Extraintestinal Involvement Research Articles

Specific Oral Manifestations in Adults with Crohn's Disease.

Background: Oral manifestations of Crohn's disease (CD) include non-specific lesions and specific lesions directly related to intestinal inflammation. Oral lesions that can be overlooked in CD are sometimes challenging to treat. Methods: In this retrospective single-center study, patients with CD aged over 18 years who complied with follow-up and treatment were included. Clinical definitions of specific oral lesions included pyostomatitis vegetans, glossitis with fissuring, lip swelling with fissuring, cobblestoning, and orofacial granulomatosis. Experienced dentists confirmed the specific lesions in each case. Three groups of patients were identified: those without oral lesions, those with non-specific oral lesions, and those with specific oral lesions. The groups were compared based on demographics, disease extent and behavior (based on the Montreal classification), extraintestinal involvement, biologic and steroid treatment, and the requirement of resective surgery. Results: A total of 96 patients (14.2%) with oral lesions were found among the 676 patients with CD (59.7% male, median age 38 years) who were followed for 6.83 years (IQR 0.5-29.87 years). Eight patients (1.2%, 9 lesions) had specific oral lesions, while eighty-eight patients (13%) had non-specific lesions. Orofacial granulomatosis (n = 3), cobblestoning (n = 2), glossitis with fissuring (n = 2), and lip swelling with fissuring (n = 2) were among the specific lesions. The majority of patients (75%) with specific lesions were male, and their median age was 46.5 years (range: 23-68 years). Disease localization was commonly ileocolonic (50%), and perianal disease was present in 25% of patients. Three patients were active smokers. Extraintestinal manifestations were peripheral arthritis/arthralgia (n = 7) and sacroiliitis (n = 1). All specific lesions were associated with moderate-to-severe disease. Five patients improved with biologic therapy, and two patients with immunomodulatory therapy. Conclusions: Specific oral lesions in CD were associated with active disease and improved with immunomodulators or biologic therapy. Close cooperation between gastroenterologists and dentists is essential for early diagnosis and optimal management of CD.

Inflammatory bowel disease evolution in the past two decades: a chronological multinational study

The multifactorial nature of inflammatory bowel disease (IBD), which manifests differently in individuals creates a need for a better understanding of the behaviour and pattern of the disease due to environmental factors. The current study aimed to study the changes in IBD behaviour, presentation, and characteristics in patients over the past two decades with a goal of improving patients' diagnosis, management and outcomes. During a 6-month period (1/02/2022-30/07/2022), the information of patients with IBD who attended IBD outpatient clinics of 11 referral centre's in six countries was collected, and based on the first time of diagnosis with IBD, they were allocated as group A (those who were diagnosed more than 15 years ago), group B (those who were diagnosed with IBD between 5 and 15 years ago) and group C (IBD cases who diagnosed in recent 5 years). Then the most prevalent subtypes and characters of the disease are evaluated and compared to make clear if the presenting pattern and behaviour of the disease has changed in the last 2 decades. Overall 1430 patients with IBD including 1207 patients with ulcerative colitis (UC) (84.5%) and 205 patients with Crohn's disease (CD; 14.3%) included. Mean age of participants at the first time of diagnosis with IBD was 30 years. The extra-intestinal involvement of IBD in groups A and B was more prevalent in comparison with group C. Most of those in groups A & B had academic education but in group C, the most prevalent educational status was high school or diploma (P=0.012). In contrast to groups A and B, the relative prevalence of medium socioeconomic level in group C had decreased (65%). Relative prevalence of UC subtypes was similar among groups A and B (extensive colitis as most prevalent) but in group C, the most prevalent subtype is left side colitis (38.17%). The most prevalent subtype of CD in groups A and B was ileocolic involvement while in group C, upper GI involvement is significantly increased. The rate of food sensitivity among groups A and B was more than group C (P=0.00001). The relative prevalence of patients with no flare has increased with a steady slope (P<0.00001). Relative prevalence of presenting symptoms among patients with UC in group C differs and nowadays the rate abdominal pain (70.7%) and bloating (43.9%) have increased and frequency of diarrhoea (67.4%) has decreased. In the recent 5 years, the pattern of UC presentation has changed. The rate of upper GI involvement in CD and relative prevalence of patients with no disease flare increased and the rate of extra intestinal involvement decreased. None.

