Evolution Of Inflammatory Bowel Disease Research Articles

EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE AMONG EARLY-INDUSTRIALIZED REGIONS OF THE WORLD: CHALLENGES IN SUSTAINABLE HEALTHCARE DELIVERY

Abstract BACKGROUND Early-industrialized regions (e.g., North America, Europe, Oceania) are currently in stage 3 of the epidemiologic evolution of inflammatory bowel disease (IBD), compounding prevalence wherein incidence stabilizes, but prevalence rises rapidly. This epidemiologic stage predicts the trajectory of healthcare infrastructure needs over the coming decades. AIMS 1. Describe current epidemiologic trends in representative stage 3 regions; 2. discuss ways to provide accessible, equitable, and quality IBD care in a sustainable manner; and 3. strategize future steps to prevent disease. METHODS The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) hosted IBD epidemiologists from representative stage 3 regions: Catalonia, Canada, Denmark, Hungary, Israel, New Zealand, Scotland, and the United States and address the rising burden of IBD. Epidemiologic data were reviewed in context using methodological differences between case ascertainment in each region to help explain heterogeneity (Table 1). Attendees engaged in a round-table consensus meeting, voting on priority needs to sustain IBD healthcare delivery given the trajectory of epidemiologic data. Four groups were formed with attendees of various backgrounds to encompass many perspectives, including epidemiologists, clinicians, IBD nurse practitioners, and patient advocates. RESULTS Table 1 describes IBD incidence and prevalence at the most recent year of historical data for each region. Canadian and Scottish studies included the forecasting of future prevalence estimates, a method that allows for proactive decision-making to accommodate the increasing number of individuals living with IBD. In 2028, the forecasted prevalence of IBD in Lothian, Scotland, was 1,023 per 100,000; and in 2030, the forecasted prevalence of IBD in Canada was 981 per 100,000. Table 2 describes the topics brought up in response to the aims, and the level of priority. Limited resources for a growing IBD population are a major cause for concern, negatively impacting access to and quality of care. To optimize quality of care, a multidisciplinary team approach is necessary. Suggestions for support in managing mild IBD cases include virtual care and remote monitoring, nurse-driven clinics, and cooperation with primary care physicians; this would help free-up in-person appointments with specialists for moderate-to-severe cases. Interventions that prevent IBD through modifying environmental and behavioral determinates, will have the largest impact on decelerating prevalence rates over time. DISCUSSION Forefront at the meeting was the fact of the continuing rise of IBD prevalence, augmenting the challenges faced by healthcare systems and practitioners. There are plausible and actionable solutions to achieve successful management of IBD upon initiating changes in healthcare policy.

P065 The evolution of inflammatory bowel disease can be monitored through multi-omics characterization of gut tissues

