Introduction

Intravenous iron administration carries a small but potentially life-threatening risk of allergic reactions. European Medicines Agency (EMA) guidelines underscore the importance of preventive strategies. This study evaluates the incidence and characteristics of allergic reactions to intravenous iron in routine clinical practice.

Results & Findings

The incidence of hypersensitivity reactions to intravenous iron preparations was 1,3% (2 out of 150 patients) during the one-year period. One allergic reaction was recorded with ferric derisomaltose, and one with ferric carboxymaltose, resulting in the discontinuation of therapy in both instances.

Summary & Discussion

The low incidence of hypersensitivity reactions to intravenous iron preparations was 1,3% in our one-year cohort of 150 patients indicates the relative safety of these drugs in clinical practice, alignin with the findings of a study A.Kumar, M.J.Brookes 2020. However, our observation highlights the crucial role of nursing interventions in minimizing potential risks. Careful patient monitoring, adherence to standardized administration protocols, and prompt recognition of early signs of hypersensitivity were key factors in ensuring patient safety. Further research is needed to identify specific nursing interventions and protocols that can further reduce the risk of these reactions and improve patient outcomes. Future studies should explore the effectiveness of infusion rate and patient edukation in preventing hypersensitivity reactions to intravenous iron.

Conclusion

An individualized, holistic approach minimizes the risk of hypersensitivity and allergic reactions. A care strategy grounded in empathy significantly influences the reduction of patient anxiety and fear associated with high- dose iron administration. Skilled and educated personnel are essential for safe and high- quality care, reacting promptly and decisively. Work experience and the ability to anticipate situations play a crucial roles in timely and effective management.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC9600424/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7697745/
https://hrcak.srce.hr/file/454702
https://jhoponline.com/issue-archive/2023-issues/december-2023-vol-13-no-6/19590:management-of-iron-infusion-reactions

Disclosure

No

Introduction

Video capsule endoscopy is a diagnostic method for examination of the small intestine. It is completely non-invasive and painless method that ensures complete examination of the small intestine because the video capsule allows a visual examination of the entire small intestine including parts that are difficult to reach with other endoscopic methods. Capsule provide high-quality images of the inner walls of the small intestine. This allows a better detection of pathological changes such as polyps, inflammation or bleeding. In a certain population of patients there is a risk that capsule "get stuck" in the intestine. This especially applies to patients with previous operations in the small intestine, in those who are on long-term therapy with nonsteroidal antirheumatic drugs, in patients who have had radiation to the pelvic region, or in patients where there is a suspicion of stenosis of the small intestine which is possible in patients with Crohn's disease.

Results & Findings

Patient underwent a small bowel video capsule examination. After the patient did not notice that the capsule had come out of the large intestine he come to our department. We performed a radiological evaluation which determined that capsule had remained in the small intestine. It was suggested to try to remove it through a single balloon enteroscope in order to avoid surgery. He was prepared for single balloon enteroscopy under general anesthesia. The endoscope was advanced through the small intestine to the site where the capsule had remained (middle part of jejunum) and with the help of a net loop the capsule was grasped and safely removed.

Summary & Discussion

One of the common risks of the procedure is capsule retention which is defined as a capsule remaining in the gastrointestinal system for longer than two weeks. Capsule retrieval is not emergent in asymptomatic retainers. In this case, the patient had no symptoms but was concerned because the capsule did not come out as expected. Considering the passage of time since installation and the type of capsule itself it was not possible to see online where the capsule is located. We used a radiological methods to detect capsule retention. Because we gave the patient clear instructions on what to expect after the capsule was placed so the retention condition was recognized in time and the extraction procedure was performed which ultimately resulted in avoiding patient surgery.

Conclusion

In order to avoid potential complications in the form of retention of the capsule in the small intestine in patients with Crohn's disease, before the actual placement of the capsule, the patient can be given a capsule to check the patency of the small intestine. A successful patency test minimizes the risk of retention and allows the safe administration of a capsule. On the other hand single baloon enteroscopy provides us possibility of therapeutic action in the small intestine and using of this endoscopic method spare patient from other invasive solutions.

References

1. Boysen M and Ritter M, Small Bowel Obstruction from Capsule Endoscopy, West J Emerg Med. 2010 Feb;11(1):71–73.
2. Mitselos IV, Katsanos KH, Tsianos, Eliakim R, Christodoulou DK, Clinical Use of Patency Capsule: A Comprehensive Review of the Literature, Inflammatory Bowel Diseases, Volume 24, Issue 11, November 2018, Pages 2339–2347

Introduction

​Anastomotic leak is a major complication following upper gastro-intestinal (UGI) surgery and is associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a promising method - we aimed to evaluate the treatment success in our treated population, and describe the nurse interventions that allows procedure efficiency

Results & Findings

We included 34 patients, 29 of them were male. The average age at surgery was 67,9 years; 9 patients were diagnosed with Squamous cell carcinoma; 21 with Adenocarcinoma, 1 with melanoma and 3 patients had iatrogenic benign surgery complications 8 received neoadjuvant chemotherapy, 19 received both chemo and radiotherapy. The median size of fistula opening was 11mm (average 19,9mm). A median of 6 interventions was performed per patient. EVT therapy was the first line of treatment in 23 patients while stent placement was performed previously in 12 patients. The average intervals between leak diagnosis and first treatment when EVT was the first line (was 4,77 days); 19 patients had complete closure of the defect, while 5 had partial closures (followed by stent placement in 4). We had two migrations. Due to pulmonary disease, we had to stop the treatment in one patient.

