Dynamics of the Gut Mycobiome in Patients With Ulcerative Colitis

Objective. To analyze the connection between the complex of platelet indices in complete blood count test with the clinical and endoscopic activity scores for Crohn's disease (CD) and ulcerative colitis (UC) in pediatric patients and to determine their most informative threshold values. Patients and methods. In this study, 370 children aged 5 to 18 years with diagnosed CD (n = 150) and UC (n = 220) were examined. The clinical activity of UC was assessed according to PUCAI, CD – according to PCDAI; the assessment of endoscopic activity in children with UC was carried out according to UCEIS and CD – according to SES-CD. The study included platelet indices of 630 complete blood count tests (270 in patients with CD and 360 in patients with UC): platelet count (PLT), mean platelet volume (MPV), platelet large cell ratio (P-LCR) and platelet distribution width (PDW). Results. Increased platelet count and decreased platelet indices were noted as the clinical and endoscopic activity of CD and UC in children increased. A positive correlation between the clinical and endoscopic activity indices in inflammatory bowel diseases and platelet count and negative correlations with platelet indices were revealed. ROC analysis showed that the informative value of platelet indices in assessing the endoscopic activity of CD and UC is higher than in assessing the clinical activity. The optimal threshold values for platelet count (cut-off) for determining the endoscopic activity of CD and UC were 340 × 109/L and 350 × 109/L (Se 77%, Sp 69% and Se 63%, Sp 67%, respectively). The specificity of determing the endoscopic activity of 99% was obtained for platelet count of 459 × 109/L and 390 × 109/L for CD and UC, respectively. In children with CD, the indicators MPV <7.8 fL, PDW <7.25 fL, P-LCR <15.2% characterized the presence of endoscopic disease activity with 99% specificity; in children with UC, the specificity of determining the endoscopic activity of 99% was obtained for MPV <9.25 fL, PDW <9.85 fL, P-LCR <17.5%. Conclusion. An increase in platelet count and a decrease in platelet indices (MPV, PDW and P-LCR) can be surrogate markers of endoscopic activity of these diseases. The established threshold values will improve the accuracy of diagnosing the activity of inflammatory bowel diseases in children. Key words: Crohn's disease, ulcerative colitis, platelets, platelet indices, clinical activity, endoscopic activity

The Use of Intestinal Ultrasound in Ulcerative Colitis—More Than a Mucosal Disease?

Цель: проанализировать содержание маркеров кишечного воспаления в крови и кале больных с неспецифическим язвенным колитом (НЯК) в сопоставлении с известными индексами активности болезни. Материалы и методы. Исследованы 60 пациентов с подтвержденным диагнозом НЯК. Клиническую активность НЯК оценивали с помощью клинического индекса активности по D. Rachmilewitz. Эндоскопическая активность НЯК определялась по индексу Mayo. Степень активности НЯК оценивали по комбинированному индексу Mayo. В сыворотке крови определяли содержание α-1-антитрипсина и С-реактивного белка. В кале исследовали содержание миелопероксидазы, кальпротектина и α-1-антитрипсина. Корреляционный анализ осуществляли с расчетом коэффициента корреляции Спирмена и его значимости. Результаты. У больных НЯК выявлено существенное повышение уровня фекальной миелопероксидазы в 4,5 раза (р = 0,027) и α-1-антитрипсина в кале в 3,6 раза (р = 0,039) по мере увеличения клинической активности НЯК. При выраженной степени эндоскопической активности НЯК отмечено достоверное увеличение уровня маркеров воспаления в кале: α-1-антитрипсина — в 17,8 раза (р = 0,037), кальпротектина — в 1,7 раза (р = 0,023), миелопероксидазы — 4,3 раза (р = 0,019). В то же время уровни С-реактивного белка и α-1-антитрипсина в крови не имели значимых различий в зависимости от степени активности НЯК. Выводы. У пациентов с НЯК установлены взаимосвязи уровня миелопероксидазы и кальпротектина в кале с индексом эндоскопической активности (r = 0,63, p = 0,0008 и r = 0,53, p = 0,001 соответственно), а также уровня фекальной миелопероксидазы со степенью активности заболевания согласно комбинированному индексу Mayo (r = 0,68, p = 0,0001).

