Multimodel PO intervention in IBD patients is recommended.

BackgroundTNF-α plays a role in angiogenesis and collagen synthesis, both essential in the wound healing process. There are concerns that pre-operative anti-TNF-α treatment may influence the surgical stress response and increase the risk of surgical complications. The aim of this study was to describe the surgical stress response in patients with inflammatory bowel disease (IBD) and to investigate whether the pre-operative administration of anti-tumor necrosis factor alpha (anti-TNF-α) agents modify the surgical stress response.MethodsThis was a prospective, multi-center cohort pilot study. The primary outcome was the change in concentration of immunological biomarkers of the surgical stress response (TNF-α, IL-6, and IL-10). Secondary outcome measures were changes in IL-8, IL-17A, C-reactive protein, white blood cells, cortisol, transferrin, ferritin, and D-Dimer in addition to 30 days’ post-operative complications and length of post-operative stay in the hospital (LOS).ResultsForty-six patients with IBD undergoing major abdominal surgery were included, and 18 received anti-TNF- α treatment pre-operatively. Peak increase of most of the immunological biomarkers occurred 6 hours after surgical incision. Then the concentration decreased after 24 h followed by a plateau at 48 h. After adjusting for confounders including detectable blood concentrations, no difference in the concentrations of immunological, endocrinological or haematological biomarkers of stress was found between anti-TNF-α treated and anti-TNF-α naïve patients. No increase in post-operative complications or LOS was noticed in patients who received anti-TNF-α treatment.ConclusionsAnti-TNF-α did not affect surgical stress response in this pilot study. Withdrawal of anti-TNF-α drugs prior to surgical intervention in IBD patients might not be justified without measurement of drug concentration and drug antibodies.Trial registrationClinicaltrails.gov.: NCT01974869.

AIMTo examine the evidence about psychiatric morbidity after inflammatory bowel disease (IBD)-related surgery.METHODSPRISMA guidelines were followed and a protocol was published at PROSPERO (CRD42016037600). Inclusion criteria were studies describing patients with inflammatory bowel disease undergoing surgery and their risk of developing psychiatric disorder.RESULTSTwelve studies (including 4340 patients) were eligible. All studies were non-randomized and most had high risk of bias. Patients operated for inflammatory bowel disease had an increased risk of developing depression, compared with surgical patients with diverticulitis or inguinal hernia, but not cancer. In addition, patients with Crohn’s disease had higher risk of depression after surgery compared with non-surgical patients. Patients with ulcerative colitis had higher risk of anxiety after surgery compared with surgical colorectal cancer patients. Charlson comorbidity score more than three and female gender were independent predictors for depression and anxiety following surgery.CONCLUSIONThe review cannot give any clear answer to the risks of psychiatric morbidity after surgery for IBD studies with the lowest risk of bias indicated an increased risk of depression among surgical patients with Crohn’s disease and increased risk of anxiety among patients with ulcerative colitis.

Purpose The authors tested the hypothesis that having a high availability of different types of alcoholic drinks (beer, wine or spirits) as compared to being confined to one type only associate with a higher alcohol intake and worse next-day hangover. Design/methodology/approach This randomized controlled pilot trial took place over one evening and included 35 individuals randomized into two groups. Individuals in the mixed-type group could consume any type of alcoholic drink (beer, wine, cocktails), whereas individuals in the single-type group were to adhere to one type of own choice. Information on number of drinks was obtained continuously during the trial. Hangover symptoms were reported by participants using the Acute Hangover Severity Scale (AHSS) at 8:00, 12:00 and 16:30 the following day. Median regression was used to assess number of drinks and maximum AHSS in two groups. Findings Participants in the mixed-type group consumed significantly more drinks compared to the single-type group (10.9 vs 5.7, p < 0.001). The maximal AHSS score the day after drinking was higher in the mixed-type group as compared to the single-type group (median 4.3 vs 2.6, p < 0.0001). Originality/value This study suggests that having a variety of alcoholic drinks available associates to a higher alcohol intake and more severe hangover as compared to having to adhere to one type only. Larger studies are warranted to validate findings.