Efficacy of Caudal Epidural Steroid Injections in Chronic Low Backache Patients.

Background: Caudal epidural steroid injections are the popular treatment for patients with chronic low back aches (LBA) and radiculopathy, pain that radiates down the legs. These injections are typically given in the lower back, and their purpose is to reduce inflammation and pain caused by a herniated disc or other issues in the lumbosacral spine. Studies have generally found that caudal epidural steroid injections effectively manage chronic LBP, although they may not provide long-term relief in all cases.

Right Superior Ophthalmic Vein Thrombosis Induced by Pansinusitis.

Superior ophthalmic vein thrombosis (SOVT) is a rare, sight-threatening condition. It can be clinically challenging to distinguish from pre-septal cellulitis or cavernous sinus thrombosis. Imaging is often a key to identifying SOVT, and multi-disciplinary input is paramount to ensuring the optimum outcome.

Ustekinumab dose escalation improves clinical responses in refractory Crohn's disease.

Background: Clinicians often utilize off-label dose escalation of ustekinumab (UST) in Crohn's disease (CD) patients with disease refractory to standard dosing. Previous studies report mixed results with dose escalation of UST.

Methods: A retrospective observational study of 143 adult patients with CD receiving UST over a 33-month time period was conducted.

Novel Nondietary Therapies for Celiac Disease.

Celiac Disease (CeD) is defined as a chronic small intestinal immune-mediated enteropathy that is precipitated by exposure to dietary gluten in genetically predisposed individuals. CeD is one of the most common autoimmune disorders affecting around 1% of the population worldwide. Currently, the only acceptable treatment for CeD is strict, lifelong adherence to a gluten-free diet (GFD) which can often present a challenging task.

Meta-analysis of dye-based chromoendoscopy compared with standard- and high-definition white-light endoscopy in patients with inflammatory bowel disease at increased risk of colon cancer.

Background: Patients with ulcerative colitis have an increased risk of colorectal cancer. We sought to assess the comparative efficacy of standard white-light endoscopy (SDWLE) or high-definition white-light endoscopy (HDWLE) versus dye-based chromoendoscopy through a meta-analysis and rate the quality of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system.

Methods: A systematic review of the literature in PubMed, EMBASE, and Web of Science was performed in April 2018.

Variations in Insurance Policies Regarding Adherence to the AGA Guideline for Therapeutic Drug Monitoring in IBD.

Background: The American Gastroenterological Association (AGA) published guidelines on therapeutic drug monitoring (TDM) in inflammatory bowel disease (IBD) in August 2017 recommending use of reactive TDM to guide treatment changes in patients with active IBD who are being treated with anti-tumor necrosis factor (anti-TNF) agents or thiopurines. We sought to determine if changes in national clinical practice guidelines result in changes in health care insurance policies within 6 months of publication.

Methods: Using the National Association of Insurance Commissioners Market Share Reports of the top 125 insurance companies by market share in 2016, we reviewed the largest 50 companies for their publicly available online policies regarding TDM of anti-TNF and thiopurine in IBD.

Meta-analysis comparing the efficacy and adverse events of biologics and thiopurines for Crohn's Disease after surgery for ulcerative colitis.

Background: Long-term inflammatory complications of IPAA include Crohn's Disease (CD) or "CD-like" (CDL) condition. We performed a meta-analysis to evaluate the efficacy of anti-tumor necrosis factor (anti-TNF) with or without immunomodulator (IM) therapy in this group of patients.

Methods: Literature databases were searched from inception to October 4, 2017.

Biologics and immunomodulators for treating Crohn's disease developing after surgery for an initial diagnosis of ulcerative colitis: a review of current literature.

Crohn's Disease (CD) or CD-like (CDL) conditions of the pouch are rare long-term inflammatory complications of patients who were initially diagnosed with ulcerative colitis (UC) who undergo total proctocolectomy with ileo-anal anastomosis (IPAA). There are no societal guidelines nor a consensus on their treatment, resulting in significant challenges for clinicians for their diagnosis and management. It is important to differentiate them from other more common pouch-related complications like pouchitis, cuffitis, irritable pouch syndrome, surgery associated stricture, and fistula.

Variations in Health Insurance Policies Regarding Biologic Therapy Use in Inflammatory Bowel Disease.

Background: The American Gastroenterological Association (AGA) has developed guidelines for the management of ulcerative colitis and Crohn's disease (CD) recommending anti-TNF therapy in moderate-severe disease. However, which drug is used is often dictated by insurance company policies. We sought to determine the insurance policy requirements prior to approval of biologic therapies.

Impact of hyperbaric oxygen on diabetic ulcers is unaffected by glycemic control.

Hyperbaric oxygen (HBO2) therapy is an established intervention for treating chronic diabetic lower extremity ulcers, but the impact of glycemic control on its efficacy has not been determined. The purpose of this study was to evaluate the impact of blood glucose control at initiation of HBO2 treatment on wound healing. Hemoglobin A1c (HbA1c) was measured at start of HBO2 therapy for 22 patients undergoing treatment of chronic lower extremity ulcers at two regional wound care centers.