This study assessed the seroprevalence of anti-Anisakis simplex antibodies in Norwegian patients with inflammatory bowel disease (IBD), specifically ulcerative colitis (UC) and Crohn’s disease (CD), compared with healthy controls. Associations between anti-A. simplex antibody positivity and clinical or laboratory parameters in IBD were also explored. A total of 86 UC patients, 68 CD patients, and 41 healthy controls were prospectively enrolled from four Norwegian hospitals (2013–2022). Diagnosis and disease activity were established using standard clinical, endoscopic, and biomarker criteria. Serum samples were analyzed for total Ig, IgG, IgM, IgA, and IgE antibodies against A. simplex and Pseudoterranova decipiens using ELISA. Anti-A. simplex IgG seroprevalence was 4.9% in controls and 3.2% in IBD (3.5% UC, 2.9% CD). IgM seroprevalence was 0% in all groups. IgA seroprevalence was higher in IBD (16.2%) than controls (4.9%), with 14.0% in UC and 19.1% in CD. IgE seroprevalence was low across all groups. Smoking correlated with lower antibody levels and higher surgery rates. In UC, higher anti-A. simplex IgG and IgE levels were associated with milder disease and better prognosis. Anti-TNFα and azathioprine treatments were linked to higher anti-A. simplex IgA. Norwegian UC and CD patients had significantly higher anti-A. simplex total Ig and IgA seroprevalence than healthy controls, indicating increased exposure or immune response. Anti-A. simplex IgG and IgE may serve as markers of clinical activity in UC. Further research is warranted to clarify the clinical significance of these findings.

<i>Background and aim:</i> Inflammatory Bowel Disease (IBD) is an autoimmune disease that is influenced by food, an important factor in accelerating its clinical disease activity because of intestinal inflammation trough formation of antigen-antibody complex. Food-specific IgG examination can identify the types of person foods consumes that are maybe responsible for disease activity. It is useful in treating IBD without risking malnourishment as it is tailored to the individual immune profile. <i>Methods</i>: This is a cross-sectional study involving 113 patients diagnosed with IBD by colonoscopy. Examination of serum IgG specific for 220 types of foods was performed using ELISA and immuno-array techniques. Disease clinical activity was assessed using the Mayo Index and Crohn Disease Activity Index. <i>Results:</i> The highest proportion of dietary IgG in Chron’s disease was peas (100%), barley (97.9%), eggs (95.9%), milk (81.6%), and corn (75.5%); while in ulcerative colitis it was barley (98.4%), peas (96.8%), egg whites (92.2%), corn (82.8%), and prunes (78.1%). In ulcerative colitis, there was a weak negative correlation between cashew nuts IgG (r = -0.347, p=0.041) and chickpeas IgG (r =-0.473, p=0.017) with clinical disease activity; while in Chron’s disease, a weak positive correlation with disease activity was seen in barley (r = 0.261, p = 0.042). <i>Conclusion:</i> There was a weak negative correlation between cashew and chickpea-specific IgG antibodies with clinical activity of ulcerative colitis, and a weak positive correlation between barley-specific IgG antibodies and Chron’s disease clinical activity.

Background: Inflammatory bowel disease (IBD) is an autoimmune disease that is influenced by food, an important factor in accelerating its clinical disease activity because of intestinal inflammation trough formation of antigen-antibody complex. Food-specific IgG examination can identify the types of person foods consumes that are maybe responsible for disease activity. It is useful in treating IBD without risking malnourishment as it is tailored to the individual immune profile.Method: This is a cross-sectional study involving 113 patients diagnosed with IBD by colonoscopy. Examination of serum IgG specific for 220 types of foods was performed using ELISA and immuno-array techniques. Disease clinical activity was assessed using the Mayo index and Crohn's disease activity index.Results: The highest proportion of dietary IgG in Crohn's disease was peas (100%), barley (97.9%), eggs (95.9%), milk (81.6%), and corn (75.5%); while in ulcerative colitis it was barley (98.4%), peas (96.8%), egg whites (92.2%), corn (82.8%), and prunes (78.1%). In ulcerative colitis, there was a weak negative correlation between cashew nuts IgG (r = -0.347; p = 0.041) and chickpeas IgG (r = -0.473; p = 0.017) with clinical disease activity; while in Crohn's disease, a weak positive correlation with disease activity was seen in barley (r = 0.261; p = 0.042).Conclusion: There was a weak negative correlation between cashew and chickpea-specific IgG antibodies with clinical activity of ulcerative colitis, and a weak positive correlation between barley-specific IgG antibodies and Crohn's disease clinical activity.