Extraintestinal manifestation of Crohn’s disease in an 11-year-old girl: a rare case report with review

Crohn’s disease (CD) is an inflammatory condition of the gastrointestinal tract with extraintestinal manifestations. Of all the patients affected by CD 40% experience at least one extraintestinal manifestation of the disease, the skin being the most common site of extraintestinal involvement. We are reporting a case of 11-year-old female child presented to us in the Dermatology OPD with redness and swelling of both upper and lower lip for a duration of 1 year, with swelling of right labia major for 3 months. Skin biopsy showed keratotic plugging, follicular plugging, and loss of rete ridges. Entire dermis and subcutis shows noncaseating granulomas without any giant cells with lymphohistiocytic cuffing around it. The patient was treated with prednisolone followed by methotrexate and supportive measures. There was a decrease in the swelling of face and vulva after a period of 1 month on the treatment. We report this case to draw the attention over the rare cutaneous manifestation of CD.

The Crohn's Disease Exclusion Diet: A Comprehensive Review of Evidence, Implementation Strategies, Practical Guidance, and Future Directions.

Dietary therapy is increasingly recognized for the management of Crohn's disease (CD) over recent years, including the use of exclusive enteral nutrition (EEN) as first-line therapy for pediatric CD according to current guidelines. The Crohn's disease exclusion diet (CDED) is a whole-food diet designed to reduce exposure to dietary components that are potentially pro-inflammatory, mediated by negative effects on the gut microbiota, immune response, and the intestinal barrier. The CDED has emerged as a valid alternative to EEN with cumulative evidence, including randomized controlled trials, supporting use for induction of remission and possibly maintenance in children and adults. We gathered a group of multidisciplinary experts, including pediatric and adult gastroenterologists, inflammatory bowel diseases (IBD) expert dietitians, and a psychologist to discuss the evidence, identify gaps, and provide insights into improving the use of CDED based on a comprehensive review of CDED literature and professional experience. This article reviews the management of CDED in both children and adults, long-term aspects of CDED, indications and contraindications, selecting the best candidates, identifying challenges with CDED, globalization, the role of the multidisciplinary team, especially of dietitian, and future directions. We concluded that CDED is an established dietary therapy that could serve as an alternative to EEN in many pediatric and adult cases, especially with mild to moderate disease. In severe disease, complicated phenotypes, or with extraintestinal involvement, CDED should be considered on a case-by-case basis, according to physician and dietitians' discretion. More studies are warranted to assess the efficacy of CDED in different scenarios.

Klinik Parametrelerin Ülseratif Kolit Seyrinde Atak Sayılarına Etkisinin Karşılaştırılması: Tek Merkezli Çalışma

Aim: The aim of this study was to find the factors affecting the frequency of attacks of patients diagnosed with ulcerative colitis (UC).&#x0D; Method: In our single-center retrospective descriptive study, 40 UC patients who admitted to our hospital for follow-up from January 2021 to December 2022. The baseline demographic and clinical characteristics, laboratory values and, treatments during the disease course were compared among patients with number of attacks &lt; 2 per year ( Group1) and number of attacks ≥2 per year ( Group 2). &#x0D; Results: There were 25 (male∕female:11∕14) patients in Group 1 and 15 (male∕female:7∕8) patients in Group 2. No statistically significant difference was found between the mean age, sex, age of diagnosis, duration of disease, co-morbidities and extraintestinal involvement of both groups. The median CRP values were significantly higher in the Group 2, compared to the group 1 (P = 0.04). There was statistically significant differences between groups in terms of endoscopic severe activity (12% vs, 40%; p

Association between body fat composition and disease duration, clinical activity, and intravenous corticosteroid-induced response in inflammatory bowel disease

