Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education.

Background. Inflammatory bowel disease (IBD) affects patients in their young reproductive years. Women with IBD require maintenance therapies during pregnancy and breastfeeding. However, physician management of IBD during pregnancy and breastfeeding has not been well characterized. Objective. To characterize physician perceptions and management of IBD during pregnancy and breastfeeding. Methods. A cross-sectional survey of Canadian physicians who are involved in the care of women with IBD was conducted. The survey included multiple-choice and Likert scale questions about perceptions and practice patterns regarding the management of IBD during pregnancy and breastfeeding. Results. 183 practicing physicians completed the questionnaire: 97/183 (53.0%) gastroenterologists; 75/183 (41.0%) general practitioners; and 11/183 (6.0%) other physicians. Almost half (87/183, 47.5%) of the physicians felt comfortable managing pregnant IBD patients. For specified IBD medications, proportions of physicians who indicated they would continue them during pregnancy were as follows: sulfasalazine, 47.4%; oral mesalamine, 67.0%; topical mesalamine, 70.3%; oral prednisone, 68.0%; topical prednisone, 78.0%; oral budesonide, 61.6%; topical budesonide, 75.0%; ciprofloxacin, 15.3%; metronidazole, 31.4%; azathioprine, 57.1%; methotrexate, 2.8%; infliximab, 55.6%; adalimumab, 78.1%. Similar proportions of physicians would continue these medications during breastfeeding. A higher proportion of gastroenterologists than nongastroenterologists indicated appropriate use of these IBD medications during pregnancy and breastfeeding. Conclusions. Physician management of IBD during pregnancy and breastfeeding varies widely. Relative to other physicians, responses of gastroenterologists more frequently reflected best practices pertaining to medications for control of IBD during pregnancy and breastfeeding. There is a need for further education regarding the management of IBD during pregnancy and breastfeeding.

Probiotics in the treatment of human inflammatory bowel diseases: update 2011.

Crohn's disease, ulcerative colitis, and pouchitis after ileal pouch anal anastomosis in ulcerative colitis patients are often refractory to standard therapy. Over the last decade, the rational to use probiotics and its beneficial efficacy in the treatment of chronic inflammatory bowel disease (IBD) is increasingly under scrutiny. Although it has become clear that intestinal epithelial-mucosal immune interactions and enteric bacteria play a critical role in the development of IBD, the substantial clinical efficacy of probiotics in these disorders is less evident. This review outlines the clinical studies regarding probiotics before October 2007. These studies formed the foundation of probiotic clinical trials in IBD, but they also indicated the need of larger and better-controlled studies than the past experimental approaches. Furthermore, this review also examines in-depth the probiotic clinical trials published between 2007 and December 2010, providing new insights into the role of probiotics for inducing and maintaining remission of IBD, and highlighting some of the breakthroughs, especially regarding induction of remission for ulcerative colitis.

Probiotics in the treatment of human inflammatory bowel diseases: update 2008.

Probiotic research and clinical trials have been forging ahead over the last decade. Although much has been learnt in relation to probiotic intestinal epithelial-mucosal immune interactions, the evidence for substantial clinical efficacy of probiotics continues to progress much slower. This review outlines the probiotic clinical studies before 2005 that formed the foundation of probiotic clinical trials in inflammatory bowel disease and then examines indepth those inflammatory bowel disease probiotic clinical trials published after 2005 that are leading to new understanding of the role of probiotics in the induction and remission of inflammatory bowel disease in humans.