. 2024 Sep 21;39(1):147.

doi: 10.1007/s00384-024-04714-8.

Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium

Virginia Solitano^{1

2}, Sudheer Kumar Vuyyuru^{1

3}, Yuhong Yuan^{1

4}, Siddharth Singh⁵, Neeraj Narula⁶, Christopher Ma^{3

7

8}, Jurij Hanzel^{3

9}, Megan Hutton¹⁰, Julie Ann Van Koughnett¹¹, Florian Rieder^{12

13

14}, Vipul Jairath^{15

16

17}

Affiliations

¹ Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
² Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
³ Alimentiv Inc, London, ON, Canada.
⁴ Lawson Health Research Institute, London, ON, Canada.
⁵ Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
⁶ Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁷ Division of Gastroenterology & Hepatology, University of Calgary, Calgary, AB, Canada.
⁸ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁹ Department of Gastroenterology, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia.
¹⁰ Nursing Practice Excellence and Innovation, London Health Sciences Centre, London, ON, Canada.
¹¹ Division of General Surgery, Department of Surgery, University of Western Ontario, London, ON, Canada.
¹² Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹³ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹⁴ Program for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹⁵ Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. vjairath@uwo.ca.
¹⁶ Alimentiv Inc, London, ON, Canada. vjairath@uwo.ca.
¹⁷ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. vjairath@uwo.ca.

PMID: 39304546
PMCID: PMC11415412
DOI: 10.1007/s00384-024-04714-8

Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium

Virginia Solitano et al. Int J Colorectal Dis. 2024.

. 2024 Sep 21;39(1):147.

doi: 10.1007/s00384-024-04714-8.

Authors

Affiliations

¹ Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
² Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
³ Alimentiv Inc, London, ON, Canada.
⁴ Lawson Health Research Institute, London, ON, Canada.
⁵ Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
⁶ Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁷ Division of Gastroenterology & Hepatology, University of Calgary, Calgary, AB, Canada.
⁸ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁹ Department of Gastroenterology, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia.
¹⁰ Nursing Practice Excellence and Innovation, London Health Sciences Centre, London, ON, Canada.
¹¹ Division of General Surgery, Department of Surgery, University of Western Ontario, London, ON, Canada.
¹² Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹³ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹⁴ Program for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.
¹⁵ Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. vjairath@uwo.ca.
¹⁶ Alimentiv Inc, London, ON, Canada. vjairath@uwo.ca.
¹⁷ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. vjairath@uwo.ca.

PMID: 39304546
PMCID: PMC11415412
DOI: 10.1007/s00384-024-04714-8

Abstract

Background: Standardized clinical care processes for patients with Crohn's disease (CD) and a permanent ileostomy (PI) are lacking. The EndOTrial consortium aims to address this gap by developing pathways for care.

Methods: In this umbrella review, we searched major databases for relevant systematic reviews (SRs) or scoping reviews (ScR) published until January 5, 2024. Screening, data extraction, and quality appraisal (AMSTAR 2) were performed by two independent reviewers.

Results: Of 1349 screened papers, 22 reviews met our inclusion criteria, including 20 SRs (eight with meta-analysis) and 2 ScRs. None exclusively focused on PI. Furthermore, nine reviews did not mention patients with inflammatory bowel disease (IBD), and only two reviews included patients with high-output ileostomy, highlighting a large evidence gap. The identified reviews covered six categories with nine types of interventions, including ostomy care pathways, peristomal skin care, patient education, clinical management of high-output stoma, management and prevention of postoperative ileus, dietary and nutritional support, nursing and supporting care, telemedicine, and self-management interventions. Most SRs including nursing interventions for stoma care highlighted nurses' role in a variety of standard and specialized treatments. Notably, none of the reviews exclusively examined disease recurrence, stoma pouching systems or adhesives, behavioral interventions, or mental health in patients living with ileostomy.

Conclusions: Evidence for best practice interventions to treat complications and improve quality of life in patients living with an ileostomy for CD is limited and heterogeneous. These results outline the need for standardized clinical care processes and pathways tailored to the unique needs of this patient population.

Keywords: IBD; Ostomates; Stoma; Umbrella.

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Conflict of interest statement

VS, YY, MH, JAVK have none to disclose. SKY has received consulting fees from Alimentiv Inc. SS has received research grants from Pfizer. NN has received speaking/advisor fees from Janssen, Abbvie, Takeda, Pfizer, Merck, Sandoz, Fresenius Kabi, Innomar, Iterative Scopes, Bristol Myers Squibb, Viatris, and Ferring. CM has received consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, BioJAMP, Bristol Myers Squibb, Celltrion, Ferring, Fresenius Kabi, Janssen, McKesson, Mylan, Takeda, Pendopharm, Pfizer, Roche, Sanofi; speaker's fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Ferring, Fresenius Kabi, Janssen, Takeda, Pendopharm, and Pfizer; royalties from Springer Publishing; research support from Ferring, Takeda, Pfizer. JH has received consulting fees from AbbVie, Alimentiv Inc, and Takeda FR is consultant to Agomab. Allergan, AbbVie, Boehringer Ingelheim, Celgene, Cowen, Falk Pharma, Genentech, Gilead, Gossamer, Guidepoint, Helmsley, Index Pharma, Jannsen, Koutif, Mestag, Metacrine, Morphic, Origo, Pfizer, Pliant, Prometheus, Receptos, RedX, Roche, Samsung, Takeda, Techlab, Theravance, Thetis, UCB and received funding from the National Institute of Health, Helmsley Charitable Trust, Crohn’s and Colitis Foundation, Rainin Foundation, UCB, Boehringer-Ingelheim, Pliant, Morphic, BMS, 89Bio. VJ has received consultancy/advisory board fees from AbbVie, Alimentiv Inc., Arena pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Reistone Biopharma, Roche, Sandoz, Second Genome, Takeda, Teva, Topivert, Ventyx, and Vividion; and speaker’s fees from, Abbvie, Ferring, Galapagos, Janssen Pfizer Shire, Takeda, and Fresenius Kabi.

Figures

**Fig. 1**
Summary of the evidence search and selection process (flowchart)

See this image and copyright information in PMC

References

1. Mithany RH, Shahid MH, Shahid R, Hannan A, Gill MU, Aslam S (2023) Ileostomy 101: understanding the basics for optimal patient care. Cureus 15(10):e46822 - PMC - PubMed
1. Valibouze C, Desreumaux P, Zerbib P (2021) Post-surgical recurrence of Crohn’s disease: situational analysis and future prospects. J Visc Surg 158(5):401–410 - PubMed
1. Solitano V, Dal Buono A, Gabbiadini R, Wozny M, Repici A, Spinelli A et al (2023) Fibro-stenosing Crohn’s disease: what is new and what is next? J Clin Med. 12(9):3052 - PMC - PubMed
1. Vuyyuru SK, Rieder F, Solitano V, Nguyen TM, Crowley E, Narula N et al (2023) Patients with Crohn’s disease and permanent ileostomy are universally excluded from clinical trials: a systematic review. Am J Gastroenterol 118(7):1285–1288 - PMC - PubMed
1. Vuyyuru SK, Ma C, Sharma T, Nguyen TM, Bessissow T, Narula N, et al (2023) Characteristics of interventional trials for patients living with intestinal stoma registered in ClinicalTrials.gov with a focus on inflammatory bowel disease. Inflamm Bowel Dis. 10.1093/ibd/izad293 - PubMed

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Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium

Affiliations

Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous