Active Inflammatory Disease Research Articles

MO480FGF-23 AND LOW BIRTH WEIGHT: IS THERE ANY ASSOCIATION?

Abstract Background and Aims According to Barker’s theory and Brenner’s hypothesis, persons were born with low birth weight (LBW) have a higher risk of CKD due to low nephron number. Also, it is well known that mineral-bone disorder (MBD) is one of the most serious complications of CKD. Views on the pathogenesis of CKD-MBD have changed considerably since Fibroblast growth factor 23 (FGF-23) was discovered. It is thought that FGF-23 increases as the nephron mass reduces. Therefore, we aimed to determine if there is an association between LBW and FGF-23. Method We conducted a cross-sectional study on 56 children with CKD stages 1-4. There were approximately equal numbers of participants in each stage. The mean age was 8.9 ±4.9 years old. We measured the concentration of FGF-23 (C-terminal) in serum by a sandwich enzyme-linked immunosorbent assay (ELISA) kit (Biomedica Medizinprodukte GmbH, Austria). The exclusion criteria: tubulopathy, active inflammatory, infectious, oncological and bone diseases, renal transplant, as well as taking steroids, calcium, and vitamin D. The informed consent was obtained from the parents. The study was conducted in accordance with the Declaration of Helsinki and approved by the Local Ethical Committee. FGF-23 concentration more than 1.5 pmol/l was considered as abnormal. Statistical analysis was performed using GraphPad Prism 9.0.0 (San Diego, USA) Results Mineral-bone disorder was diagnosed as CKD complication in 20 (35.7%) children. LBW was revealed in 14 (25%) patients. The median (IQR) eGFR among patients with normal birth weight was 65.23 (31.23-84.73) ml/min/1.73m2, among LBW – 68.93 (24.59-98.9) ml/min/1.73m2, so there were no differences in kidney function between the two groups (p=0.64). The median (IQR) level of serum FGF-23 in patients with normal birth weight was 1.75 (0.68- 2.5) pmol/l, in LBW children was 1.85 (0.78 -3.1) pmol/l. Analysis of serum level of FGF-23 in relation to weight at birth revealed no statistical differences in patients with LBW and those with normal birth weight (p=0.719), and the Spearman rank correlation was insignificant as well (r=-0.08, p=0.560). Conclusion FGF-23 is an important biomarker of CKD-MBD. FGF-23 does not depend on the birth weight although LBW is considered as a risk factor for CKD. However, further investigations and studies in this area are needed to make the right conclusions regarding the association between this bone biomarker and birth weight.

P428 Early and Late Fecal Calprotectin Remission - Analysis of a proactive Therapeutic Drug Monitoring Treatment Protocol

Abstract Background Fecal calprotectin (Fc) is an adequate surrogate marker for endoscopic activity in inflammatory bowel disease. The timing of Fc remission may have prognostic implications in patients under biologic therapy. Methods Using a prospectively maintained database we followed 135 patients under a proactive therapeutic drug monitoring (pTDM) protocol aiming at an Infliximab trough level (IFXTL) between 5-10 µg/mL with sequential measurements of Fc. We evaluated the rates of early (at week 14) and late (after week 14) Fc remission (<250 µg/g) and associated clinical outcomes at 2-years of follow up. Results 77 patients (57.0%) reached early Fc remission and 30 patients (22.2%) reached late Fc remission. Patients with late Fc remission presented higher Fc at baseline (1708.5 μg/g [681-3483] vs 803 μg/g [339-1477], P=0.006) and lower IFXTL at week 14 (2.71 µg/mL [1.24-6.30] vs 6.59 µg/mL [3.41-10.63], P=0.001) than patients with early Fc remission. However, by the end of follow-up, IFXTL were similar in both groups: 7.94 µg/mL (4.79-11.25) vs 8.54 µg/mL (6.49-11.07), P=0.514. In patients without early Fc remission, week 14 IFXTL did not differ between those with and without late Fc remission (2.71 µg/mL [1.24-6.30] vs 3.47 µg/mL [0.945-6.94], P=0.957), but significantly increased in late responders by the end of follow-up: 8.54 µg/mL (6.49-11.07) vs 4.37 µg/mL (1.77-7.49), P=0.002. Patients with early and late Fc remission presented similar rates of clinical remission (88.3% vs 83.0%, P=0.493), steroid-free clinical remission (79.1% vs 92.9% P=0.239), lower rates of IFX discontinuation (14.3% vs 16.7%, P=0.756), hospitalization (11.7% vs 13.3%, P=0.815), and surgery (1.3% vs 3.3%, P=0.485). Conclusion The magnitude of Fc at baseline and IFXTL at week 14 significantly influence the timing of Fc remission. The use of PTDM results in similar pharmacokinetics and clinical outcomes in both groups.