BackgroundBody fat composition is believed to be associated with the progression, medical response, and prognosis of inflammatory bowel disease (IBD). Hence, we conducted this study to explore if fat metrics were associated with the disease activity of severe IBD and the response to intravenous corticosteroids (IVCS).MethodsWe included 69 patients with ulcerative colitis (UC) and 72 patients with Crohn's disease (CD) who had previously received IVCS during hospitalization. We quantified individual fat distribution using abdominal computed tomography slices. The correlations between fat parameters and disease activity were available with Spearman correlation analysis. The prediction model was developed using independent risk factors derived from multivariable logistic regression analysis. Model discrimination was evaluated leveraging the receiver operating characteristic curve. 1000 bootstrap resamples internally validated the model's prediction performance.ResultsNotable differences in age, nutritional status, serum cytomegalovirus replication, stool condition, and extraintestinal involvement between UC and CD patients were observed. UC subjects who responded to IVCS had higher subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), and mesorectal adipose tissue index (MATI) than non-responders. IVCS-responding CD individuals had lower VATI and mesenteric fat index (MFI) than non-responders. CD patients with a prolonged disease duration had a decreased SATI and an elevated MFI. VATI and MATI were reduced as UC clinically progressed, while more prominent clinical activity in CD correlated with increased VATI, MATI, and MFI. A high SATI indicated that patients with UC were more prone to be IVCS responders. For patients with CD, levels of VATI and MFI were negatively associated with effective IVCS treatment. The established models showed a discriminative accuracy of 0.834 [95% confidence interval (CI) 0.740–0.928] in the UC cohort and 0.871 (95% CI 0.793–0.949) in the CD cohort. Repeated samples supported the reliability of the developed models (AUCUC = 0.836, 95% CI 0.735–0.919; AUCCD = 0.876, 95% CI 0.785–0.946).ConclusionHuman fat indexes represent novel imaging biomarkers for identifying IBD patients who respond to IVCS, thus building accelerated therapy regimens and avoiding the adverse effects of ineffective IVCS.

Quality of Life of Patients With Inflammatory Bowel Disease in Bangladesh.

Introduction The importance of maintaining quality of life in managing inflammatory bowel disease (IBD) has increased in recent years. However, there is a lack of studies examining the health-related quality of life (HRQoL) of IBD patients in Bangladesh. Methodology This cross-sectional study was carried out in the IBD clinic, Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2020 to 2022. Data were collected from both ulcerative colitis(UC) and Crohn's disease (CD) patients. HRQoL was recorded on the EuroQol 5 Dimension 5 Level (EQ-5D-5L) questionnaire. Statistical analysis was done by Statistical Analysis Software (SAS, SAS Institute, Cary, NC). Results The mean age was 36.3 years. The majority of the patients were male and had low incomes. People with more monthly income, more frequent relapse, extraintestinal involvement, and moderate to severe disease had lower utility index (p = 0.01, 0.01, 0.0004, and <0.0001, respectively). Among the five individual components, only usual activity was lower in UC patients (p = 0.03); all the other components and consequently the overall utility index did not vary between UC and CD. The visual analog scale (VAS) score seemed to be comparable in UC and CD patients. Conclusion In more severe and frequently relapsing cases of IBD, the utility index representing HRQoL was found to be lower. Comparatively, the HRQoL was mostly similar between patients with UCand CD. Additionally, the mean utility score in IBD patients was higher than that observed in patients with type 2 diabetes mellitus in Bangladesh.

P729 Evaluation of hepatobiliary pathologies using transient elastography in patients with inflammatory bowel disease: What about the effect of drugs?

