Common Instances of Low-value Care in Inflammatory Bowel Diseases

Singh, Siddharth; Velayos, Fernando S.; Rubin, David T.

doi:10.1016/j.cgh.2023.09.043

Clinical Gastroenterology and Hepatology

2024

DOI: 10.1016/j.cgh.2023.09.043

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Common Instances of Low-value Care in Inflammatory Bowel Diseases

Siddharth Singh,

Fernando S. Velayos,

David T. Rubin

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2024

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Cited by 3 publications

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Review article: The role of the gut–brain axis in inflammatory bowel disease and its therapeutic implications

Riggott,

Ford,

Gracie

2024

Aliment Pharmacol Ther

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SummaryBackgroundTreatments targeting the gut–brain axis (GBA) are effective at reducing symptom burden in irritable bowel syndrome (IBS). The prevalence of common mental disorders and IBS‐type symptom reporting is significantly higher in inflammatory bowel disease (IBD) than would be expected, suggesting potential GBA effects in this setting. Manipulation of the GBA may offer novel treatment strategies in selected patients with IBD. We present a narrative review of the bi‐directional effects of the GBA in IBD and explore the potential for GBA‐targeted therapies in this setting.MethodsWe searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published by March 2024.ResultsThe bi‐directional relationship between psychological well‐being and adverse longitudinal disease activity outcomes, and the high prevalence of IBS‐type symptom reporting highlight the presence of GBA‐mediated effects in IBD. Treatments targeting gut–brain interactions including brain–gut behavioural treatments, neuromodulators, and dietary interventions appear to be useful adjunctive treatments in a subset of patients.ConclusionsPsychological morbidity is prevalent in patients with IBD. The relationship between longitudinal disease activity outcomes, IBS‐type symptom reporting, and poor psychological health is mediated via the GBA. Proactive management of psychological health should be integrated into routine care. Further clinical trials of GBA‐targeted therapies, conducted in selected groups of patients with co‐existent common mental disorders, or those who report IBS‐type symptoms, are required to inform effective integrated models of care in the future.

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Review article: The role of the gut–brain axis in inflammatory bowel disease and its therapeutic implications

Riggott,

Ford,

Gracie

2024

Aliment Pharmacol Ther

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Review Article: Green Management of IBD—New Paradigms for an Eco‐Friendly Approach

Cammarota,

Laterza,

Bibbò

et al. 2024

Aliment Pharmacol Ther

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BackgroundThe worldwide prevalence of inflammatory bowel disease (IBD) is increasing, with its potential evolution as a global disease and a consequent increase in its burden on healthcare systems. These estimates do not factor in the ‘real’ price of IBD, which, beyond curbing career aspirations, instilling social stigma, and impairing the quality of life in patients, could also significantly affect the environment.AimTo highlight potential areas for intervention and develop management strategies aimed at minimising environmental impacts in the field of IBD over time.MethodsVarious aspects of IBD care (organisation of IBD centres, diagnostics and therapeutics) are examined from an environmental sustainability perspective.ResultsEach stage, from the patient's means of transport to the hospital to the physician's diagnostic and therapeutic decisions, contribute to CO2 and waste production. Strategies to contain the environmental impact are feasible. Some are easy to implement, such as ensuring the appropriateness of the diagnostic and therapeutic pathway for patients; others need to be implemented in synergy with healthcare providers' policies and pharmaceutical companies.ConclusionsWith an inevitable increase in the number of patient visits, endoscopies, laboratory testing, and long‐term therapeutic strategies for IBD, the clinical community should be aware of environmental concerns and investigate possible strategies to reduce the environmental impact of IBD care.

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Common Mistakes in Managing Patients with Inflammatory Bowel Disease

Gisbert,

Chaparro

2024

JCM

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Introduction: Errors are very common in medical practice and in particular, in the healthcare of patients with inflammatory bowel disease (IBD); however, most of these can be prevented. Aim: To address common errors in the management of IBD. Methods: Our approach to this problem consists in identifying mistakes frequently observed in clinical practice (according to our experience) in the management of patients with IBD, then reviewing the scientific evidence available on the subject, and finally proposing the most appropriate recommendation for each case. Results: The most common mistakes in the management of IBD include those related to diagnosis and differential diagnosis, prevention, nutrition and diet, treatment with different drugs (mainly 5-aminosalicylates, corticosteroids, thiopurines, and anti-TNF agents), extraintestinal manifestations, anemia, elderly patients, pregnancy, and surgery. Conclusions: Despite the availability of guidelines for both disease management and preventive aspects of IBD care, a considerable variation in clinical practice still remains. In this review, we have identified common mistakes in the management of patients with IBD in clinical practice. There is a clear need for a greater dissemination of clinical practice guidelines among gastroenterologists and for the implementation of ongoing training activities supported by scientific societies. Finally, it is desirable to follow IBD patients in specialized units, which would undoubtedly be associated with higher-quality healthcare and a lower likelihood of errors in managing these patients.

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Common Instances of Low-value Care in Inflammatory Bowel Diseases

Cited by 3 publications

References 55 publications

Review article: The role of the gut–brain axis in inflammatory bowel disease and its therapeutic implications

Review article: The role of the gut–brain axis in inflammatory bowel disease and its therapeutic implications

Review Article: Green Management of IBD—New Paradigms for an Eco‐Friendly Approach

Common Mistakes in Managing Patients with Inflammatory Bowel Disease

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