P180 Endoscopic scoring systems for Crohn’s Disease and Ulcerative Colitis and their correlation with histological and clinical outcomes

Abstract Background Endoscopy and histopathology are vital for evaluating disease activity and treatment response in inflammatory bowel disease. Correlation between endoscopic and histological indices has not been fully examined. The primary aim of this study was to examine the correlation of endoscopic scores with histological assessment and association with flare/hospitalisation in the ensuing 12 months. Methods We selected 100 random colonoscopies performed for IBD surveillance/assessment in 2019. Adult patients with a complete colonoscopy were included. All reports were blindly scored by 2 expert endoscopists using SES CD or Mayo score as appropriate. Histology was retrieved from HistoLab database and classified as normal, mild, moderate and severe. Clinical demographics, CRP, fecal calprotectin levels, flare episodes and hospitalisations were recorded. Correlation between endoscopic and histologic activity was tested. Comparisons were made between patients in histologic and endoscopic remission v those with endoscopic and histologic activity regarding association with flare/hospitalisation. Results 100 IBD patients (median age 49 IQR 22; 54% female; 50% Crohn’s disease) were included. A wide range of SES-CD scores were noted (median score 2 and IQR 6). 48% were in remission (0–2), 34% mild with score 3–6, 18% moderate with score 7–15 and 4% severe disease activity scoring > 16. Of those in endoscopic remission, 87.5% had normal histology. Of the 9 with moderate endoscopic disease all ranges of histological status were described. All levels of the Mayo scale (median score 1) were represented. Similar to the Crohn’s group, 87.5% of those in endoscopic remission also had normal histology. In total 42 patients were in both endoscopic and histological remission, and only 7% experienced a flare of disease activity in the following 12 months, with no hospitalisations. In total 40 patients had both endoscopically and histologically active disease, and 45% of these had a flare in the ensuing 12 months with two hospitalisations.The ROC curve for SES-CD score and histological remission is 0.73 +/- 0.07 95%CI 0.59 -0.87 and for the Mayo score and histological remission 0.87 +/- 0.05 95%CI 0.78- 0.97. Conclusion Accurate assessment of disease activity guides therapy choices and helps assess response to treatment in our IBD cohort. In this study the SES-CD and Mayo endoscopic scores showed good correlation with histological assessment. Those with active endoscopic and histologic disease experienced more flares and had higher rates of hospitalisation than those in remission. Further investigation with higher study numbers and incorporation of a standardised histological grading system are required.

P214 Faecal S100A12 as a non-invasive marker of inflammatory activity in pediatric Inflammatory Bowel Disease