Abstract Background In this study, we evaluated hepatobiliary involvement in inflammatory bowel disease (IBD) with FibroScan® (transient elastography) and examined drug effects on liver fibrosis and steatosis. We particularly focused on the effect of azathioprine (AZT) on spleen stiffness (SS). Methods A total of 352 subjects were included in this study, including 298 IBD patients and 54 healthy controls. LSM (liver stiffness measurement), SS, and CAP™ (controlled attenuation parameter) scores were measured by FibroScan®. In addition to disease and patient characteristics; laboratory tests, and effect of the drugs were evaluated and compared within the groups. Results The patient and control groups were similar in terms of age and gender. The characteristics of the groups are shown in Table 1. Mean LSM (5.2±3.1kPa vs 4.5±1,1kPa), mean SS (22.69±13,10kPa vs 17.96±7,44kPa), CAP™ score (hepatosteatosis) (233±56dB/m vs 224±47dB/m) were significantly higher in the patients with IBD than in the control group (p&amp;lt;0.05). Liver fibrosis and steatosis grades are shown in Figure 1. A positive correlation was found between CAP™ score and male gender, hypertension, diabetes, BMI, smoking, penetrating disease, GGT, triglyceride, LSM, and SS (p&amp;lt;0.05). LSM (5.7±3,1kPa vs 5.0±3,1kPa) was significantly higher in patients with extraintestinal involvement (p&amp;lt;0.05). In patients with significant liver fibrosis (F2-3-4), the frequency of anti-TNF treatment was lower (44,4% vs 69,5%; p=0,008) (Figure 2). In patients who use alcohol regularly compared to nondrinkers (25.54±14,83kPa vs 21.05±11,24kPa) SS was significantly higher (p&amp;lt;0.05). Additionally, in patients using AZT≥100 mg/day compared to those using AZT&amp;lt;100 mg/day (23.48±14,61kPa vs 19.99±11,84kPa; p&amp;lt;0,05) SS was significantly higher (Figure 3). AZT dose was positively correlated with SS (Spearman analysis; r=0.182 and p=0.013); however, no correlation was found with the duration or cumulative dose of AZT. The mean level of platelets was significantly higher in patients with IBD than in controls (300±104x10³/µL vs 251±52x10³/µL, p=0,001); however, there was no correlation between SS and trombosit level (p&amp;gt;0,05). 83% of patients were in clinical remission (Mayo score≤2/CDAI&amp;lt;150). No positive correlation was found between disease activity and SS in IBD patients. AZT-associated non-cirrhotic portal hypertension was detected in only one patient. Conclusion In this study, fatty liver, liver fibrosis, and SS were found to be significantly higher in IBD patients than in healthy controls. Although there is no relationship with the duration of AZT therapy, AZT dose was positively correlated with SS. We recommend that spleen stiffness should be evaluated in patients who use high doses of AZT (≥100 mg/day).

P280 Quality of life in military patients with Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD), represented by Crohn's disease (CD) and Ulcerative Colitis (UC), are chronic conditions that can impair quality of life (HRQOL). Active military personnel are particularly at risk, given the strain of their work and military missions. The aim of our study was to evaluate the HRQOL of active military patients with IBD and to search for factors related to its alteration. Methods This was a prospective cross-sectional study, over a period of 5 months [February 2022 - June 2022], including male military patients that were still serving. The HRQOL of these patients was assessed by the IBD-Disk, which is a visual scale that consists of 10 items (Abdominal pain, diarrhea, social behavior, education and work, sleep, energy, emotions, body image, sexual activity, joint pain). It is validated for the assessment of HRQOL in IBD patients. Each dimension is scored from 0 to 10, with a total score of 0 to 100. The higher the score, the more impaired the HRQOL. The overall IBD-Disk score was considered impaired if it was higher than 40. Results We included 30 patients. The most represented age range was from 31 to 40 years. Ten patients were smokers. Twenty-four patients had CD and 6 had UC. The majority of CD was isolated ileal (n=16) with an upper gastrointestinal tract involvement in one patient and anoperineal manifestations in 5 patients. UC was distal in 3 patients and extensive in the other 3. Nine patients had extra-intestinal involvement, principally rheumatological (n=8). The mean overall IBD-Disk score was 21.6 [6 - 66]. We noted that CD was associated with the alteration of the dimensions related to urgent stools (p=0.001), social life (0.002) and sleep (p=0.004). The presence of anoperineal lesions during CD was associated with impairment of the social (p=0.002) and energy (p=0.006) dimensions. The presence of extra-intestinal manifestations was associated with elevated social dimension score (p=0.002). Azathioprine treatment was associated with impaired sleep dimension (p=0.048). Patients with a disease that had been evolving for more than 5 years had an alteration in the dimension related to urgent stools (diarrhea) (p=0.036), energy (p=0.048) as well as the dimension of sexual life (p=0.042). History of hospitalization for IBD was associated with impaired body image (p=0.030). History of surgical resection was associated with impaired energy (p=0.029), sexuality (p=0.015) and overall quality of life (p=0.02). Conclusion In our active military patients, HRQOL was not impaired overall, but several factors, related to severe forms, were associated with lower HRQOL.

P282 Isolated colonic Crohn’s disease and extensive ulcerative colitis: is there a reel difference?