Abstract Background The aim of the study is to dissect the mechanisms associated with the evolution of Inflammatory Bowel Disease (IBD), including Crohn’s Disease (CD) and Ulcerative Colitis (UC) in both pediatric and adult patients, along with the severity of the disease and the risk to develop malignancy. Methods A multiomics approach, including miRNA (N=700), gene expression (N=800 genes) (nCounter platform; Nanostring) and methylation (Infinium Methylation Epic Bead Chip kit, Illumina), was utilized to characterize the gut tissue biopsies from pediatric (N=20) and adult (N=18) IBD patients. Moreover, a cohort of patients with gut malignancies with history of IBD were also enrolled in the study. Additionally, the role of Natural Killer Group 2D ligands (NKG2DLs) along with different stages of IBD (remission, mild, moderate and severe) were investigated. Results Differential miRNA and gene signatures were found by the comparison of tissues from pediatric and adult patients with different stages of the disease. N=83 miRs were significantly differentially detected between pediatric and adult patients (P<0.05). miR-630, miR-493-3p and miR-370-3p were found over-expressed in adult vs. pediatric gut tissues. These miRs are involved in epithelial-to-mesenchymal transition (EMT) through the WNT/β-catenin pathway. These miRNAs can also regulate cell proliferation, cell adhesion and migration and cancer development. Interestingly, miR-20a and miR-34a, which are known modulators of NKG2DLs expression were upregulated in tissues from severe vs. mild disease. The gene expression analysis highlighted, among multiple differentially detected pathways in tissues with different grades of IBD, genes, such as SMAD4, EGR1, CHUCK and JAG1, associated with inflammation, stemness, immune regulation, cell proliferation and migration. Through qPCR analyses, the higher expression of the NKG2DLs MICB was detected in tissues from left or right sides, respectively for both pediatric and adult patients while similar observation occurred for MICA only in adult patients. Soluble NKG2DLs were also detected in the plasma of IBD patients, with in some cases differences (P<0.05) in patients vs. healthy donors. sULBP3 correlated with the presence of active inflammation in adult IBD tissues. Confocal imaging of IBD tissues showed upregulation of stemness-associated markers (e.g., LGR5) and NKG2DLs (ULBP-1 and ULBP-3) in adult vs. pediatric patients. Conclusion The ongoing integration of data from multi-omics and the expression of immune-related molecules can lead to the identification of candidate molecular mechanisms associated with the evolution of IBD.

Lactobacillus plantarum surface-displayed FomA (Fusobacterium nucleatum) protein generally stimulates protective immune responses in mice.

A significant correlation is observed between Fusobacterium nucleatum (F. nucleatum) and the evolution of inflammatory bowel disease (IBD). Particularly, FomA, a critical pathogenic element of F. nucleatum, inflicts substantial detriment to human intestinal health. Our research focused on the development of recombinant Lactobacillus plantarum that expresses FomA protein, demonstrating its potential in protecting mice from severe IBD induced by F. nucleatum. To commence, two recombinant strains, namely L. plantarum NC8-pSIP409-pgsA'-FomA and NC8-pSIP409-FnBPA-pgsA'-FomA, were successfully developed. Validation of the results was achieved through flow cytometry, ELISA, and MTT assays. It was observed that recombinant L. plantarum instigated mouse-specific humoral immunity and elicited mucosal and T cell-mediated immune responses. Significantly, it amplified the immune reaction of B cells and CD4+T cells, facilitated the secretion of cytokines such as IgA, IL4, and IL10, and induced lymphocyte proliferation in response to FomA protein stimulation. Finally, we discovered that administering recombinant L. plantarum could protect mice from severe IBD triggered by F. nucleatum, subsequently reducing pathological alterations and inflammatory responses. These empirical findings further the study of an innovative oral recombinant Lactobacillus vaccine.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care.

Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.

P081 The application of multiomics to investigate the evolution of inflammatory bowel disease in pediatric and adult patients

Abstract Background The aim of this study is to monitor the evolution of Inflammatory Bowel Disease (IBD), including Crohn’s Disease (CD) and Ulcerative Colitis through the integration of genomic and immunological investigations to assess the mechanisms of IBD severity and the risk to develop malignancy Methods The study included pediatric (N=20) and adult (N=18) IBD patients at different stages of the disease (remission, mild, moderate and severe) and CRC patients with IBD history (N=13). Retrospectively collected tissues of IBD, inflamed non-IBD and normal gut tissues (N=10) were also utilized. Gut tissue biopsies (from both left and right side) and peripheral blood were collected from patients. DNA and RNA were extracted from fresh small size (2 mm in diameter) of gut tissues using the BioMasher II (Kimble) and All Prep DNA/RNA kits (Qiagen). Multiomics approach including MicroRNA (miRNA; N=700) and gene expression (N=800 genes) profiling were performed (cCounter platform; Nanostring) as well as the methylation profiling microarray (Infinium Methylation Epic Bead Chip kit, Illumina) to interrogate up to 850,000 methylation sites across the genome. These analyses were coped with immunological investigations. See Figure 1. Results Differential miRNA (such as miRNA92a-3p, 135-5p, 152-3p, 612; p<0.05) and gene signatures were found by the comparison of tissues from pediatric and adult patients with different stages of the disease. The differentially expressed genes belong to molecular pathways of inflammation, stemness, fibrosis, cell proliferation and migration (representative genes are: STAT3, CXCL2, MPM1, BIRC3, ISG15, ISG20, PECAM1). Pathways associated with the development of malignancy, such as PI3K/Akt/STAT and Wnt/GSK-3b were also detected as significantly differentially expressed. Differential profiles were also detected when comparing biopsies collected from right and left sides of gut in both pediatric and adult patients. Methylation sites at single nucleotide resolution have been also analyzed and correlated with miRNA and gene expression profiles Conclusion Although the results are currently under further investigation, the ongoing integration of data from multiple platforms provide insights of the overall molecular determinants in IBD patients along with the evolution of the disease and the clinical outcome