Abstract Background Calgranulin-C (S100A12) is a new faecal marker of inflammation that is potentially more specific for Inflammatory Bowel Disease (IBD) than calprotectin, since it is only released by activated granulocytes. In recent years it has been confirmed that the S100A12 has comparable sensitivity and specificity to fecal calprotectin (FC) in adult patients with IBD. The aim of our study was to evaluate concentration of faecal S100A12 and calprotectin (FC) to see which of the two tests best correlated to inflammation in IBD children. Methods Between September 2019 and March 2020, we prospectively enrolled all IBD pediatric patients, both Crohn’s Disease (CD) and Ulcerative Colitis (UC). Blood and faecal samples were collected in order to evaluate serological markers of inflammation, faecal S100A12A and FC. S100A12 and FC were determined by enzyme-linked immunosorbent assay (ELISA). Results One hundred seventeen consecutive children, 46 (39%) with CD and 71 (61%) with UC were enrolled in the study. The mean age was 14.6 years (range:5–18), 44% female. Twenty three children were in clinical relapse (20%). No significant differences in S100 A12A levels were found between the UC and the CD groups (mean ±ds 25 ±32mcg/ml vs 34 ±27 mcg/ml respectively, p=0.22).In the UC group we found a statistically significant correlation of both calprotectin and S100A12 with CRP (r=0.253, p=0.044 and r=0.252, p=0.040, respectively). In CD group we found that both calprotectin and S100A12 correlated with hemoglobin (r= -0.343, p=0,024; r=-0.401, p 0.008 respectively), hematocrit (r=-0.361, p=0,046; r=-0.434, p=0.015, respectively), fibrinogen (r=0.499, p< 0,001; r=0.325, p =0.038, respectively), and white blood cells count (r=0.309, p=0.044; r=0.394, p=0.021, respectively). Moreover, in CD group, FC correlated with CRP (r=0.431, p=0.004) and erythrocyte sedimentation rate (r=0.430, p=0.004). Finally, S100A12 correlated with platelet count both in CD and UC group (r=0.351, p=0.021and r=0.254, p=0.038, respectively) IBD children in clinical relapse had higher values ​​of S100A12 and FC than patients in remission (66±47 mcg/ml vs 43±42 mcg/ml, p=0.05 and 260±192 mg/Kg vs 166±169 mg/Kg, p=0.046, respectively) Conclusion Our preliminary data show that both faecal S100A12 and FC are useful non-invasive biomarkers which reflect inflammatory activity of IBD children. Our future aim is to evaluate the correlation of S100A12 and endoscopic finding in order to further clarify its role in the diagnosis and the management of pediatric IBD.

P033 Dendritic cells from patients with active IBD imprint pro-inflammatory α4β7+CLA+ T cells with potential for gut and skin homing

Abstract Background T cell trafficking contributes to inflammation and is a therapeutic target in IBD. Exposure of T cells to retinoic acid during activation induces expression of the gut trafficking integrin α4β7 and suppresses expression of cutaneous leukocyte antigen (CLA) which is required for entry into the skin. Although α4β7+ (gut homing) and CLA+ (skin homing) T cells are generally non-overlapping populations, we have recently observed a low frequency of α4β7+CLA+ (dual tropic) T cells in human blood; these cells may provide an immunological link between gut and skin. Here we investigate the generation of these population by DC in vitro, analyse the function of cells with different tissue tropism and examine the impact of intestinal and skin inflammation. Methods Using flow cytometry, expression of α4β7 and CLA was assessed in whole blood, gut tissues, and on proliferating cells generated by stimulation of naïve CD4+ T cells with monoclonal antibodies (anti-CD3/28/2), or with allogeneic colonic or monocyte-derived DC (moDC). Production of TNFα and IFNγ was measured by intracellular cytokine staining. Results α4β7+CLA+ T cells were found at low frequency in ileal lamina propria tissue as well as peripheral blood. Naïve CD4 T cells activated in vitro with antibodies expressed α4β7 but not CLA. In contrast, activation with DC resulted in the expression of both α4β7 and CLA and generated a dual tropic a4b7+CLA+ population. Colonic DC generated significantly more α4β7+ cells (p<0.05) and higher levels of α4β7 (p<0.05) than did moDC; colonic DC generated significantly fewer CLA+ cells (p<0.01). Nonetheless, a similar frequency of dual tropic cells was generated by both types of DC. moDC from healthy controls and patients with active IBD or skin inflammation all generated dual tropic cells. moDC from patients with active IBD, but not from patients with active inflammatory skin disease generated more gut tropic (α4β7+) T cells (p<0.05) compared with moDC from healthy controls. Following activation with moDC, cytokine production varied with homing profile. The frequency of TNFα+ and IFNg+ cells was significantly greater in CLA+ expressing populations (p<0.05 and p<0.01, respectively). Conclusion CLA expression is induced by gut DC even though they potently upregulate α4β7. The dual tropic population generated is enriched for cells that produce inflammatory cytokines and it may provide a link between gut and skin inflammation. Monocyte-derived cells may contribute to the imprinting of T cell homing to the intestine and upregulation of this activity, specifically in active IBD, supports the concept that intestinal inflammation reprogrammes circulating monocytes.