Abstract Background The management of isolated colonic Crohn's disease (CDc) is often modeled on that of Ulcerative Colitis (UCc). The aim of our study was to compare epidemiological and evolutive profiles of CDc and UCc. Methods We conducted a retrospective, descriptive and comparative study, including patients diagnosed with CDc as well as UCc, who were hospitalized in our department over a 9-year period [January 2011 - January 2020]. The group 1 included patients with CDc and group 2 included patients with UCc. Patients with less than 2 years of follow-up were excluded. Data were recorded and analyzed by SPSS software version 26. Results We included 130 patients with a sex ratio M/F= 0.68. The mean age at diagnosis was 34.85 years [6-68 years]. Sixty-three patients had CDc, while 67 patients had UCc. The two groups were comparable for age (p=0.56) and sex (p=0.54). The percentage of patients with smoking and alcoholism was also comparable between the two groups (p=0.4 and p=0.8 respectively). The presence of at least one autoimmune disease and a family history of Inflammatory Bowel Disease were more noted in patients in group 1 than in group 2 (p= 0.011 and p=0.046 respectively). The mean BMI at diagnosis was 22.28 kg/m² and was comparable between the 2 groups. The main phenotype was inflammatory (93.6%) in group 1. Twenty-five patients in group 1 (39.6%) and 22 patients (32.8%) in group 2 had associated extra-intestinal involvement (p=0.41), represented mainly by rheumatological involvement (n=39, 30%). The mean albumin level at diagnosis was 29.21 g/L and 30.96 g/L in groups 1 and 2 respectively. The occurrence of Severe Acute Colitis during follow-up was more frequent in group 2 than in group 1 (58.2% vs. 46%), although the difference was not significant (p=0.13). However, the rate of colectomy was significantly higher in group 2 (p=0.029). The use of anti-TNF therapy was significantly higher in group 1 (p=0.046). The maximum duration of hospitalization and the number of relapses were not statistically different between the 2 groups (p=0.81 and p=0.8 respectively). Finally, there was no significant difference between the 2 groups considering the use of corticosteroid or immunosuppressive therapy (p=0.88 and p=0.96 respectively). The main limit of our study is that it was conducted only in hospitalized patients who had relatively severe disease. Conclusion CDc is more prone to intensive medical treatment, whereas colectomy is more noted in UCc.

Celiac Disease and Neurological Manifestations: From Gluten to Neuroinflammation.

Celiac disease (CD) is a complex multi-organ disease with a high prevalence of extra-intestinal involvement, including neurological and psychiatric manifestations, such as cerebellar ataxia, peripheral neuropathy, epilepsy, headache, cognitive impairment, and depression. However, the mechanisms behind the neurological involvement in CD remain controversial. Recent evidence shows these can be related to gluten-mediated pathogenesis, including antibody cross-reaction, deposition of immune-complex, direct neurotoxicity, and in severe cases, vitamins or nutrients deficiency. Here, we have summarized new evidence related to gut microbiota and the so-called "gut-liver-brain axis" involved in CD-related neurological manifestations. Additionally, there has yet to be an agreement on whether serological or neurophysiological findings can effectively early diagnose and properly monitor CD-associated neurological involvement; notably, most of them can revert to normal with a rigorous gluten-free diet. Moving from a molecular level to a symptom-based approach, clinical, serological, and neurophysiology data might help to disentangle the many-faceted interactions between the gut and brain in CD. Eventually, the identification of multimodal biomarkers might help diagnose, monitor, and improve the quality of life of patients with "neuroCD".

