8 research outputs found
Attachment and perceived stress in patients with ulcerative colitis, a case–control study
No full textWhat is known on the subject?: Ulcerative colitis (UC) is a chronic inflammatory disorder associated with high perceived psychological stress. The attachment theory provides a psychodynamic perspective to investigate the relationship between close interpersonal relationships and stress in UC. Researchers have hypothesized that the chronic illness might affect personality trait as the attachment style of patients. What this paper adds to existing knowledge?: UC patients exhibit a more pronounced attachment insecurity that, in turn, resulted as a determinant of psychological stress. This study suggests that UC could determine a shift towards insecurity in the attachment style that, in turn, promotes psychological stress and increases the risk of psychopathologies. What are the implications for practice?: The more accurate knowledge of attachment insecurity in patients with chronic disorders such as UC may help the nurses to face with often dysfunctional patients’ styles of manifesting distress, patterns of help seeking and expectations of health professionals. The knowledge of psychopathological mechanisms in patients with UC could improve the prevention and treatment of psychological disorders in affected patients. Abstract: Introduction Ulcerative colitis (UC) is a chronic disorder characterized by recurrent intestinal symptoms. The attachment theory provides a psychodynamic perspective to investigate the relationship between interpersonal relationships and stress in UC. Aim The aim of this study was to compare the attachment dimensions between UC patients and controls and to evaluate the impact of these dimensions on perceived stress in patients. Method In all, 101 patients with UC completed the attachment style questionnaire and the perceived stress questionnaire (PSQ). Clinical and psychometric parameters were added as predictor variables in a regression with the PSQ score as dependent variable. One hundred and five healthy subjects took part in the study as controls. Results Compared to controls, UC patients exhibited greater scores in relationships as secondary, need for approval and preoccupation with relationships. In UC, disease activity, confidence and preoccupation with relationships resulted predictors of perceived stress. Discussion Compared to healthy controls, UC patients exhibited more pronounced attachment insecurity that, in turn, was a significant predictor of the perceived stress. Implications for practice The knowledge of attachment insecurity may help the nurses and all health care providers to face with dysfunctional patients’ styles of manifesting distress, help seeking and expectations of health professionals
M1085 Use of Infliximab and Adalimumab in Refractory Pouchitis
No full textINTRODUCTION: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. Anti-TNF agents are effective in both refractory ulcerative colitis and Crohn's disease.
AIMS & METHODS: This study aimed to evaluate the effectiveness of Infliximab (IFX) or Adalimumab (ADA) in inducing remission and improving quality-of-life (QOL) in such patients. From January 2007 to May 2009, 19 consecutive patients with refractory pouchitis were prospectively followed in a single tertiary center Patients with active pouchitis not responding after 1 month of antibiotic treatment (metronidazole 1g/day or ciprofloxacin 1g/
day) and 2 months of oral budesonide CIR at 9mg/day, were treated with IFX 5mg/kg at 0,2,6 weeks or ADA 160mg/80mg at weeks 0-2 and then 40 mg every-other-week. Shortterm efficacy was evaluated at week 10. Symptomatic, endoscopic and histological evaluations were done before and after treatment using the Pouchitis Disease Activity Index (PDAI) score. Remission was defined as a combination of a clinical PDAI score of 1. QOL was assessed using Inflammatory Bowel less or equal 2 and endoscopic PDAI score less or equal than Disease Questionnaire (IBDQ).
RESULTS: Twelve patients (7 males, 5 females, median age 32,6 years) received IFX, 7 (5 males, 2 females, median age 36,4 years) were treated with ADA; 2 of the patients treated with ADA were secondary failure to IFX. Nine of 12 (75 %) and 5 of 7 (71,4%) showed remission respectively in the IFX and ADA group. The median PDAI scores before and after therapy were 13 (range 8-18) and 2 (range 0-9) in IFX group(p<0.001), and 14 (range 9-18) and 2 (range 0-10) in the ADA group (p<0.001).
The median IBDQ score also significantly improved from 96 (range 74- 184) to 196 (range 92-230) in the IFX group (p<0.001), and from 105 (range 78-176) to 206 (range 94-226) in the ADA group (p<0.001).No serious side-effects were registered.