Clinical activity and quality of life (QOL) indices assess disease activity in Crohn's disease (CD) and ulcerative colitis (UC). However, a paucity of data exists on the validity of these indices according to disease characteristics. To examine the correlation between QOL and clinical activity indices and endoscopic disease activity according to disease characteristics. We used a prospective registry to identify CD and UC patients ≥18years old with available information on Short Inflammatory Bowel Disease Questionnaire scores (SIBDQ), Harvey-Bradshaw Index (HBI) and simple endoscopic scores for CD (SES-CD), and Simple Clinical Colitis Activity Index (SCCAI) and Mayo endoscopic score for UC. We used Spearman rank correlations to calculate correlations between indices and Fisher transformation to compare correlations across disease characteristics. Among 282 CD patients, we observed poor correlation between clinical activity and QOL indices to SES-CD with no differences in correlation according to disease characteristics. Conversely, among 226 UC patients, clinical activity and QOL had good correlation to Mayo endoscopic score (r=0.55 and -0.56, respectively) with better correlations observed with left-sided versus extensive colitis (r=0.73 vs. 0.45, p=0.005) and shorter duration of disease (r=0.61 vs. 0.37, p=0.04). Our data suggest good correlation between SCCAI and endoscopic disease activity in UC, particularly in left-sided disease. Poor correlations between HBI or SIBDQ and SES-CD appear to be consistent across different disease phenotypes.

Background In Ulcerative Colitis (UC), loss of muscle mass has been associated with high disease activity and worse clinical prognosis1. Measures such as appendicular lean mass (ALM) have been used and its height-adjusted index (ALMI), obtained through dual-energy X-ray absorptiometry (DXA), are validated and accepted markers for assessing muscle status, as well as for evaluating muscle function using dynamometry. Linked to muscle mass, Protein intake has been identified as the primary nutrient for maintaining a positive nitrogen balance and preventing sarcopenia2. The RDA for protein is 0.8-1g/kg/day, which is the minimum intake necessary to avoid muscle loss2. However, in patients with active UC, it is recommended to increase the intake to 1.2-1.5g/kg/day3. Aim: To assess whether total protein intake is associated with clinical activity and decreases ALMI. Methods Patients with UC were included. Disease activity was determined using the modified Truelove and Witts criteria. Protein intake was assessed by a 24-hour dietary recall and analyzed with the EvalFinut software. Adequate intake was determinate as ≥1g/kg intake in patients in remission and as ≥1.2g/kg in patients with UC activity. Muscle function was determined using dynamometry, with cutoff points of &amp;lt;16 kg for women and &amp;lt; 27 kg for men. ALM was estimated using DXA, and ALMI was calculated. Cutoff points for low lean mass were &amp;lt;5.5 kg/m² in women and &amp;lt;7 kg/m² in men4. The Mann-Whitney U test was used to assess differences between patients with activity and in remission. Odds ratios (OR) were calculated to determine the risk association between inadequate protein intake with clinical activity. Results A total of 53 patients were included, of whom 47% were clinically active and 53% in remission. Active patients showed a higher frequency of inadequate protein intake compared to those in remission (44% vs 14%) and presented with lower ALMI in women but not in men (table 1). Patients with low protein intake were associated with clinical activity, with an OR of 3.1 (95% CI, 1.1–8.4; p = 0.018), but not associated with lower grip strength (p = 0.461). On the other hand, clinical activity, and not low protein intake, was associated with greater likelihood of having decreased ALMI, with an OR of 1.8 (95% CI, 1.1–3.2; p = 0.044). The prevalence of sarcopenia was 13% of this population. Conclusion Inadequate protein intake is associated with clinical activity of UC, and clinical activity is associated with a lower amount of ALMI in women. There were no differences in grip strength between patients according to their activity level; however, follow-up will be needed to determine if those with low ALMI and low protein intake develop sarcopenia.

The Effect of Acute Psychologic Stress on Systemic and Rectal Mucosal Measures of Inflammation in Ulcerative Colitis

Objectives Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings. Methods The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0–1: remission, and MES 2–3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression. Results According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914–0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085–0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g. Conclusion Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGES Faecal calprotectin is an independent predictor of remission in UC patients. Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn’t been evaluated yet. We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.

In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biomarker of disease activity in patients with inflammatory bowel disease (IBD) and to compare TFF3 values with those of fecal calprotectin (FC). 128 patients with IBD were divided into four groups: 1) active ulcerative colitis (UC); 2) quiescent UC; 3) active Crohn's disease (CD); 4) quiescent CD. The serum levels of TFF3 and FC levels were assessed in all patients and 16 controls. Patients with active UC had higher TFF3 levels than those with quiescent UC (p<0.001), those with active (p<0.001) or quiescent CD (p<0.001) and controls (p <0.001). We found a correlation between TFF3 and FC values in patients with active (r = 0.478, p = 0.006) and quiescent UC (r=0.528, p=0.002). TFF3 levels correlated with endoscopic activity in UC (evaluated by UC Endoscopic Index of Severity - UCEIS) (r=0.662, p<0.001). Serum TFF3 is able to identify patients with active UC. It could be used as a marker to predict disease activity in patients with UC.

