Farraye, Francis A.

Abstract Background The increasing incidence and prevalence of inflammatory bowel disease (IBD), has fuelled the need for innovative models of care. We aimed to compare effectiveness of e-health interventions (virtual clinics, telephone consultation, remote monitoring or any web-based health platform) with standard care in management of IBD. Our primary outcomes were to assess the difference in disease activity and percentage of patients in clinical remission at the end of follow up. Our secondary outcomes were to investigate differences in quality of life (QoL), IBD-knowledge & rate ratios (RR) for endoscopic procedures, total healthcare encounters, corticosteroid use, and IBD related hospitalisation or surgery. Methods We searched Medline, Embase, PubMed, CINAHL, PsychInfo, Clinical trials registry and Cochrane databases for randomised controlled trials (RCT) published in the English language until November 2020, comparing e-health interventions to standard care for patients with IBD. Pooled estimates of dichotomous outcomes were calculated using the odds ratio (OR) and 95% confidence interval (CI) using the Mantel-Haenszel statistical method. For continuous data, the standardised mean difference (SMD) and 95% CI were calculated using the inverse variance statistical method. Event data were analysed and expressed as RR with 95% CI using the inverse variance statistical method. Random effects model was used. Results Nine studies involving 1841 participants (991 e-health group and 850 controls) were identified. There was no statistically significant difference between the mean disease activity scores for UC (SMD 0.22, 95% CI: -0.04–0.48) and CD (SMD 0.02, 95% CI: -0.18–0.22) in the e-health and standard care groups and no statistically significant difference in the percentage of patients in clinical remission at the end of follow up between both groups (OR -1.05, 95% CI: 0.76–1.45). Higher QoL (SMD 0.19, 95% CI: 0.05–0.34) and IBD knowledge (SMD 0.25, 95% CI: 0.12–0.37) scores were noted in the e-health group compared to standard care. There were no statistically significant differences noted in the RR for endoscopic procedures (RR 1.01, 95% CI: 0.81–1.26), total healthcare encounters (RR 1.03, 95% CI: 0.93–1.15;), IBD related, corticosteroid use (RR 0.99, 95% CI: 0.51–1.92), and IBD related hospitalisation (RR 0.81, 95% CI: 0.53–1.25) or surgery (RR 0.87, 95% CI: 0.49–1.55) between both groups. Conclusion E-health interventions are comparable with standard care for impact on disease activity, remission, endoscopy utilisation, total healthcare encounters, corticosteroid use, and IBD related hospitalisation or surgery. QoL and IBD related knowledge were higher in the e-health compared to the standard care group.

Abstract The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients’ concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.

AbstractIleocolic resection (ICR) is the most common surgical procedure in Crohn disease (CD). There are many surgical techniques for performing ICRs and subsequent anastomoses. Recurrence of CD after ICR is common, often clinically silent, and thus requires monitoring including periodic use of endoscopy to detect early active disease. There is emerging evidence that surgical approaches may influence CD recurrence. This review explores the various surgical considerations, the data behind each decision, and how these techniques influence subsequent endoscopic surveillance.

Abstract The relatively high cost of anti-TNF agents and looming or actual expiry of patents for several biologics have led to the development of “highly similar” versions of the “originator” drugs called “biosimilars.” The approval of biosimilars has been based on “extrapolation,” whereby approval is granted in licensed indications for the reference product without the need for clinical trials. We discuss efficacy and safety data in support of biosimilar use from prospective studies, switching from originator biologic, impact on immunogenicity, pharmaco-economic, and practical considerations for clinicians.

Abstract Background Data on efficacy of hepatitis-B vaccine (HBV) in patients with inflammatory bowel disease (IBD) is limited. Our aim was to review the literature and perform meta-analysis of available studies to quantify efficacy of HBV in patients with IBD. Methods We conducted a comprehensive search of several databases (inception to July 2020) to identify studies evaluating efficacy of HBV in patients with IBD. Random effects model was used to calculate the pooled rates and I2 percentage values were used to assess the heterogeneity. Results A total of 14 studies (2375 patients) were included. Four data sets were available from 2 studies that compared HBV response in patients with IBD against healthy controls. The pooled odds ratio of HBV response in IBD patients was 0.13 (95% CI, 0.05–0.33, P = 0.001). The pooled proportion of adequate immune response (AIR) was 64% (95% CI, 55–72.1, P = 0.003) from 13 data sets, and effective immune response (EIR) was 39.7% (95% CI, 30.7–49.5, P = 0.04) from 10 data sets. Conclusion Patients with IBD on immunosuppression demonstrated significantly reduced HBV response as compared with general population.