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Systematic review of nutrition screening and assessment in inflammatory bowel disease

World Journal of Gastroenterology 2019年第28期25卷 3823-3837页

作者： Suqing Li Michael Ney Tannaz Eslamparast Ben Vandermeer Kathleen P Ismond Karen Kroeker brendan halloran Maitreyi Raman Puneeta Tandon Division of Internal Medicine Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta T6G 2G3 Canada Division of Gastroenterology and Hepatology Department of Medicine University of Calgary Calgary Alberta T2N 2T9 Canada Cirrhosis Care Clinic Division of Gastroenterology Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta T6G 2X8 Canada Alberta Research Centre for Health Evidence Biostatistician Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta T6G 1C9 Canada

BACKGROUND Malnutrition is prevalent in inflammatory bowel disease (IBD). Multiple nutrition screening (NST) and assessment tools (NAT) have been developed for general populations, but the evidence in patients with IBD remains unclear. AIM To systematically review the prevalence of abnormalities on NSTs and NATs, whether NSTs are associated with NATs, and whether they predict clinical outcomes in patients with IBD. METHODS Comprehensive searches performed in Medline, CINAHL Plus and PubMed. Included: English language studies correlating NSTs with NATs or NSTs/NATs with clinical outcomes in IBD. Excluded: Review articles/case studies;use of body mass index/laboratory values as sole NST/NAT;age<16. RESULTS Of 16 studies and 1618 patients were included, 72% Crohn’s disease and 28% ulcerative colitis. Four NSTs (the Malnutrition Universal Screening Tool, Malnutrition Inflammation Risk Tool (MIRT), Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT) and Nutrition Risk Screening 2002 (NRS-2002) were significantly associated with nutritional assessment measures of sarcopenia and the Subjective Global Assessment (SGA). Three NSTs (MIRT, NRS-2002 and Nutritional Risk Index) were associated with clinical outcomes including hospitalizations, need for surgery, disease flares, and length of stay (LOS). Sarcopenia was the most commonly evaluated NAT associated with outcomes including the need for surgery and post-operative complications. The SGA was not associated with clinical outcomes aside from LOS. CONCLUSION There is limited evidence correlating NSTs, NATs and clinical outcomes in IBD. Although studies support the association of NSTs/NATs with relevant outcomes, the heterogeneity calls for further studies before an optimal tool can be recommended. The NRS-2002, measures of sarcopenia and developments of novel NSTs/NATs, such as the MIRT, represent key, clinically-relevant areas for future exploration.

关键词： Nutrition Inflammatory bowel disease Ulcerative colitis Crohn’s disease Screening Outcomes research

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Lymphoproliferative disorders in inflammatory bowel disease patients on immunosuppression: Lessons from other inflammatory disorders

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World Journal of Gastrointestinal Pathophysiology 2015年第4期6卷 181-192页

作者： Grace Y Lam brendan P halloran Anthea C Peters Richard N Fedorak Department of Medicine Division of Internal Medicine University of Alberta Department of Medicine Division of Gastroenterology University of Alberta Department of Medicine Division of HematologyUniversity of Alberta

Immunosuppressive agents, such as thiopurines, methotrexate, and biologics, have revolutionized the treatment of inflammatory bowel disease(IBD). However, a number of case reports, case control studies and retrospective studies over the last decade have identified a concerning link between immunosuppression and lymphoproliferative disorders(LPDs), the oncological phenomenon whereby lymphocytes divide uncontrollably. These LPDs have been associated with Epstein-Barr virus(EBV) infection in which the virus provides the impetus for malignant transformation while immunosuppression hampers the immune system's ability to detect and clear these malignant cells. As such, the use of immunosuppressive agents may come at the cost of increased risk of developing LPD. While little is known about the LPD risk in IBD, more is known about immunosuppression in the post-transplantation setting and the development of EBV associated posttransplantation lymphoproliferative disorders(PTLD). In review of the PTLD literature, evidence is available to demonstrate that certain immune suppressants such as cyclosporine and T-lymphocyte modulators in particular are associated with an increased risk of PTLD development. As well, high doses of immunosuppressive agents and multiple immunosuppressive agent use are also linked to increased PTLD development. Here,we discuss these findings in context of IBD and what future studies can be taken to understand and reduce the risk of EBV-associated LPD development from immunosuppression use in IBD.

关键词： Epstein-Barr virus Immunosuppression Post-transpla

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Evaluation of the Quick Wee method of inducing faster clean catch urine collection in pre‑continent infants: a randomized controlled trial

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World Journal of Pediatrics 2022年第1期18卷 43-49页

作者： Aoife Branagan Niofa Canty Evanne O’halloran Marian Madden Michael brendan O’Neill Department of Paediatrics Mayo University HospitalCastlebarCo.MayoIreland

Introduction The acquisition of non-contaminated urine samples in pre-continent infants remains a *** Quick Wee method uses bladder stimulation to induce voiding.A previous randomized trial showed a higher rate of voiding within 5 minutes using this *** evaluated this method in an Irish hospital providing secondary *** A non-blinded,randomized,controlled trial was carried *** infants were between 1 and 12 months of age,who required urine sampling as part of clinical *** were randomly allocated to receive the intervention(Quick Wee Method—supra-pubic stimulation with cold saline)or the control(usual care—clean catch with no bladder stimulation)for 5 *** outcome was voiding of urine within 5 *** A total of 140 infants were included in this study(73 in intervention group;67 in control group).Baseline characteristics were similar.25%in the intervention group passed urine in the 5-min trial period compared with 18%in the control group[P=0.4,absolute diference 7%(95%confdence interval:−7%to+20%)].Conclusion The Quick Wee method is a simple and inexpensive intervention that did not show a statistically signifcant increase in urine samples obtained in pre-continent infants.

关键词： Infant Urinalysis Urinary tract infection Urine specimen collection

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