- MeSH
- angiotensin konvertující enzym 2 fyziologie škodlivé účinky MeSH
- COVID-19 * komplikace mortalita patofyziologie prevence a kontrola MeSH
- gastrointestinální endoskopie škodlivé účinky MeSH
- idiopatické střevní záněty farmakoterapie komplikace mortalita MeSH
- jaterní cirhóza komplikace patofyziologie MeSH
- játra patofyziologie MeSH
- komorbidita MeSH
- lidé MeSH
- nemoci jater etiologie komplikace patofyziologie MeSH
- pankreas patologie MeSH
- průjem etiologie patofyziologie MeSH
- riziko MeSH
- transplantace jater škodlivé účinky MeSH
- virová hepatitida u lidí komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- biologická terapie MeSH
- Crohnova nemoc farmakoterapie mortalita MeSH
- dospělí MeSH
- hormony kůry nadledvin škodlivé účinky terapeutické užití MeSH
- idiopatické střevní záněty * farmakoterapie mortalita MeSH
- infliximab aplikace a dávkování MeSH
- inhibitory TNF aplikace a dávkování MeSH
- lidé MeSH
- monoklonální protilátky aplikace a dávkování MeSH
- terapie neúspěšná MeSH
- ustekinumab aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- idiopatické střevní záněty * epidemiologie mortalita MeSH
- kvalita života MeSH
- lidé MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- analýza přežití MeSH
- idiopatické střevní záněty * mortalita MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- hospitalizace statistika a číselné údaje MeSH
- idiopatické střevní záněty * epidemiologie komplikace mortalita MeSH
- interpretace statistických dat MeSH
- komorbidita MeSH
- lidé MeSH
- příčina smrti MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Risk benefit strategies in managing inflammatory bowel diseases (IBD) are dependent upon understanding the risks of uncontrolled inflammation vs those of treatments. Malignancy and mortality in IBD have been associated with disease-related inflammation and immune suppression, but data are limited due to their rare occurrence. AIM: To identify and describe the most common causes of mortality, types of cancer and previous or current therapy among children and young adults with paediatric-onset IBD. METHODS: Information on paediatric-onset IBD patients diagnosed with malignancy or mortality was prospectively collected via a survey in 25 countries over a 42-month period. Patients were included if death or malignancy occurred after IBD diagnosis but before the age of 26 years. RESULTS: In total, 60 patients were identified including 43 malignancies and 26 fatal cases (9 due to cancer). Main causes of fatality were malignancies (n = 9), IBD or IBD-therapy related nonmalignant causes (n = 10; including 5 infections), and suicides (n = 3). Three cases, all fatal, of hepatosplenic T-cell lymphoma were identified, all were biologic-naïve but thiopurine-exposed. No other haematological malignancies were fatal. The 6 other fatal cancer cases included 3 colorectal adenocarcinomas and 3 cholangiocarcinomas (CCAs). Primary sclerosing cholangitis (PSC) was present in 5 (56%) fatal cancers (1 colorectal carcinoma, 3 CCAs and 1 hepatosplenic T-cell lymphoma). CONCLUSIONS: We report the largest number of paediatric-onset IBD patients with cancer and/or fatal outcomes to date. Malignancies followed by infections were the major causes of mortality. We identified PSC as a significant risk factor for cancer-associated mortality. Disease-related adenocarcinomas were a commoner cause of death than lymphomas.
- MeSH
- dítě MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- idiopatické střevní záněty komplikace epidemiologie mortalita MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory komplikace epidemiologie mortalita MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- věk při počátku nemoci MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.
- MeSH
- celosvětové zdraví MeSH
- chirurgie trávicího traktu trendy MeSH
- hodnocení rizik metody MeSH
- hospitalizace trendy MeSH
- idiopatické střevní záněty * komplikace mortalita terapie MeSH
- incidence MeSH
- infekce epidemiologie etiologie MeSH
- lidé MeSH
- míra přežití trendy MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Patients with inflammatory bowel disease (IBD) have a 1.5-3.5-fold higher risk of thromboembolism when compared to the non-IBD population and the risk is much more prominent at the time of a flare. Arterial thromboembolism (ischemic stroke, focal white matter ischemia, cardiac ischemia, peripheral vascular disease and mesenteric ischemia) and venous thromboembolism (deep vein thrombosis and pulmonary embolism, cerebral venous sinus thrombosis, retinal, hepatic, portal and mesenteric vein thromboses) belong to the group of underestimated extraintestinal complications in IBD patients, which are associated with a high morbidity and mortality rate (the overall mortality is as high as 25 % per episode). Thromboembolism occurs in younger patients compared to the non-IBD population and has a high recurrence rate. Multiple risk factors are involved in the etiopathogenesis, but the acquired ones play the key role. Congenital alterations do not occur more frequently in IBD patients when compared to the non-IBD population. Standardized guidelines for the prophylaxis of thromboembolism in IBD patients are urgently needed and these should be respected in clinical practice to avoid preventable morbidity and mortality.
- MeSH
- idiopatické střevní záněty * komplikace mortalita patologie terapie MeSH
- lidé MeSH
- recidiva MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- tromboembolie * etiologie mortalita patologie prevence a kontrola MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