P325 Proton pump inhibitors are associated with a disabling course of Crohn’s disease

Abstract Background The impact of proton pump inhibitors (PPIs) on the evolution of inflammatory bowel disease (IBD) remains debated with only sparse data available. The primary objective of this study was to analyze the impact of PPIs on the course of IBD. Methods This was a single-center, retrospective cohort study. We included consecutive adult patients diagnosed with Crohn disease (CD) or ulcerative colitis (UC) who were followed prospectively in our day hospital over a 4-month period (from May to August 2022). PPI exposure was defined as PPI use for a cumulative duration of more than seven days from the date of IBD diagnosis until the end of follow-up. We performed a time to event analysis to investigate the association of PPI exposure with treatment failure defined as an IBD-related surgery or hospitalization and/or failure for more than four biologic treatment (Anti TNF, Vedolizumab, Ustekinumab). Results Among the 281 patients identified, 244 patients were eligible for analysis of the primary objective (152 with CD, mean age 45 years, sex ratio 1:1). 113 (46%) patients had been previously exposed to a PPI. PPI-exposed patients were significantly older (p=0.013), more often women (p=0.029), with more frequent active smoking (p=0.001). A total of 152 patients (62%) had treatment failure. Using Cox regression analysis, (Table 1), PPI use identified as an independent factor associated with treatment failure (HR = 1.920; 95% CI [1.084-3.403]; p0.025). In a subgroup analysis by IBD type, this remained statistically significant only for CD (HR = 3.190; 95% CI (1.412-7.206); p 0.005) but not for UC (HR = 0.981; 95% CI (0.384-2.504); p0.968). Survival without treatment failure (Figure 1) was significantly higher in patients without PPI exposure compared to patients with PPI exposure, (325 months vs. 228 months, respectively, p=0.022 (Log-Rank). In a subgroup analysis of infliximab-treated patients, PPI use was not associated with risk of immunogenicity (HR = 1.071; 95% CI (0.515-2.226); p0.854). Conclusion This study demonstrates the negative impact of PPIs on the disease course in patients with CD. The use PPIs should better be discussed on a case-by-case basis.

P841 Implication of Clostridioides difficile in the diagnosis and evolution of patients with pediatric inflammatory bowel disease

