It is estimated that 24% of those diagnosed with inflammatory bowel disease (IBD) will experience faecal incontinence, which is 1.5 times greater than the general population. While higher levels of anxiety and depression are associated with faecal incontinence generally, IBD patients are more likely to report higher levels of these than the general population. A quantitative survey examined the relationship between faecal incontinence and levels of anxiety and depression in 117 IBD patients. The results revealed statistically significant differences between the levels of anxiety (p<0.001) and depression (p=0.005) reported in patients who had recent experience of incontinence and those who did not. The study also raised concerns that incontinence is often concealed by patients and unidentified by health professions.

Summary Background Proactive therapeutic drug monitoring (proactive‐TDM) to optimise maintenance infliximab (IFX) trough levels prior to loss of response reduces the risk of treatment failure, inflammatory bowel disease (IBD)‐related surgery and hospitalisation when compared with reactive monitoring (reactive‐TDM). Aim The aim of this study is to investigate if proactive‐TDM in a virtual biologic clinic (VBC) improves patient disease control determined by number of hospital admissions, surgeries, patient reported outcome measures (PROMs) and biomarkers of disease activity. Methods We conducted a single‐centre retrospective observational study. Data were collected from commencement of the VBC in June 2016 to September 2017. All IBD patients on IFX in the VBC were included. PROMs were recorded using the IBD‐Control‐8 sub‐score and Visual Analogue Scale. Results One hundred and twenty‐three patients were included in the study. A statistically significant improvement in faecal calprotectin was observed with proactive‐TDM with a P‐value <.001. There was a 59% reduction in crisis IBD admissions with the introduction of proactive‐TDM in the VBC (P‐value <.005). Dose de‐escalations in the first 3 months of the VBC lead to cost savings of €32 000 per annum. Conclusions The introduction of proactive‐TDM resulted in a significant reduction in hospital admissions, an increase in mean IFX trough levels, a significant improvement in faecal calprotectin and adjustment to therapy in 33% of patients. Proactive‐TDM in the setting of a VBC is a method of managing IBD patients on IFX therapy with the potential for significant cost savings.

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IntroductionAccelerated dose infliximab (IFX) induction is associated with reduced short-term colectomy rate in acute severe ulcerative colitis (ASUC). Data on medium/long-term outcomes of this strategy are limited.AimsEvaluate medium/long-term outcomes in patients receiving IFX induction for ASUC, comparing accelerated dose (AD) and standard dose (SD) induction.MethodsRetrospective study of consecutive patients admitted with corticosteroid-refractory ASUC in four tertiary referral centres within INITIative IBD research network (www.initiativeibd.ie). IFX rescue was given either as SD (weeks 0, 2, 6) or AD (<28 days) from January 2010 to September 2017. AD induction has been utilised in participating centres since 2014. Consequently SD patients were subdivided based on time period of IFX rescue: historical SD group (SD1) (2010–2013) and current SD group (SD2) (2014–2017). Primary endpoint was time to colectomy; secondary endpoint was time to IFX discontinuation if induction was complete.Results145 patients received rescue IFX (AD=58, SD1=32, SD2=55). Disease severity at induction was comparable between AD and SD1 groups; however, SD2 group had less severe disease: median C-reactive protein (CRP) 39, 44 and 20 mg/L for AD, SD1 and SD2 groups, respectively (p=0.026, Kruskal-Wallis); median CRP: albumin ratio was 1.4, 1.8 and 0.6 (p=0.016). Median follow-up for AD, SD1 and SD2 groups was 1.6 (IQR 1.1–3.1), 4.9 (IQR 2.6–5.5) and 1.5 (IQR 0.9–2.3) years. Time to colectomy was shorter in SD1 (log rank p=0.0013); no significant difference in time to colectomy was observed comparing AD and SD2 groups (log rank p=0.32). 123 patients (84%) completed IFX induction and received maintenance therapy. Time to IFX discontinuation was shorter in SD1 (log rank p=0.009).ConclusionTime to colectomy is significantly prolonged with use of AD IFX in selected ASUC patients with more severe disease. Historical use of standard IFX induction for all ASUC patients is associated with inferior long-term outcomes.

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