S3494 Whipple’s Disease Without Arthropathy in an Immunocompromised Patient

Introduction: Whipple’s disease (WD) is a rare disorder caused by the pathogen Tropheryma whipplei. It presents with non-specific symptoms which can mimic the presentation of other gastrointestinal pathogens, especially in immunocompromised patients. We report a unique presentation of WD involving an immunocompromised patient who experienced non-specific gastrointestinal symptoms without arthralgia, which is a characteristic symptom of this disease. Case Description/Methods: A 67-year-old man with a history of chronic hepatitis B infection and Human immunodeficiency virus (HIV) infection presented with weight loss, nausea, vomiting and myalgia. Of note, patient did not have arthralgia. Physical exam revealed cervical lymphadenopathy and diffuse abdominal tenderness. Patient was anemic (hemoglobin of 8.6 g/dL) with a normal white count. Endoscopy demonstrated erythema in the gastric body, lymphangiectasia of the duodenum, and increased granularity of the terminal ileum. Mucosal biopsies revealed macrophages in the lamina propria with focal histiocytic aggregates throughout the small bowel and cecum, with positive PAS staining, consistent with Whipple’s disease. Confirmatory T. whipplei PCR testing was positive (Figure). Discussion: WD is a rare diagnosis that must be considered in the differential diagnoses of patients presenting with unexplained nausea, vomiting, diarrhea and anemia. Furthermore, in patients with HIV, the possibilities would also include opportunistic gastrointestinal pathogens. Classic WD is characterized by diarrhea, weight loss, abdominal pain and extra-intestinal involvement manifesting as joint pain, endocarditis, dementia, supranuclear gaze palsy, and mediastinal lymphadenopathy. Diagnosis involves biopsy of affected tissue demonstrating foamy macrophages with PAS (+) substance, which can be confirmed by PCR or immunohistochemistry. Treatment involves an initial course of penicillin or ceftriaxone followed by a prolonged course of Bactrim, or a one-year course of doxycycline and hydroxychloroquine, followed by lifelong doxycycline therapy, which is more likely to prevent disease relapse. In the absence of suppressive therapy, relapse of WD is common and may lead to further complications, including neurological involvement.Figure 1.: Periodic Acid-Schiff-Staining Macrophages (circles) Within the Lamina Propria of the Duodenal Bulb (a) and Cecum (b) as Seen Via Light Microscopy with a 20x Objective Lens.

Relationship between Serum Protein Electrophoresis, Endoscopic and Histopathological Scores in 99 Cats with Chronic Enteropathy.

Simple SummarySerum protein electrophoresis (SPE) is a laboratory test used to separate different protein fractions. It is used to investigate animals with hyperglobulinemia and to distinguish between monoclonal and polyclonal gammopathies. SPE can also highlight acute or chronic inflammation patterns which are useful in disease monitoring. SPE is effective in humans with intestinal bowel disease (IBD) and chronic liver diseases. In addition, hypergammaglobulinemia is a marker of extraintestinal manifestations in human IBD patients, which often includes hepatic and pancreatic disease. Concurrent pancreatic and/or hepatic diseases in cats with chronic enteropathy (CE) have often been found, which may contribute to SPE alterations. The present study investigated the relationship between SPE and endoscopy, histopathology, and hepatic and pancreatic ultrasonographic findings in ninety-nine cats diagnosed with CE. No significant differences were observed between SPE and endoscopic and histopathological severity scores. Cats with concurrent pancreatic and/or hepatic ultrasonographic alterations showed lower albumin, lower α-globulin, and higher γ-globulin levels than cats diagnosed with enteropathy alone. This study suggests that hepatic and/or pancreatic alterations may influence SPE fractions in cats with CE, and should form the basis for further prospective studies on cats with diaditis and triaditis.Few studies have investigated total protein (TP) and serum protein electrophoresis (SPE) in cats with chronic enteropathy (CE). Cats diagnosed with CE were evaluated to investigate the relationships between TP, SPE and endoscopy, histopathology, and extraintestinal involvement. Medical records were searched for cats with a history of chronic gastrointestinal signs and a final diagnosis of CE. Information on signalment, TP, SPE, endoscopic score, histopathological diagnosis and score, and concurrent hepatic or pancreatic ultrasonographic alterations was collected. Relationships between protein profiles and other variables were investigated. Ninety-nine cats were included in the study, 63 diagnosed with various degrees of bowel inflammation and 36 with small-cell alimentary lymphoma. The most common TP alteration was hypoproteinemia (24%). No significant differences were observed between protein profiles and endoscopic and histopathological severity scores. Forty-five cats showing concurrent pancreatic and/or hepatic ultrasonographic alterations, had significantly lower albumin, lower α-globulin, and higher γ-globulin levels than cats not showing concurrent alterations. Disease severity scores did not seem to influence the protein profile in cats with CE. Extraintestinal involvement may be suspected in cats with lower albumin and α-globulins and higher γ-globulins.

Pancreatic involvement in celiac disease.