Abstract Background In the recent decades, the incidence of Clostridioides difficile (Cd) infection in children with inflammatory bowel disease (IBD) has increased, possibly due to underlying dysbiosis. The main objective of this study is to compare the prevalence of this infection in patients with IBD and without it, as well as secondarily to describe risk factors for Cd and its impact on the evolution of IBD. Methods Unicentric, observational and retrospective study of paediatric patients (<18 years old) undergoing Cd screening at the Hospital Infantil Universitario Niño Jesús in the last 5 years. Patients with IBD were those who met the Porto criteria. Statistical analysis was performed using SPSS. Results 3,360 paediatric patients were included. Of the 150 patients whose screening was requested by the Digestive Section, 87 had IBD. There were no statistically significant differences in the prevalence of infection in patients with IBD compared to other patients (p=0,061). According to the Paris Classification, no differences were found in relation to the prevalence of Cd infection, except for patients with growth impairment (G1), with a higher prevalence of infection compared to those without (G0) (33.3% vs. 13.9%) p<0.05. Regarding treatment, a higher prevalence of Cd infection was observed in patients receiving aminosalicylates monotherapy (42.9% vs. 13.4%) p<0.05 and in patients receiving NEE in monotherapy (60% vs. 15.8%) p<0.05. In contrast, a lower prevalence of Cd was observed in patients treated with azathioprine (with or without other therapies) compared to those not receiving azathioprine (10.3% vs. 26.2%) p<0.05. A lower prevalence of positives was also observed among those treated with biologics (with or without other therapies) (8% vs. 23.2%) p<0.05. Patients with IBD in whom the test was positive required more frequent changes in their baseline treatment than those who had negative screening (72.2% vs. 14.9%, p<0.05). Conclusion Although it has not been demonstrated that Cd is more prevalent in patients with IBD, it does seem to condition the course of the disease, being patients in whom more treatment changes have been made. Given the complexity of the data related to infection rates in relation to the different treatments, further studies in pediatric patients with concomitant IBD and Cd are considered necessary to confirm such differences and explain the possible pathophysiology.

Outcomes of bariatric surgery in patients with inflammatory bowel disease from a French nationwide database.

The outcomes of bariatric surgery (BS) in patients with chronic inflammatory bowel disease (IBD) remain rarely described. We aimed to evaluate the 90-day morbidity and mortality rates, and the risk of IBD complications 2 years after BS. Patients from the French Programme de Médicalisation des Systèmes d'Information (PMSI) database who underwent a primary BS between 2016 and 2018 were included. We identified patients with a previous diagnosis of IBD. Postoperative 90-day (POD90) morbidity and mortality rates were compared between the two groups. The evolution of IBD was followed 2 years after BS. Between 2016 and 2018, 138 980 patients underwent primary BS, including 587 patients with IBD: 326 (55.5 per cent) with Crohn's disease (CD) and 261 (44.5 per cent) with ulcerative colitis (UC). The preferred surgical technique was sleeve gastrectomy, especially in the IBD group (81.1 per cent), followed by gastric bypass (14.6 per cent). Patients with IBD had more comorbidities (Charlson Comorbidity Index of 1 or more, hypertension, and diabetes; P < 0.001) than those without IBD. The POD90 mortality rate did not differ between the two groups (0.049 per cent in the IBD group versus 0 per cent in the non-IBD group), but more unscheduled rehospitalizations at POD90 were observed in patients with IBD (6.0 per cent versus 3.7 per cent; P = 0.004). Two years after BS, 86 patients (14.6 per cent) in the IBD group had at least one unplanned readmission for the management of their IBD; 15 patients stayed for 3 or more days. After multivariable analysis, patients with CD had an independent elevated risk of IBD-related unplanned readmissions 2 years after BS versus UC (adjusted odds ratio 1.90, 95 per cent c.i. 1.22 to 2.97; P = 0.005). In a highly selected cohort of patients with well-controlled IBD, BS did not result in added mortality or morbidity. A point of vigilance must be underlined regarding BS in patients with CD.

New translational and experimental insights into the role of pro-resolving lipid mediators in inflammatory bowel disease.

The resolution of inflammation is an active process, guided by specialized pro-resolution lipid mediators (SPMs). These mediators originate from polyunsaturated fatty acids, such as omega-3. Sufficient evidence suggests that the beneficial effects attributed to omega-3 are, at least in part, the result of the immunomodulatory action of the SPMs, which act systemically by overcoming inflammation and repairing tissue damage, without suppressing the immune response. Recent studies suggest that an imbalance in the synthesis and/or activity of these compounds may be associated with the pathogenesis of several inflammatory conditions, such as inflammatory bowel disease (IBD). Thus, this review highlights the advances made in recent years with regard to the endo-genous synthesis and the biological role of lipoxins, resolvins, protectins, and maresins, as well as their precursors, in the regulation of inflammation; and provides an update on the participation of these mediators in the development and evolution of IBD and the therapeutic approaches that these immunomodulating substances are involved in this context.