CONCLUSION: IFX and ADA were both effective in inducing remission and improving QOL in patients with refractory pouchitis, and were well tolerated
Four cases of carcinoid tumour in Crohn's disease: coincidence or correlation?
No full textThe association between Crohn’s disease and adenocarcinoma of the small intestine has been established, but the relation between Crohn’s and carcinoid tumours remains uncertain, although the diagnosis of carcinoid tumours has significantly increased in the last years.
We describe four cases of carcinoid tumour diagnosed in patients with Crohn’s disease followed at our IBD outpatients’ clini
Probiotics, Prebiotics and Antibiotics in the Treatment of Inflammatory Bowel Disease
No full textThe rationale for using probiotics, prebiotics, and antibiotics in inflammatory bowel diseases (IBD) is based on convincing evidence that intestinal bacteria are implicated in the pathogenesis of these diseases. Probiotics are “living organisms, which upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition. Several mechanisms have been proposed to account for the action of probiotics. VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses. Results on the use of probiotics in UC are promising, both in terms of the prevention of relapses and the treatment of mildto-moderate attacks. Results in Crohn’s disease are not yet clear because of conflicting data and the limited number of well-performed studies. Prebiotics are dietary substances, usually nondigestible carbohydrates, which beneficially affect the host by selectively stimulating the growth and activity of protective commensal enteric bacteria. Evidence supporting the use of these nutriceuticals in IBD is still limited. Antibiotics have an essential role in treating the septic complications of Crohn’s disease, including intrabdominal and perianal abscesses and perianal fistulae. The use of antibiotics in UC is not supported by the available studies while their use in pouchitis is largely justified although proper controlled trials have not been conducted
Probiotics in IBD: A critical review
No full textThe rationale underlying probiotics use in the treatment of IBD is based on compelling evidence that intestinal bacteria have a role in disease pathogenesis. The distal ileum and the colon are the areas with the highest bacterial concentrations and are also the sites of inflammation in IBD. Similarly, pouchitis, the nonspecific inflammation of the ileal reservoir that can occur after ileo-anal anastomosis, appears to be associated with bacterial overgrowth and dysbiosis. Enteric bacteria and their products have also been found within the inflamed mucosa of patients with Crohn’s diseas
Role of conventional therapies in the era of biological treatment in Crohn’s disease
No full textOutstanding progress regarding the pathophysiology of Crohn's disease (CD) has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD. This review concentrates on the results of randomized, placebo-controlled trials, and meta-analyses when available, that provide the highest degree of evidence. Current guidelines on the management of CD recommend a step-up approach to treatment involving the addition of more powerful therapies as the severity of disease and refractoriness to therapy increase. The advent of biological drugs has opened new therapeutic horizons for treating CD, modifying the treatment goals. However, the large majority of patients with CD will be managed through conventional therapy, even if they are a prelude to biological therapy
Use of concomitant proton pump inhibitors, statins or metformin in patients treated with pembrolizumab for metastatic urothelial carcinoma: data from the ARON-2 retrospective study
No full textBackground: Concomitant medications may potentially affect the outcome of cancer patients. In this sub-analysis of the ARON-2 real-world study (NCT05290038), we aimed to assess the impact of concomitant use of proton pump inhibitors (PPI), statins, or metformin on outcome of patients with metastatic urothelial cancer (mUC) receiving second-line pembrolizumab. Methods: We collected data from the hospital medical records of patients with mUC treated with pembrolizumab as second-line therapy at 87 institutions from 22 countries. Patients were assessed for overall survival (OS), progression-free survival (PFS), and overall response rate. We carried out a survival analysis by a Cox regression model. Results: A total of 802 patients were eligible for this retrospective study; the median follow-up time was 15.3 months. PPI users compared to non-users showed inferior PFS (4.5 vs. 7.2 months, p = 0.002) and OS (8.7 vs. 14.1 months, p < 0.001). Concomitant PPI use remained a significant predictor of PFS and OS after multivariate Cox analysis. The use of statins or metformin was not associated with response or survival. Conclusions: Our study results suggest a significant prognostic impact of concomitant PPI use in mUC patients receiving pembrolizumab in the real-world context. The mechanism of this interaction warrants further elucidation. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature
