The Multiple Dimensions of Self-Management in Active Inflammatory Bowel Disease: A Qualitative Analysis of Patients’ Daily Lived Experiences

Digestive Diseases and Sciences · 2026-03-31

PURPOSE: Self-management is critical to improving inflammatory bowel disease (IBD) health but challenging for patients. To inform the development of IBD self-management interventions and improve IBD health, our objective was to develop an in-depth understanding of factors that affect quality of life and health outcomes for patients with IBD. METHODS: We conducted semi-structured interviews of adult IBD patients with a recent flare drawn from two health system cohorts. We analyzed interview data using an inductive-deductive rapid qualitative analysis process to identify key domains by age (18-44 years, 45-64 years, ≥ 65 years) and cohort. RESULTS: We conducted 55 total interviews. Participants in both cohorts and across all ages focused on five key domains that are critical to living well with IBD: 1) key skills required for living and dealing with IBD; 2) perceptions about living with and confidence in dealing with IBD; 3) impact of social support; 4) effects of stress and emotions; and 5) self-management tools and resources. CONCLUSION: IBD self-management requires complex behavioral changes, including building several skills in recognizing and managing symptoms, managing diet and treatment, navigating care, and coping with unpredictability. Patients must work to build their confidence, avoid maladaptive thinking, and remain motivated despite setbacks. Addressing stress and mental health issues as well as eliciting social support are also critical to helping patients cope with IBD.

Mo1962: A MIXED-METHODS ASSESSMENT OF PATIENT SELF-EFFICACY AND DAILY LIVED EXPERIENCES WITH SELF-MANAGEMENT IN ACTIVE INFLAMMATORY BOWEL DISEASE

Gastroenterology · 2025-05-01

THE VA ENDOSCOPY QUALITY IMPROVEMENT PROGRAM (VA-EQUIP): RESULTS OF A LARGE PRAGMATIC RANDOMIZED CONTROLLED TRIAL IN A NATIONAL US HEALTHCARE SYSTEM

Gastrointestinal Endoscopy · 2025-05-01

Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians

Annals of Internal Medicine · 2025-04-04 · 11 citations

DESCRIPTION: The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients seeking this therapy. METHODS: The PHMSC considers areas where evidence is uncertain or emerging or practice does not follow the evidence to provide clinical advice based on a review and assessment of scientific work, including systematic reviews and individual studies. Sources of evidence included a living systematic review on cannabis and cannabinoid treatments for chronic noncancer pain and a series of living systematic reviews and primary studies. BEST PRACTICE ADVICE 1A: Clinicians should counsel patients about the benefits and harms of cannabis or cannabinoids when patients are considering whether to start or continue to use cannabis or cannabinoids to manage their chronic noncancer pain. BEST PRACTICE ADVICE 1B: Clinicians should counsel the following subgroups of patients that the harms of cannabis or cannabinoid use for chronic noncancer pain are likely to outweigh the benefits: young adult and adolescent patients, patients with current or past substance use disorder, patients with serious mental illness, and frail patients and those at risk for falling. BEST PRACTICE ADVICE 2: Clinicians should advise against starting or continuing to use cannabis or cannabinoids to manage chronic noncancer pain in patients who are pregnant or breastfeeding or actively trying to conceive. BEST PRACTICE ADVICE 3: cannabis to manage chronic noncancer pain.

A cooling off period: decline in the use of hot biopsy forceps technique in colonoscopy in the U.S. Medicare population 2000–2019

BMC Gastroenterology · 2025-05-27

BACKGROUND: The use of hot biopsy forceps (with electrocautery) is no longer routinely recommended given increased complications compared to cold biopsy forceps (without electrocautery). It is unknown how often the technique is currently used in the United States (U.S.) or how its usage has changed over time. AIM: To characterize the use of hot biopsy forceps by U.S. Medicare providers over time, identify provider characteristics of those who more commonly perform this technique, and determine if there are regional differences in use of this technique within the U.S. METHODS: We performed a retrospective cross-sectional study using U.S. Medicare summary data from 2000 to 2019 to analyze the frequency of cold and hot biopsies. We used detailed provider and state summary files to characterize providers' demographics, including geographic region, to identify regional variation in use of these techniques, and identify factors associated with use of hot biopsy forceps from 2012 to 2019. RESULTS: The hot biopsy forceps technique peaked in 2003 (412,165/year) and declined to 108,232/year in 2019, while the cold biopsy forceps technique increased from 482,862/year in 2000 to 1,533,558/year in 2019. Use of hot biopsy forceps was more common by non-gastroenterologists and in rural practice settings. In addition, there was up to 50-fold difference in utilization in these techniques between states (on a population normalized basis), with the highest rate of use in the southeastern U.S. CONCLUSION: Variation in the use of hot biopsy forceps by region and provider suggests a potential area for quality improvement given the comparative advantages of the cold biopsy forceps technique. De-implementation of an existing endoscopic practice may require different approaches than implementation of a new practice.