Highlighting the Relevance of Gut Microbiota Manipulation in Inflammatory Bowel Disease.

Two different conditions are included in inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), being distinguished by chronic recurrence of gut inflammation in persons that are genetically predisposed and subjected to environmental causative factors. The normal structure of the gut microbiome and its alterations in IBD were defined in several microbial studies. An important factor in the prolonged inflammatory process in IBD is the impaired microbiome or “dysbiosis”. Thus, gut microbiome management is likely to be an objective in IBD treatment. In this review, we analyzed the existing data regarding the pathophysiological/therapeutic implications of intestinal microflora in the development and evolution of IBD. Furthermore, the main effects generated by the administration of probiotics, prebiotics, fecal transplantation, and phytochemicals supplementation were analyzed regarding their potential roles in improving the clinical and biochemical status of patients suffering from Crohn’s disease (CD) and ulcerative colitis (UC), and are depicted in the sections/subsections of the present paper. Data from the literature give evidence in support of probiotic and prebiotic therapy, showing effects such as improving remission rate, improving macroscopic and microscopic aspects of IBD, reducing the pro-inflammatory cytokines and interleukins, and improving the disease activity index. Therefore, the additional benefits of these therapies should not be ignored as adjuvants to medical therapy.

Impact of Epstein-Barr virus infection on inflammatory bowel disease (IBD) clinical outcomes.

to evaluate the role of Epstein-Barr virus (EBV) on the intestinal mucosa in the evolution of inflammatory bowel disease (IBD). The risk factors for EBV infection and the frequency of EBV-associated lymphoproliferative disorders in IBD patients were also investigated. intestinal biopsies of IBD patients with available EBV status determined by Epstein-Barr-encoding RNA (EBER) in situ hybridization were identified in the Pathology Database of our center. Clinical information, including phenotypic characteristics of IBD, previous treatments, diagnosis of lymphoma and patient outcome were reviewed in all cases. fifty-six patients with IBD (28 Crohn's disease, 27 ulcerative colitis and one unclassified colitis) were included. EBV in intestinal mucosa was positive in 26 patients (46 %) and was associated to a lymphoproliferative syndrome in one case. EBV positivity was associated with severe histological activity (52 % vs 17.2 %; p 0.007), the presence of a lymphoplasmacytic infiltrate (50 % vs 33.3 %; p 0.03) and active steroid treatment (61.5 % vs 33.3 %; p 0.03). Multivariate analyses only found an association between EBV and lymphoplasmacytosis (p 0.001). Escalation in previous treatment was significantly more frequent in the EBER+ group (53.8 % vs 26.7 %; p 0.038). No cases developed lymphoma during follow-up. EBV on the intestinal mucosa is associated with a poor outcome of IBD and the need for escalation of therapy. Lymphoplasmacytic infiltrate is associated with EBV infection. EBER+ patients used steroids more frequently compared with EBER- patients. No EBER+ patients developed lymphoma during follow-up.

The specialized educational and psychological counseling in inflammatory bowel disease patients - a target or a challenge?