P216 Comparative Assessment C-reactive Protein Between a Point-of-Care Testing and Current Standard of Care (Immunonephelometric testing)

Abstract Background C-reactive protein (CRP) is widely used as a biomarker of inflammatory disease activity in hospitalized and non-hospitalized patients. In particular, CRP is commonly used in patients suspected to have an inflammatory bowel disease (IBD) or with a confirmed diagnosis of IBD diagnosis in order to drive the diagnostic approach, to monitor disease activity and to guide therapeutic adjustments. However, standard laboratory CRP testing (Immunonephelometric assays) present some drawbacks, including a turnaround time of 1–2 hours, and the need of specialized equipment, offices and laboratory personnel. Because of that, point-of care testing (POCT) was recently developed in order to provide results within 2 minutes from blood collection, enabling a rapid response to clinical condition. Aim To determine the degree of analytical correlation between a recently developed POCT (ProciseDx) using capillary whole blood and the comparative Immunonephelometric assay using serum samples. Methods From October to November 2020, consecutive patients hospitalized at Gastroenterology Unit, Padua University Hospital, aged > 18 years and with clinical evidence of active inflammatory disease or infection, who underwent to a standard of care CRP test (Dimension Vista – Siemens Healthineers) were included in the study (range 2.9–340 g/L). Within 1 hour from blood collection, in each patient, CRP quantitation from capillary whole blood collected by finger stick was performed using the ProciseDx CRP assay, with reportable range between 3.6–100 g/L. A Deming regression test was used to identify the correlation between the two methods. Results Eighty-three patients were enrolled (62.5% males with mean age ± SD: 60±18). The most common indications for hospitalisation were liver disease (34.9%), pancreatic disturbance (27.7%) and suspicious or recurrence of IBD (16.7%). ProciseDx POCT with finger prick samples required a turnaround time of 2±0.2 minutes, whereas serum samples analyzed in clinical laboratory with the reference method required a turnaround time of about 180±15 minutes (p<0.001). Overall, the correlation between the two tests was high (R squared of 0.899 (95% CI 0.916–0.968)). In particular, the correlation between the methods was even higher with CRP values between 0–100 g/L with R squared of 0.961 (95% CI 0.958–0.986). Conclusion The ProciseDx POCT allows a more rapid and comparable accuracy of CRP assessment in hospitalized patients as compared to the standard laboratory measurement. Moreover, the ProciseDx POCT does not require specialised personnel to be performed. The use of ProciseDx POCT may improve and accelerate the decision-making approach, further reducing the resources required for CRP assessment.

Evaluation of the Brazilian functional fruit Morinda citrifolia as phospholipases A2 and proteases modulator: Morinda citrifolia: enzymatic modulation

Morinda citrifolia is a plant widely consumed as food and used in folk medicine. However, there is little scientific information regarding its therapeutic properties. In this study, aqueous extracts from the peel and pulp of M. citrifolia were characterized according to their modulatory action on phospholipases A2 and proteases (involved in hemostasis and inflammation). Bothrops moojeni venom was used for prospecting the effects of extracts on the human organism since there is high homology between the venom and human enzymes. The aqueous extracts pre-incubated with the venom significantly inhibited (12 to 16%) the phospholipase activity, in the different doses evaluated. M. citrifolia aqueous extract obtained from the peel and pulp (obtained without distillation) completely inhibited the venom-induced hemolytic activity. In contrast, the pulp extract (with distillation) reduced the activity up to 37.5%. The peel extract of M. citrifolia significantly inhibited the caseinolytic activity induced by proteases present in the venom (37% up to 56%). The pulp extract (obtained without distillation) inhibited approximately 50% of the thrombolysis induced by hemorrhagic proteases. The inhibition of phospholipases A2, proteases, and lysis of erythrocytes exerted by the extracts demonstrate their anti-inflammatory potential. They also have effects on blood coagulation, platelet aggregation and others processes related to the pathophysiology of hemostasis. Further studies are needed to confirm their potential use as a nutraceutical with preventive activity in inflammatory diseases and disorders of hemostasis.

