Management of Inflammatory Bowel Diseases in Jehovah’s Witness

Abstract

Background: Treatment of Inflammatory Bowel Disease (IBD) patients who are known to be Jehovah's Witness (JW) can be a unique challenge. JW accept most available medical treatments, but may not accept blood transfusions or blood products due to their religious beliefs. We looked at the experience of treating IBD in JW, their care during acute bleed and also the outcome. Methods: A retrospective review was performed to identify patients treated for IBD known to be JW between the years 2005-2009 at two University of Pittsburgh Medical Center Hospitals. Demographic data, clinical presentation, treatment during hospitalizations and outpatient clinics were abstracted from the chart. All patients were confirmed to be having IBD either by colonoscopy or by documented evidence during clinical care. JW was confirmed by documentation in the chart. We took note of complications secondary to IBD, treatment measures during emergent conditions like acute bleed, bowel obstruction and also different treatment options used for long term management of IBD. Results: Twenty two patients were identified in both the university (n=14) and community hospital (n=8). Out of them, 13 patients had ulcerative colitis and 9 had Crohn's disease. Caucasians comprised majority of the population (68%). Mean age was 51 years. Mean time interval between initial diagnosis and most recent follow-up was 14 years. Among study subjects, 68% had documented colonoscopy reports with 6 patients (27%) showing active disease. Nine (41%) of these patients were post surgical and 6(27%) patients developed complication (clostridium difficile, abscess, fistula, colon cancer and small bowel obstruction) secondary to their IBD. Seventeen (77%) IBD patients were treated as an outpatient and 5(23%) as an inpatient. Three (14%) patients had to be admitted to Intensive Care Unit (ICU) during their inpatient stay. Hemoglobin was more than 10 g/dl in 68%, between 7 to 10 g/dl in 18% and less than 7 g/dl in 14% at baseline. After treatment with conservative measures for anemia, hemoglobin improved to more than 10 g/dl in 91%, and between 7 to 10 g/dl in 9%. One patient died with organ failure secondary to sepsis. Two patients (9%) underwent bloodless surgery with cell saver technique with no mortality. Conclusion: Management of IBD related anemia in JW has a good outcome and can be treated conservatively without blood transfusion. Complications secondary to IBD does not adversely affect the outcome.