Celiac disease (CD) is well recognized as a systemic, chronic autoimmune disease mainly characterized by gluten-sensitive enteropathy in genetically predisposed individuals but with various extraintestinal features. One of the affected organs in CD is the pancreas, consisting of both endocrine and exocrine alterations. Over the last decades there has been increasing interest in the pancreatic changes in CD, and this has been reflected by a great number of publications looking at this extraintestinal involvement during the course of CD. While pancreatic endocrine changes in CD, focusing on type 1 diabetes mellitus, are well documented in the literature, the relationship with the exocrine pancreas has been less studied. This review summarizes currently available evidence with regard to pancreatic exocrine alterations in CD, focusing on risk of pancreatitis in CD patients, association with autoimmune pancreatitis, prevalence and outcomes of pancreatic exocrine insufficiency in newly diagnosed and gluten-free diet treated CD patients, and the link with cystic fibrosis. In addition, we discuss mechanisms behind the associated pancreatic exocrine impairment in CD and highlight the recommendations for clinical practice.

Vinculum of Cardiovascular Disease and Inflammatory Bowel Disease: A Narrative Review.

Inflammatory bowel disease (IBD), comprising of ulcerative colitis (UC) and Crohn's disease (CrD), is a chronic relapsing-remitting inflammation of the bowel with extraintestinal involvement. Numerous studies published in the last decade have underlined the dangerous cardiovascular disease (CVD) outcomes of IBD, such as ischemic heart disease, heart failure, and stroke, and the need for better therapeutic and prognostic strategies. This article elucidated the pathological web of mechanisms that link IBD with CVD, such as immune dysregulation, endothelial dysfunction, arterial stiffness, and dysbiosis, with a comprehensive review of clinical studies standing for and against the notion in pediatric and adult populations. The current treatment and prevention aim at disease remission and dietary strategies shown to reduce the CVD risk. Exploration of other supplemental preventive and treatment methods, especially during active flares of disease, to reduce the risk of arterial thromboembolic disease (ATED) is the need of the hour.

Infecciones por Salmonella y Yersinia

The Salmonella and Yersinia genera comprise various species that can lead to gastrointestinal and systemic clinical symptoms. Salmonella encompass a wide variety of serotypes capable of infecting animals and human beings. They are divided into two groups according to the symptoms they produce: non-typhoid salmonellae produce gastrointestinal symptoms, although they sometimes have extraintestinal involvement, especially in immunosuppressed patients or those with cardiovascular disease, and serotypes that cause typhoid fever, characterized by high fever and systemic involvement. Yersinia, like the aforementioned genus, comprises two groups based on the symptoms they produce. Y. enterocolitica and Y. pseudotuberculosis which cause enterocolitis and are more prevalent in countries with a cold climate. They can produce mesenteric adenitis and terminal ileitis that can be confused with acute appendicitis and, in 10% to 20% of cases, cause post-infection sequelae such as erythema nodosum and reactive arthritis. Y. pestis is the causative agent of the plague, a clinical condition of enormous severity, especially in its pneumonic form, which has given rise to significant outbreaks in countries in Africa in recent years.

P473 Real world experience with the Crohn’s Disease Exclusion Diet (CDED) in a tertiary IBD clinic