Clinical Signs, Activity Indices and Prognostic Indicators in Dogs with Idiopathic Inflammatory Bowel Disease

Background: Canine inflammatory bowel disease (IBD) includes a set of diseases characterized by the presence of recurrent gastrointestinal clinical signs and histologic evidence of intestinal inflammation. Diagnosis can only be made by excluding other possible causes of enteritis. Since the diagnosis of this disease is of great challenge to the veterinarians and currently very little work have been carried out in India, the present study was planned and conducted to study the clinicopathological changes and prognostic indicators of idiopathic inflammatory bowel disease (IBD) in dogs.Methods: After a detailed clinical, laboratoty and endoscopic examination, 33 IBD dogs with signs of chronic gastrointestinal disorders and histologic evidence of mucosal lymphocytic plasmacytic infiltration were selected for the study.Result: Moderate to severe form of IBD with haematochezia as a chief complaint was predominantly recorded. Haematobiochemical changes were not remarkable except a rise in serum alkaline phosphatase level. Decreased IgA expression was observed in serum by flowcytometry indicating impaired mucosal immunity in IBD dogs. It was observed that, increased clinical inflammatory bowel disease activity index score (CIBDAI), increased C-Reactive Protein, decreased cobalamin and folate may act as negative predictors in idiopathic IBD.

Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS): An International Multidisciplinary Consensus

Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS): An International Multidisciplinary Consensus

Dairy Consumption: Does It Make an Impact on Self-Reported Disease Activity of Inflammatory Arthritis?

BackgroundAs researchers and the public become more cognizant of the impacts of diet and nutrition on health, continued research is needed to provide evidence to support dietary claims. At present, there exists mixed reporting on the effects of dairy consumption and disease activity of inflammatory arthritis (IA).ObjectiveThis study attempts to advance current research on the relationship between dairy consumption and self-reported disease activity in patients with IA and to investigate whether dietary modifications can be helpful as a conservative, cost-effective, and accessible supplement to established treatments.MethodsParticipants completed a modified diet history questionnaire (DHQ), which assessed dairy consumption over the past year, and a Routine Assessment of Patient Index Data 3 (RAPID3) questionnaire, which assessed a participants’ self-reported inflammatory disease activity. DHQ and RAPID3 were analyzed using a Pearson product-moment partial correlation to assess variables’ relationships. Participants completed the questionnaire in the setting of a rheumatology clinic. Two hundred and four participants were recruited for this study. All of the participants were at least 18 years of age, capable of giving informed consent, and were formally diagnosed with either rheumatoid arthritis or psoriatic arthritis by a board-certified rheumatologist. ResultsThe results from the questionnaires found that dairy consumption does not contribute to self-reported IA disease activity. While 11 of the 16 DHQ variables maintained a positive correlation with the overall RAPID3 scores, none of these possessed statistical significance. Only when controlling for age and sex did the study find two statistically significant variable correlations between the quantity of milk consumed as a beverage (r=0.147, n=193, p=0.043) and milk added to cereal (r=0.170, n=189, p=0.019) with the RAPID3 scores.ConclusionIn summation, the study found no notable correlation between dairy consumption and patients’ self-reported IA disease activity.

Type D personality is associated with depressive symptoms and clinical activity in inflammatory bowel disease.

