Newman, Kira L.

Abstract Background Sexual dysfunction is common among patients with inflammatory bowel disease (IBD). For lesbian, gay, bisexual, transgender, or queer (LGBTQ+) patients, these challenges may be compounded by health disparities related to sexual health, stigma, and fear of discrimination in the clinical setting. There has been little research related to sexual health and IBD among this patient demographic. Methods Patients with IBD who receive care at Massachusetts General Hospital and the Brigham and Women’s Hospital were invited to participate in a 4-part survey on sexual health via an electronic patient portal messaging system and outpatient clinic flyers. Patients from the broader IBD community were invited to participate via social media outlets. Demographic data, IBD disease characteristics, and information related to health care experiences and interactions with IBD providers were collected. Sexual history information was obtained using an adapted version of the IBD-Specific Sexual Dysfunction Scale. Results In total, 340 patients completed the survey, of which 20.3% (n = 69) identified as LGBTQ+. The majority of patients (75%, n = 255) reported distress in their sexual life due to IBD; however, only 5% (n = 17) of respondents had previously discussed the topic of sexual health with their IBD provider. One in 4 LGBTQ+ patients listed fear of discrimination as a source of discomfort in these discussions, and a similar proportion expressed uncertainty regarding whether their sexual and/or gender identity negatively impacted their IBD care. Conclusions Further research and enhanced provider awareness of sexual health challenges related to IBD among LGBTQ+ patients may serve as an important step toward advancing inclusive and culturally sensitive care for this patient population.

INTRODUCTION: Little is known about the impact of gender-affirming hormone therapy (GAHT) on transgender and gender diverse adults with inflammatory bowel disease (IBD). The primary aim was to evaluate the incidence of IBD flare in the year before and after GAHT initiation. METHODS: A retrospective study across 5 IBD centers. Flare was defined as need for steroids, IBD-associated emergency department visit, or need for IBD medication change. Factors associated with IBD flare were assessed with univariate analysis and multivariable logistic regression controlling for age and IBD type. RESULTS: A total of 85 transgender and gender diverse adults with IBD who initiated GAHT were included in this study. Forty-six (54.1%) received estrogen and 39 (45.9%) received testosterone. In the year before GAHT, 42 (49%) flared compared with 32 (38%) in the year after, P = 0.06. There was no statistically significant difference in incidence of flare by age, IBD type, or IBD therapy type. Individuals with active IBD at GAHT initiation were more likely to flare in univariate (58% vs 24%, P = 0.003) and multivariable analyses (adjusted odds ratio 5.1, 95% confidence interval 1.7–15.2). In both univariate and multivariable analyses, individuals who received testosterone were more likely to flare in the year after starting GAHT, testosterone: 51% vs estrogen: 26%, P = 0.02 with an adjusted odds ratio 3.1 (95% confidence interval 1.2–8.1). DISCUSSION: Although there was no overall increased risk of flare in the year after GAHT start, those with active IBD before hormone start and those who received testosterone were more likely to experience an IBD flare.

INTRODUCTION: Evidence-based recommendations for sexual practices regarding anoreceptive intercourse (ARI) do not exist in patients with inflammatory bowel diseases undergoing restorative proctocolectomy with ileal pouch anal anastomosis (IPAA). This study surveys providers on perspectives and attitudes related to sexual practices after IPAA. METHODS: We developed a 23-item survey and distributed it to providers caring for patients with inflammatory bowel diseases. RESULTS: 95% of providers believe that it is important to discuss sexual orientation or practices before IPAA, but only 27% routinely discuss this. 50% did not feel comfortable and 74% did not feel confident discussing ARI recommendations with patients who underwent or will undergo IPAA. DISCUSSION: Future interventions should aim to standardize recommendations regarding feasibility and time line to safe ARI after IPAA.

Objective: To describe the incidence and risk factors for mortality and morbidity in patients with cirrhosis undergoing elective or emergent abdominal surgeries. Background: Postoperative morbidity and mortality are higher in patients with cirrhosis; variation by surgical procedure type and cirrhosis severity remain unclear. Methods: We analyzed prospectively-collected data from the Veterans Affairs (VA) Surgical Quality Improvement Program for 8193 patients with cirrhosis, 864 noncirrhotic controls with chronic hepatitis B infection, and 5468 noncirrhotic controls without chronic liver disease, who underwent abdominal surgery from 2001 to 2017. Data were analyzed using random-effects models controlling for potential confounders. Results: Patients with cirrhosis had significantly higher 30-day mortality than noncirrhotic patients with chronic hepatitis B [4.4% vs 1.3%, adjusted odds ratio (aOR) 2.80, 95% confidence interval (CI) 1.57–4.98] or with no chronic liver disease (0.8%, aOR 4.68, 95% CI 3.27–6.69); mortality difference was highest in patients with Model for End-stage Liver Disease (MELD) score ≥10. Among patients with cirrhosis, postoperative mortality was almost 6 times higher after emergent rather than elective surgery (17.2% vs. 2.1%, aOR 5.82, 95% CI 4.66–7.27). For elective surgeries, 30-day mortality was highest after colorectal resection (7.0%) and lowest after inguinal hernia repair (0.6%). Predictors of postoperative mortality included cirrhosis-related characteristics (high MELD score, low serum albumin, ascites, encephalopathy), surgery-related characteristics (emergent vs elective, type of surgery, intraoperative blood transfusion), comorbidities (chronic obstructive pulmonary disease, cancer, sepsis, ventilator dependence, functional status), and age. Conclusions: Accurate preoperative risk assessments in patients with cirrhosis should account for cirrhosis severity, comorbidities, type of procedure, and whether the procedure is emergent versus elective.