Abstract Background The Crohn’s Disease Exclusion Diet (CDED) is a whole-food diet designed to reduce exposure to dietary components, hypothesized to negatively affect the microbiome, intestinal barrier, and immune response. In a clinical study in adults with mild-moderate CD (&amp;lt;5 years duration), an inflammatory phenotype involving the terminal ileum, it induced clinical, biochemical and endoscopic disease remission. We aimed to describe our real-world experience with the CDED, in a clinically diverse CD population. Methods A retrospective cohort study of CD patients prescribed with the CDED, between 1.2018 and 11.21. Patients’ medical background, medical therapy, nutritional status and clinical disease activity as well as adherence and clinical outcomes were documented from patients’ medical files. Results The CDED was recommended to 218 CD patients. Of these, 62 were excluded from the analysis due to lack of medical information (n=11), prior personal experience with the CDED (n=23), patient’s refusal (n=24), and stoma patients (n=4). The CDED was initiated in 155 patients (age 37.7±16.3, 66% men, disease duration 7.8±9.6), 35.3% had colonic/ileo-colonic disease, 23.7% and 25% had a stricturing and penetrating disease respectively, 27.5% had a history of intestinal resection, 19.9% had extra-intestinal involvement, and 7.7% had a severe endoscopic disease at diet initiation. Indications for therapy included patient’s will (44.7%), adjunctive therapy (23.7%), bridge with biologic induction (20.4%), rescue therapy (3.9%), exhaustion/contraindication of other advanced therapy options (1.4%), de-escalation of biologics (0.7%), preparation for surgery (0.7%), and others (3.9%). Upon initiation, 67.3% (n=105) had an active disease [Harvey Bradshaw index (HBI) ≥5 / Calprotectin ≥250 g/l] and 32.7% were in remission. Physician and dietician follow-up at the end of phase 1 was documented in 89 (57.4%) and 74 (47.7%) of patients with an active disease (mean follow-up period 14.6±9.3 weeks). Fifty-eight percent of patients with dietary follow-up (n=43) were fairly-fully compliant to the CDED. Clinical response (drop in HBI&amp;gt;2 points) and remission (HBI&amp;lt;5) at the end of phase 1, were achieved by 58.9% (n=62) and 57.5% (n=60) of patients who were treated for an active disease (n=105). Clinical remission rate at the end of phase 1 was lower among patients with higher baseline HBI score (P for trend=0.028), lower dietary adherence (P for trend&amp;lt;0.001) and a surgical history (P=0.033). Conclusion The CDED may have efficacy across different clinical scenarios. Adherence is reasonable, and is associated with higher remission rates among patients treated for an active disease.

Rare gastrointestinal presentation of enterobius vermicularis: Anal abscess

Enterobius vermicularis (E. vermicularis) is a human roundworm that does not have an intermediate host. It is a common parasite worldwide, especially in temperate regions and in developing countries. It lives in the human large intestine, particularly in the cecum lumen, appendix, rectum area, and rarely in the last parts of the small intestine and causes enterobiasis (oxyuriasis). Likewise, it is usually transmitted by close contact between infected and non-infected individuals and swallowing or inhalation of eggs. Primary school children are the most likely to be affected. It is generally asymptomatic, the most common symptom is itching in the perianal area. Sometimes it can be complicated by extraintestinal involvement. In countries with high prevalence, such as our country, oxyuriasis should be kept in mind as a rare cause of gastrointestinal involvement including anal abscess. The aim of the case report was to present an extremely rare case of anal abscess caused by E. vermicularis as well as to review the literature.

Computed tomography enterocolongraphy in assessment of degree of ulcerative colitis activity.

Inflammatory bowel diseases are gaining more interest in the past few years. Ulcerative colitis (UC) is a chronic disease that requires accurate follow-up for a good treatment plan. Colonoscopy alone cannot be efficient to detect disease extent and has a high risk of perforation in acute severe UC and toxic megacolon. Computed tomographic enterocolonography (CTE) is widely used now to detect intramural, extra-intestinal involvement and intestinal complications. Hence, this study aimed to evaluate CTE in the assessment of the degree of activity of UC. This cross-sectional study was carried on 50 UC patients, divided into 36 males and 14 females presented at the Gastroenterology Unit, Alexandria Main University, Faculty of Medicine. Assessment of UC activity was done to all patients on three levels; the ulcerative colitis disease activity index for the clinical level, ulcerative colitis endoscopic index of severity by endoscopy and pathologically by degree of neutrophilic invasion, crypt abscess or cryptitis, presence of oedema and mucosal surface ulceration, then CTE was done and the findings were compared with the histopathological findings. Bowel wall thickening in CTE was divided into: normal (<3 mm, score 0), mild (3-6 mm, score 1), moderate (6-9 mm, score 2) and severe (>9 mm, score 3). Mesenteric hyperaemia, mucosal hyper enhancement and enlarged pericolic lymph nodes were recorded. CTE findings in the form of bowel wall thickening and hyper enhancement were found in 74% of active cases and were correlated with all histopathological findings investigated in this study with high statistical significance except in chronic stages, whereas lymph node enlargement and mesenteric hyperaemia did not show statistical significance with disease activity. CTE is a good tool for diagnosing disease activity in UC.

Liver Abscess: Complications and Treatment.

Liver Abscess: Complications and Treatment.