Inflammatory bowel disease (IBD) can be exacerbated by stress and depression. Type D personality, characterised by high negative affectivity and social inhibition, represents a vulnerability towards stressors and is associated with adverse outcomes in coronary heart disease. To assess the prevalence of Type D personality in IBD patients and investigate potential associations with disease course. We tested for associations between Type D (Type D Scale-14), depressive symptoms (Hospital Anxiety and Depression Scale's depression subscore ≥11) and recurrent IBD amongst Swiss IBD cohort patients. We built regression models for cross-sectional and Cox proportional hazards models for time-to-event analyses. IBD disease course was assessed by the future occurrence of active disease (Crohn's Disease Activity Index ≥150/Modified Truelove & Witts activity index ≥10) and several IBD-relevant endpoints. Amongst 2275 patients (1005 ulcerative colitis, 1270 Crohn's disease), 672 (29.5%) had Type D. Type D was a significant risk factor for future active disease (adjusted hazard ratio, aHR: 1.60, corrected P value, q=0.007) and predicted the future presence of depressive symptoms (aHR: 3.30, P<0.001). The combination of Type D and depressive symptoms further increased the risk for active disease (aHR: 3.98, q<0.001). However, Type D associated depressive symptoms seemed to be the main contributor to this effect as Type D's predictive power decreased considerably in models corrected for depressive symptoms (aHR: 1.32, CI: 0.97-1.79, q=0.292). Type D personality's prevalence amongst IBD patients was comparable with its prevalence in the general population. Type D was strongly associated with depressive symptoms and showed modest independent associations with IBD prognosis.

International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease

ObjectiveEffective medical therapy and validated trial outcomes are lacking for small bowel Crohn’s disease (CD) strictures. Histopathology of surgically resected specimens is the gold standard for correlation with imaging techniques....

Leucine-rich alpha-2 glycoprotein is a potential biomarker to monitor disease activity in inflammatory bowel disease receiving adalimumab: PLANET study

BackgroundThis multicenter prospective study (UMIN000019958) aimed to evaluate the usefulness of serum leucin-rich alpha-2 glycoprotein (LRG) levels in monitoring disease activity in inflammatory bowel disease (IBD).MethodsPatients with moderate-to-severe IBD initiated on adalimumab therapy were enrolled herein. Serum LRG, C-reactive protein (CRP), and fecal calprotectin (fCal) levels were measured at week 0, 12, 24, and 52. Colonoscopy was performed at week 0, 12, and 52 for ulcerative colitis (UC), and at week 0, 24, and 52 for Crohn’s disease (CD). Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn’s Disease (SES-CD) for CD and the Mayo endoscopic subscore (MES) for UC.ResultsA total of 81 patients was enrolled. Serum LRG levels decreased along with improvements in clinical and endoscopic outcomes upon adalimumab treatment (27.4 ± 12.6 μg/ml at week 0, 15.5 ± 7.7 μg/ml at week 12, 15.7 ± 9.6 μg/ml at week 24, and 14.5 ± 6.8 μg/ml at week 52), being correlated with endoscopic activity at each time point (SES-CD: r = 0.391 at week 0, r = 0.563 at week 24, r = 0.697 at week 52; MES: r = 0.534 at week 0, r = 0.429 at week 12, r = 0.335 at week 52). Endoscopic activity better correlated with LRG compared to CRP and fCal on pooled analysis at all time points (SES-CD: LRG: r = 0.636, CRP: r = 0.402, fCal: r = 0.435; MES: LRG: r = 0.568, CRP: 0.389, fCal: r = 0.426).ConclusionsSerum LRG is a useful biomarker of endoscopic activity both in CD and UC during the adalimumab treatment.