Liver Tests

2025-04-01

Abstract This chapter guides the reader on the approaches to using and interpreting liver tests for inpatient care.

A Retrospective Study of the Real-World Effectiveness of 8-L Polyethylene Glycol-Electrolyte Lavage Solution (PEG-ELS) Prep After Failure of Standard Prep

Journal of Clinical Gastroenterology · 2025-12-16

BACKGROUND/AIMS: While commonly prescribed in patients with inadequate bowel preparation, split-dose, 2-day bowel preparation (2DBP) with 8 L of polyethylene glycol-electrolyte lavage solution (PEG-ELS) has unknown effectiveness and safety. STUDY AIMS: To assess the effectiveness of a split-dose, 8 L-2DBP in patients with a prior failed bowel preparation. METHODS: We retrospectively identified all outpatients with inadequate bowel preparation on index colonoscopy with a 1-day split-dose prep who had repeat colonoscopy with a split-dose 2DBP (2015 to 2021) at a single Veterans Affairs medical center. We then assessed adequate bowel preparation (outcome), defined as excellent/good or Boston Bowel Prep Score (BBPS) 6 or greater, with a score of 2 in all colon segments. We also collected data on patient factors associated with inadequate preparation. Logistic regression was used to identify associations between these factors and inadequate preparation after split-dose 2DBP. All patient records were manually reviewed to identify potential adverse effects resulting in emergency room presentation. RESULTS: Among 400 patients given 2DBP, 83.5% (95% CI: 79.5%-87.0%) achieved an adequate preparation. In multivariable analysis, a higher CCI (OR: 1.14, 95% CI: 1.04-1.25), opioid use (OR: 1.97, 95% CI: 1.03-3.77), and rural home address (OR: 1.87, 95% CI: 1.01-3.46) were associated with inadequate bowel preparation. No attributable adverse events were recorded. CONCLUSION: In this difficult-to-prep population, split-dose 2DBP is effective in more than 80% of patients without evidence of severe adverse events. This intensive prep was less effective in patients with greater comorbidity burden, opioid use, or a rural home address.

Influenza Vaccines for 2025–2026 in Adults Who Are Not Pregnant or Immunocompromised: Rapid Practice Points From the American College of Physicians

Annals of Internal Medicine · 2025-11-17 · 2 citations

DESCRIPTION: The American College of Physicians (ACP) developed these rapid practice points addressing the comparative effectiveness and harms of trivalent (3 different influenza viruses or viral proteins) and quadrivalent (4 different influenza viruses or viral proteins) influenza vaccines in adults aged 18 years or older who are not pregnant or immunocompromised. These practice points do not address adults aged 18 years or older who are pregnant or immunocompromised. METHODS: The ACP Population Health and Medical Science Committee (PHMSC) developed the rapid practice points on the basis of a rapid review by the ACP Center for Evidence Reviews at Cochrane Austria. The rapid review was a focused update of the 2024 comprehensive, high-quality systematic review and meta-analysis conducted by the European Centre for Disease Prevention and Control. The ACP PHMSC focused on the comparative effectiveness of influenza vaccines compared with each other because of the established efficacy and safety of the standard influenza vaccines.

Acute Gastrointestinal Bleeding

2025-04-01

Abstract This chapter guides the reader on the general principles, clinical manifestations, and management of acute gastrointestinal bleeding in hospitalized patients.

Acute Diarrhea

2025-04-01

Abstract This chapter guides the reader on the general principles, clinical manifestations, and management of acute diarrhea in hospitalized patients.