Summary & Discussion

All cases were in patients (4 needed Invasive mechanical ventilation and were in the Intensive Care Unit and 30 underwent therapy at Gastroenterology unit). Nurse staff prepared all the equipment and necessary materials; confirmed all anesthetic safety requirements (fasting, dental prosthesis, current medication, allergies); checked the bottle contents, cut the sponge according to the size of the cavity (when necessary) and wrapped it in lubricant gel. The nurse also secured the overtube while the gastroenterologist pushed the sponge into the cavity and held the forceps used to convert the draining tube from oro- to nasogastric. The sponge was then connected to the vacuum bottle. All connections were verified and sealed with waterproof tape before switching on the vacuum device, this is a very important step because it prevents the loss of vacuum pressure. It was necessary to confirm the pressure level. During the period that patients had EVT, gastroenterology nursing staff communicated with in patient nursing staff, giving all the indications, support and necessary training.

Conclusion

EVT is a safe and effective treatment for management of anastomotic leaks following esophageal surgery. Trained nursing staff improves the outcomes of this therapy, allows the efficiency of the procedure, and reduces anesthetic risks.

Disclosure

No conflit of interest

Introduction

Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic gastrointestinal disorder characterized by relapsing inflammation and significant psychological burden [1]. Patients with IBD often experience depression, anxiety, and reduced quality of life [2]. However, emerging research highlights posttraumatic growth (PTG)—positive psychological transformation following trauma—as a potential outcome in chronic illness [3].
PTG arises from cognitive restructuring after traumatic events, with rumination playing a key role [4]. Rumination includes intrusive rumination (unwanted, distressing thoughts) and deliberate rumination (purposeful reflection). While deliberate rumination typically fosters PTG, findings on intrusive rumination are inconsistent, with some studies reporting negative, positive, or null effects [5].

Results & Findings

A cross-sectional survey of 237 Chinese IBD patients. Intrusive rumination was negatively associated with PTG (β = -0.33; 95% CI: -0.61, -0.04), with education level impacting this effect (P for interaction < 0.05). Deliberate rumination showed a positive linear relationship with PTG (β = 0.87; 95% CI: 0.57, 1.17). Above a threshold of 17, intrusive rumination had a stronger negative impact (β = -1.01; 95% CI: -1.73, -0.30).

Summary & Discussion

This finding aligns with cognitive theories of trauma processing, which suggest that excessive intrusive thoughts may overwhelm an individual's cognitive and emotional resources, impeding adaptive meaning-making [6]. Below this threshold, intrusive rumination may serve as an initial, albeit distressing, step in cognitive processing, whereas higher levels may entrench negative thought patterns[9].This non-linear association helps reconcile conflicting findings in the literature [7]. Future research should explore whether interventions (e.g., mindfulness, cognitive restructuring) facilitate a transition toward deliberate rumination and subsequent PTG.
In contrast to intrusive rumination, deliberate rumination demonstrated a robust positive association with PTG across all models[8]. For IBD patients, who often experience fluctuating symptoms and emotional distress, facilitating deliberate cognitive processing may help them reframe their illness narrative, enhancing resilience and adaptive coping.
Individuals with lower education levels may lack the cognitive resources and flexibility needed to transform intrusive rumination into constructive meaning-making, making them more susceptible to negative emotional cycles that hinder PTG [9].

Conclusion

In conclusion, a nonlinear relationship between intrusive rumination and PTG in patients with IBD was found. When intrusive rumination exceeded a threshold of 17, it was negatively correlated with PTG. Additionally, deliberate rumination was positively associated with PTG, highlighting its potential as a facilitator of psychological growth.

References

1. Barberio B, Zamani M, Black CJ, et al. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370.
2. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.
3. Joseph S, Murphy D, Regel S. An affective-cognitive processing model of post-traumatic growth. Clin Psychol Psychother. 2012;19(4):316-325.
4. Allen N, Hevey D, Cogley C, et al. A meta-analysis of the association between event-related rumination and posttraumatic growth: the event-related rumination inventory and the posttraumatic growth inventory. J Trauma Stress. 2022;35(6):1575-1585. https://doi.org/10.1002/jts.22875
5. Jones SR, Fernyhough C. Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model. Behav Res Ther. 2009;47(1):54-59.
6. Hill EM, Watkins K. Women with ovarian cancer: Examining the role of social support and rumination in posttraumatic growth, psychological distress, and psychological well-being. J Clin Psychol Med Settings. 2017;24(1):47-58
7. Tedeschi RG, Shakespeare-Finch J, Taku K, et al. Posttraumatic growth: Theory, research, and applications. Routledge. 2018.
8. Niemeyer H, Bieda A, Michalak J, et al. Education and mental health: Do psychosocial resources matter? SSM Popul Health. 2019;7:100392.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.