Pharmacological modulation of T cell immunity results in long-term remission of autoimmune arthritis

Chronic inflammatory diseases like rheumatoid arthritis are characterized by a deficit in fully functional regulatory T cells. DNA-methylation inhibitors have previously been shown to promote regulatory T cell responses and, in the present study, we evaluated their potential to ameliorate chronic and acute animal models of rheumatoid arthritis. Of the drugs tested, decitabine was the most effective, producing a sustained therapeutic effect that was dependent on indoleamine 2,3-dioxygenase (IDO) and was associated with expansion of induced regulatory T cells, particularly at the site of disease activity. Treatment with decitabine also caused apoptosis of Th1 and Th17 cells in active arthritis in a highly selective manner. The molecular basis for this selectivity was shown to be ENT1, a nucleoside transporter, which facilitates intracellular entry of the drug and is up-regulated on effector T cells during active arthritis. It was further shown that short-term treatment with decitabine resulted in the generation of a population of regulatory T cells that were able to suppress arthritis upon adoptive transfer. In summary, a therapeutic approach using an approved drug is described that treats active inflammatory disease effectively and generates robust regulatory T cells with the IDO-dependent capacity to maintain remission.

Validity and reliability of the health-related questionnaire IBDQ-32 in Mexican patients with inflammatory bowel disease

BackgroundInflammatory bowel disease comprises two conditions: ulcerative colitis and Crohn's disease. Inflammatory Bowel Disease Questionnaire 32 (IBDQ-32) is a specific questionnaire which has been translated from English into Spanish and validated. In the Spanish-speaking countries of America it has not been validated. The aim was to determine the psychometric properties, validity and reliability of the Mexican version of the IBDQ-32 questionnaire. MethodsA total of 316 patients with inflammatory bowel disease and 100 healthy controls participated in the study. The questionnaires IBDQ-32 and SF-36 were issued on two occasions (separated by 15 days). The psychometric properties of the Mexican version of the IBDQ-32 questionnaire were determined. ResultsPatients with inflammatory bowel disease had an impaired quality of life compared to healthy controls. There were no differences between ulcerative colitis and Crohn's disease in the total scores of IBDQ-32 and its domains. The internal consistency reliability was good. The intraclass coefficient showed good reliability (repeated measurement) for total scale and all four subscales. Factor analysis explained variance is higher than 50% therefore is considered adequate/acceptable. The correlation between IBDQ-32 and SF-36 showed a satisfactory association. The social domain is the only one that presented a ceiling effect. ConclusionsThe Mexican version of the IBDQ-32 quality of life questionnaire is valid and reliable. This sample included the entire spectrum of inflammatory disease (remission and activity) and was comparable when assessing quality of life with the SF-36 generic questionnaire.

Patient experiences with the role of physical activity in inflammatory bowel disease: results from a survey and interviews

BackgroundPhysical activity may affect disease activity in patients with inflammatory bowel disease. We used a survey to investigate this association and performed interviews to get a better understanding of patient experiences, and therefore the nature of this association.MethodsPatients with Crohn’s disease (CD, n = 176) and ulcerative colitis (UC, n = 162) completed the short Crohn’s Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI) and the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Associations were investigated by multiple linear regression. Semi-structured interviews (7 CD, 7 UC) were conducted to assess patient experiences with the role of physical activity in their disease.ResultsThe majority of survey participants were in remission (70%) and adhered to the Dutch physical activity guidelines (61%). In Crohn’s disease, the total physical activity score was inversely associated with disease activity, even after adjustment for confounders (β = − 0.375; p = 0.013). No association between physical activity and disease activity was found in ulcerative colitis. Of the interviewees, 86% experienced beneficial effects of physical activity, such as improved general fitness, quality of life and self-image. However, during periods of active disease they struggled to find the motivation and perseverance to be physically active due to physical barriers.ConclusionsCrohn’s disease participants with a higher physical activity level had a lower disease activity. This inverse association was not found in ulcerative colitis. Interviews revealed that IBD patients generally experience beneficial effects from physical activity, although the barriers caused by active disease may put them off to be physically active.

Accuracy of the highly sensitive C-reactive protein/albumin ratio to determine disease activity in inflammatory bowel disease.

