5 points, r=0.400, p=0.001) and MCS scores (mean=3.4±4.0 points, r=0.574, p<0.001).
Among patients who did not consider themselves in remission, 42% rated the activity of their disease as mild, 23% as moderate, and 9% as severe. The attending physician assessed 26% with mild disease, 22% with moderate disease, and 18% with severe disease (table 1). There was a statistically significant positive correlation between patient and physician assessments (r=0.374; p<0.001).
The mean SIBDQ score was 50.7 ± 12.1 points (table 1), and a statistically significant negative correlation was found between patient self-assessment of disease activity and the SIBDQ (r=-0.417, p<0.001).
| Female gender, % (N) | 52% (55) |
| Age, mean ± standard deviation (SD), years | 44.1 ± 15.0 |
| Type of IBD, % (N) CD UC | 68% (71) 32% (34) |
| History of IBD-related surgery, % (n) | 25% (26) |
| History of IBD-related hospitalization, % (n) | 39% (41) |
| Current medical therapy, % (n) 5-Aminosalicylates monotherapy Immunomodulators (mono or combo therapy) Advanced therapy | 19% (20) 31% (32) 71% (74) |
| Disease activity indices, mean ± SD HBI MCS | 2.5 ± 6.5 3.4 ± 4.0 |
| Patient-reported disease activity, % (N) Remission Mild Moderate Severe | 27% (28) 42% (44) 23% (24) 8% (9) |
| Physician’s global assessment, % (N) Remission Mild Moderate Severe | 34% (36) 26% (27) 23% (24) 18% (19) |
| Quality of life, mean ± SD SIBDQ-PT | 50.7 ± 12.1 |
Conclusion
These observational data suggest a weak correlation between patient-reported disease activity and the physician’s global assessment. Divergent perceptions of disease activity between patients and physicians may compromise patient-engagement. Furthermore, the moderate correlation observed with overall quality of life supports the importance of alignment patients and physicians to improve the quality of care provided.
References
1 - Fiorino G et al. Quality of Care Standards in Inflammatory Bowel Diseases: a European Crohn's and Colitis Organisation [ECCO] Position Paper. J Crohns Colitis. 2020 Sep 7;14(8):1037-1048. doi: 10.1093/ecco-jcc/jjaa023.
2 - Turner D et al. International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031.
3 - Roseira J et al. Short Inflammatory Bowel Disease Questionnaire: translation and validation to the Portuguese language. Health Qual Life Outcomes. 2021 Feb 18;19(1):59. doi: 10.1186/s12955-021-01698-9.
CORRELATION BETWEEN PATIENT-REPORTED DISEASE ACTIVITY, PHYSICIAN’S GLOBAL ASSESSMENT AND QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE
Sara Ramos Lopes 1, Madalena Teixeira 1, David Ferro Tomás 1, António Bastos 1, Cristiana Sequeira 2, Cristina Teixeira 1, Elia Gamito 1, Ana Luísa Alves 1
1 Unidade Local de Saúde da Arrábida, Setúbal, Portugal
2 Hospital de Cascais, Cascais, Portugal
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Immune-related adverse events and their management: Luminal GI
1 Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
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OUTPATIENT ERCP: EVALUATING PRECUT TECHNIQUES VERSUS STANDARD SPHINCTEROTOMY FOR BILIARY ACCESS
David Ferro Tomás 1, António Bastos 1, Madalena Teixeira 1, Sara Ramos Lopes 1, João Mangualde 1, claudia cardoso 1, Ricardo Freire 1
1 Hospital São Bernardo - Unidade Local de Saúde da Arrábida, Setúbal, Portugal
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And now the pancreas is gone: Suspected cancer turns out benign - Gastroenterologist and surgeon
1 Erasmus University MC Dept. of Gastronterology, Rotterdam, Netherlands
2 Sahlgrenska University Hospital instead of Karolinska, Gothenburg, Sweden
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