Stress, in its various forms, plays an important role in the development and evolution of inflammatory bowel disease (IBD). For patients with IBD, the evidence related to the effects of various types of psychological therapies remains inconclusive. This study aimed to evaluate whether cognitive behavioral therapy, in combination with educational counseling, influenced disease activity and quality of life (QoL) among patients with IBD. We conducted a randomized controlled trial with 60 patients diagnosed with IBD. All patients completed the IBD questionnaire-32 (IBDQ-32) and the Big Five Inventory. Group A (experimental group) received specialized educational and psychological counseling (SEPC), and group B (control group) was treated according to the current medical practice. All patients were reassessed after 12 months. After the SEPC, there was no improvement in disease activity as estimated by fecal calprotectin levels. However, the QoL of patients in group A was significantly improved. The highest mean difference between the initial and final IBDQ scores was found among patients whose main personality trait was openness to experience (48.58±28.80), and the lowest mean difference between these 2 scores was found among patients whose main personality trait was closedness to experience (3.33±2.97, p=0.009). Although there was no improvement in disease activity after the SEPC, this therapy improved patients' QoL in terms of both emotional and social functions, especially among patients whose dominant personality trait was openness to experience or neuroticism.

The four epidemiological stages in the global evolution of inflammatory bowel disease

Inflammatory bowel disease (IBD) is a global disease; its evolution can be stratified into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium. In 2020, developing countries are in the Emergence stage, newly industrialized countries are in the Acceleration in Incidence stage, and Western regions are in the Compounding Prevalence stage. Western regions will eventually transition to the Prevalence Equilibrium stage, in which the accelerating prevalence levels off as the IBD population ages and possibly as a result of an unexpected rise in mortality during the COVID-19 pandemic. Mitigating the global burden of IBD will require concerted efforts in disease prevention and health-care delivery innovations that respond to changing demographics of the global IBD population. In this Perspective, we summarize the global epidemiology of IBD and use these data to stratify disease evolution into four epidemiological stages.

Doença inflamatória intestinal: como funciona o tratamento nutricional?

Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory pathology of the gastrointestinal tract caused by a dysregulated immune response against the commensal intestinal microbiome. The goals of therapy are to achieve and maintain disease remission, preventing its progression. Nutritional therapy is associated with changed intestinal microflora, improved mucosal barrier function and direct anti-inflammatory effect. Aim: To understand the functioning and effectiveness of nutritional treatment in the evolution of inflammatory bowel disease. Review of data on nutritional treatment in pediatric age. Materials and Methods: A bibliographic revision of scientific online reviews was conducted, gathering and comparing different sets of data found in the referred sources. Results: Exclusive enteral nutrition is as effective as corticosteroid therapy in inducing remission of active Crohn's disease. In maintaining remission, data are scarce, but nutritional therapy appears to decrease the risk of relapse. Conclusion: Exclusive enteral nutrition is currently the first line to induce remission of active Crohn's disease and shows a reduced risk of relapse in maintaining remission in children with IBD.

Dietary Composition and Effects in Inflammatory Bowel Disease.

Dramatic changes in the environment and human lifestyle have been associated with the rise of various chronic complex diseases, such as inflammatory bowel disease (IBD). A dysbiotic gut microbiota has been proposed as a crucial pathogenic element, contributing to immune imbalances and fostering a proinflammatory milieu, which may be associated with disease relapses or even the initiation of IBD. In addition to representing important regulators of the mucosal immunity and the composition of the gut microbiota, food components have been shown to be potential environmental triggers of epigenetic modifications. In the context of chronic intestinal inflammation, dietary habits and specific food components have been implicated as important modulators of epigenetic mechanisms, including DNA methylation, which may predispose a person to the increased risk of the initiation and evolution of IBD. This review provides novel insights about how dietary factors may interact with the intestinal mucosa and modulate immune homeostasis by shaping the intestinal ecosystem, as well as the potential influence of diet in the etiopathogenesis and management of IBD.

Environmental risk factors in the development and evolution of inflammatory bowel disease

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.