P120 The concentrations of calprotectin in stool samples vary during the day in patients with active ulcerative colitis

Background: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and Ulcerative Colitis (UC), is a chron-ic gastrointestinal condition affecting over 6.8 million people globally. It is linked to relapse and remission, necessitating reg-ular monitoring for disease activity. Aim of Study: To evaluate Faecal Myeloperoxidase (fMPO) as a potential marker of activity in patients confirmed to have UC compared to C-reactive protein (CRP) and faecal Calpro-tectin (fCAL), which are the standard laboratory markers to in-itially diagnose activity in quiescent UC. Patients and Methods: This cross-sectional study was con-ductedon 39 patients, divided into 3 groups with ulcerative co-litis attending The Memorial Souad Kafafi University Hospital, Misr University for Science and Technology. Group 1: Newly diagnosed patients (15 patients). Group 2: Patients on No-bi-ological therapy (11 patients). Group 3: Patients of biological therapy (13 patients). Results: The study demonstrated a significant positive cor-relation between fCAL and Mayo score, but no correlation was found between Mayo score and fMPO. However, a significant positive relation was found between fCAL and disease activity groups, with a difference between mild and moderate disease activity groups. The area under curve for fCAL was excellent in distinguishing between moderate and mild disease groups, with a sensitivity of 85.7% and specificity of 87.5%. Conclusion: The study demonstrated that fMPO is effec-tive in stratifying UC patients’ activity, while fCAL showed the best diagnostic ability. Combining markers could improve diagnostics.

AimFecal calprotectin (FC) levels correlate with clinical or endoscopic activity in ulcerative colitis (UC), however, these values vary widely between detection methods, and optimal cut-off values remain debated. To assess the correlation between FC levels measured by fluorescent immunochromatography assay (FICA) and disease activity and to identify optimal cut-off values for predicting clinical and endoscopic activity in UC.MethodThe study included patients hospitalized at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2021 and June 2022. All the patients had a confirmed diagnosis of UC. Clinical activity was determined using the partial Mayo score (pMS), and endoscopic activity was determined using the ulcerative colitis endoscopy index of severity (UCEIS) and Mayo endoscopic score (MES).ResultsIn 110 patients with UC, FC levels were significantly correlated with pMS (r = 0.609, P < 0.001), UCEIS (r = 0.751, P < 0.001) and MES (r = 0.635, P < 0.001). Moreover, the optimal FC cut-off values to predict clinical activity (pMS 3–12) and endoscopic activity (UCEIS 1–8 or MES 1–3) were 57.38 µg/g and 53.30 µg/g, respectively.ConclusionFC measured by FICA was a good predictor of clinical and endoscopic activity in patients with UC. When using FICA to detect FC, the optimal cut-off value to identify clinical activity in patients with UC was 57.38 µg/g, and a lower value should be chosen to optimize the identification of endoscopic activity in these patients, which was determined as 53.30 µg/g.

The therapeutic goal in ulcerative colitis is mucosal healing, which requires improved non-invasive biomarkers to evaluate disease activity. Gelsolin is associated with several autoimmune diseases, and here, we aimed to analyze its usefulness as a serological biomarker for clinical and endoscopic activities in ulcerative colitis. Patients with ulcerative colitis (n = 138) who had undergone blood tests and colonoscopy were included. Serum gelsolin was measured using enzyme-linked immunosorbent assay, and correlation between the gelsolin level and clinical and endoscopic activities was examined. The serum gelsolin level in patients with ulcerative colitis was significantly lower than that in healthy subjects, and it decreased in proportion to increasing Mayo score and Mayo endoscopic subscore. The area under the curve for correlation between clinical and endoscopic remission and serum gelsolin level was higher than that for C-reactive protein. Furthermore, in C-reactive protein-negative patients, the serum gelsolin level was lower in the active phase than in remission. Our findings indicate that the serum gelsolin level correlates with clinical and endoscopic activities in ulcerative colitis, has a higher sensitivity and specificity than C-reactive protein, and can detect mucosal healing, suggesting that gelsolin can be used as a biomarker for ulcerative colitis.