Persistent disease activity is associated with a poor prognosis in patients with inflammatory bowel disease (IBD). This study aims to explore the accuracy of the highly sensitive C-reactive protein/albumin ratio (CAR) in determining IBD activity.The clinical data of 231 IBD patients treated at Peking Union Medical College Hospital from 2012 to 2018 were analyzed retrospectively. The patients were classified as having active disease or remission according to the Crohn disease activity index scores for patients with Crohn disease (CD) and partial Mayo scores for patients with ulcerative colitis (UC).This study included 231 IBD patients (137 CD and 94 UC). From these groups, 182 patients had active disease, while 49 patients were in remission. The platelet counts, erythrocyte sedimentation rates, high-sensitivity C-reactive protein levels, and CAR scores were significantly higher, while hemoglobin levels, ALB, and body mass indexes were significantly lower in patients with active disease (P < 0.01). The hsCRP, CAR, and ALB significantly correlated with disease activity for both CD and UC (P < 0.001). The area under the curve (AUC) of CAR was highest among the laboratory indexes at 0.829, and the AUC of CAR in the UC patients was larger than that of the CD patients. Also, CAR with cutoff value of 0.06 displayed the highest sensitivity among the indexes for IBD activity at 83.05%.CAR is a useful biomarker for identifying disease activity in patients with CD and UC. Higher CAR levels are indicative of increased IBD activity. CAR may be more valuable in UC than that in CD for assessing the degree of IBD activity.

A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices.

Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.

Acute Kidney Injury in the Context of Inflammatory Bowel Disease - A Clinical Case

Extraintestinal manifestations of inflammatory bowel disease are common and extendable to all organs. Kidney and lower genitourinary system occurs in 4-23% of cases. This may be dependent on inflammatory bowel disease activity, secondary to metabolic disorders, drugs or others.

Associations between participation in, intensity of, and time spent on leisure time physical activity and risk of inflammatory bowel disease among older adults (PA-IBD): a prospective cohort study

BackgroundInflammatory bowel diseases (IBDs) are diseases of the immune system that share some genetic and lifestyle-related predisposing factors. Increasing incidences have been reported in all age groups. Based on experimental studies suggesting a role of physical activity on intestinal inflammation, this study aimed to investigate the association between leisure time physical activity and the risk of IBD in older adults.MethodsThe study is a prospective cohort study using Danish registry data and questionnaire data from the Danish “Diet, Cancer and Health” cohort. The outcome IBD was defined as having at least two main diagnoses of Crohn’s disease or ulcerative colitis registered in the National Patient Registry from the period between December 1993 and May 1997 with an average follow-up of 25 years. Cox proportional hazard models were used to estimate hazard-ratios for IBD onset associated with being physically active and with levels of the metabolic equivalent of task (MET) hours/week of physical activity and hours/week spent on six types of physical activity. All analyses were adjusted for potential confounders. Furthermore, the analyses were stratified according to age-group, occupational physical activity, smoking, BMI and work status to test for effect modification.ResultsIn total, 54,645 men and women aged between 50 and 64 years were included, and of which there were 529 cases. When comparing physically active with inactive participants measured by MET hours/week there was no statistically significant difference in risk of IBD (0.89 [0.13; 6.27]), regardless of how participation was measured. Results did not indicate any dose-response effect when comparing quartile groups of MET hours/week (HR = 0.97 [0.76; 1.22], HR = 0.82 [0.64; 1.05] and HR = 0.83 [0.65; 1.07] or whether five of the six types of activities were compared with the lowest quartile as reference. For do-it-yourself-work, the third quartile of hours/week was associated with a higher risk of IBD compared to the second quartile of hours/week (HR = 1.44 [1.10; 1.90]. No effect modification was found.ConclusionsThere was no association between physical activity and risk of IBD when comparing physically active with inactive participants. Neither did the results indicate any dose-response effect when comparing quartile groups of MET hours/week with the lowest quartile as reference. Do-it-yourself work, however, appeared to be associated with a higher risk of IBD when comparing the third quartile with the second quartile of hours/week. The study has clinical relevance by its contribution to the explanatory field of the causes of IBD. However, the study has some limitations, and further research is needed to clarify associations between physical activity and risk of IBD.