Biologic Therapies: From Complexity to Clinical Practice in a Changing Environment

This symposium provided an opportunity for global experts to discuss the challenges posed by the introduction of biosimilars. The impact of the manufacturing process on clinical outcomes, maintaining treatment responses over the long term, and issues surrounding patient management in a changing environment were addressed. The symposium was opened by Prof Panaccione describing the evolution of inflammatory bowel disease (IBD) treatment in the last 20 years and how biologics have improved outcomes. Prof D’Haens provided an explanation of the complexity surrounding biologic drug development and the hurdles facing drug manufacturers when ensuring high quality and consistently performing products over time. Prof Panaccione discussed the clinical challenges in balancing the transition from induction to maintenance therapy in order to provide a clinically relevant and sustained response to therapy. He also discussed the evidence for long-term outcomes with adalimumab for IBD. Prof Feagan highlighted the issues faced by clinicians treating patients with biologics, including the ability to switch between biologics without loss of efficacy or impact on safety, and the need to consider interchangeability between biologic therapies and the potential risk and impact of immunogenicity.

N005. Emotional Stress and its Influence in the Clinical Evolution of Inflammatory Bowel Disease (IBD)

N005. Emotional Stress and its Influence in the Clinical Evolution of Inflammatory Bowel Disease (IBD)

Assessment of antibodies anti-saccharomyces cerevisiae (ASCA) and autoantibodies in patients with inflammatory bowel disease

The incidence of inflammatory bowel disease (IBD) has been increasing worldwide, and despite the advances regarding their pathogenesis and therapeutics, the differential diagnosis between Crohn's Disease (CD) and Ulcerative Colitis (UC) is mainly based on clinically invasive tests. Recent studies have identified new serological markers with a potential value for the diagnosis of these pathologies, in particular the anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA). Also of note are the anti-goblet cells antibodies (anti-CCI) and the anti-pancreatic exocrine autoantibodies that react with the pancreatic acinus (anti-AP). We assessed these new serological markers and compared the efficiency between immune enzymatic (ELISA) and indirect immunofluorescence tests in the identification of ASCA of IgG or IgA class. We studied a set of 81 serum samples (with an initial diagnosis of IBD) and 33 control samples from healthy blood donors. The laboratory tests were correlated with the diagnosis of each patient, established in the Gastroenterology outpatient unit based on conventional methods. The agreement between the two laboratory methods employed in the identification of the ASCA was excellent (k = 0.63) for the IgG antibodies and good (k = 0.56) for the IgA antibodies. We found a weak agreement (k = 0.137) between ELISA (MPO and PR3 purified antigens) and the IFA test for ANCA. Regarding the serologic markers ANCA, anti-AP and anti-CCI, only the later showed no differences in the distribution of positive results between the studied groups. Positive ASCA IgG and IgA were significantly associated with diagnosis of DC, with both laboratorial methods tested. The identification of ANCA with the available solidphase tests does not seem appropriate for the screening of the autoantibodies with the atypical p-ANCA pattern of IBD. The combination between anti-AP and ASCA antibodies seems a good option for the laboratorial diagnosis of CD. This study shows that these serologic markers in spite of being non invasive laboratory tests, also have a considerable overlapping in the different IBD. Nevertheless, further prospective studies based on larger populations are required to clarify the relationship between these antibodies, the diagnosis and clinical evolution of inflammatory bowel disease.

Impact of nutritional treatment in the evolution of inflammatory bowel disease

Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary treatment for the disease. Some nutrients could induce a low antigenic stimuli, regulate inflammatory and immunological responses and stimulate intestinal mucosal trophism. Present available evidence supports enteral nutrition in Crohn's disease as a primary treatment if treatment with steroids is not possible (failure or contraindication) (grade of recommendation A) or either combined treatment with drugs in malnourished patients or those with inflammatory bowel stenosis. In those patients with sustained clinical remission, no benefit of either enteral nutrition or supplements in the absence of nutritional deficits has been shown. Elemental or modified formula (glutamine, omega 3 fatty acids) could not be recommended. In ulcerative colitis, nutritional influence over the activity of the disease has not been shown, although there are some promising results regarding enteric coated W3 fatty acids and a possible role for probiotics. In the treatment and prevention of pouchitis, there could be a role for probiotics (VSL#3). Nutritional treatment should be considered an integral component in the Management of patients with inflammatory bowel disease.