Inflammatory Bowel Disease Group Research Articles

Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study

ObjectivesIt is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. MethodsRetrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15–55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. ResultsWe matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20–1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03,;95% CI 1–1.07). ConclusionsThe higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.

"Decoding inflammation: glycoprotein a repetition predominant, microRNA-142-3-p, and metastasis associated lung adenocarcinoma transcript 1: as novel inflammatory biomarkers of inflammatory bowel disease".

Inflammatory bowel disease (IBD) is a chronic gastrointestinal (GI) condition comprising Crohn's disease (CD) and ulcerative colitis (UC). The pathogenesis involves immune system dysregulation, with increased Th (T helper cell)17 cells and reduced regulatory T cell (Treg) differentiation. Transforming growth factor-β (TGF-β) secretion from Tregs helps control inflammation, and its production is regulated by glycoprotein-A repetition predominant (GARP) protein along with non-coding RNAs (ncRNAs) like microRNA(miR)-142-3p and metastasis associated lung adenocarcinoma transcript 1 (MALAT1) long non-coding RNAs (LncRNAs). This study analyzed their expression in IBD. Blood samples were collected from 44 IBD patients, and 22 healthy controls (HC). RNA extraction and circular DNA (cDNA) synthesis were performed. Real-time polymerase chain reaction (RT-PCR) measured gene expression of GARP, MALAT1, and miR-142-3p. Correlations and group differences were statistically analyzed. Compared to controls, GARP was downregulated while MALAT1 and miR-142-3p were upregulated significantly in IBD group. GARP and MALAT1 expressions positively correlated in controls. MALAT1 and miR-142-3p expressions positively correlated in IBD group. MALAT1 was downregulated in aged HC but upregulated with smoking history across groups. No correlations occurred between gene expression and gender, diet, infections, or disease activity scores. Dysregulation of GARP, MALAT1, and miR-142-3p likely contributes to inflammation in IBD by reducing TGF-β. MALAT1 is linked to smoking and age-related changes. These genes have potential as diagnostic markers or therapeutic targets for personalized IBD treatment.

A study to assess the prevalence and risk factors for Clostridioides difficile infection in patients with inflammatory bowel disease in a tertiary care hospital in Northern India

Objectives: The prevalence of Clostridioides difficile infection (CDI) is on rise among patients with inflammatory bowel disease (IBD). This study sought to describe the prevalence and risk factors of CDI in patients with IBD as compared to non-IBD controls. Materials and Methods: This was a prospective study conducted at a Department of Microbiology in collaboration with a Department of Gastroenterology. The patients with IBD and controls without IBD presenting with diarrhea were included in the study. The screening test for C. difficile infection was done by glutamate dehydrogenase (GDH) assay and toxin detection by enzyme-linked immunoassay (ELISA). Anaerobic culture for C. difficile was done on a selective cycloserine cefoxitin fructose agar and polymerase chain reaction (PCR) was done for Toxin A (TcdA) and Toxin B (TcdB) gene detection. C. difficile infection was confirmed if GDH and toxin ELISA or PCR were positive. Statistical Analysis: Data were analyzed with the Statistical Package for the Social Sciences version 20.0.The numerical variables were presented by means and standard deviations. Comparison of continuous variables was done using Student’s t-test. Categorical variables were analyzed by Chi square test. P<0.05 was considered to be statistically significant. Results: A total of 160 cases and 112 age- and gender-matched control were included in IBD group and nonIBD group, respectively. Only one culture was positive, 12 and six were positive for GDH ELISA and TcdA and TcdB ELISA, respectively, and 7 were positive by PCR for toxin genes. The factors found significantly associated with CDI were proton-pump inhibitors use (P = 0.001), levofloxacin (P =0.001), and azathioprine (P =0.042). Using PCR as a reference method for C. difficile toxin detection, the sensitivity, and specificity of GDH ELISA and ELISA for toxins were 100%, 96.8% and 85.7%, and 100%, respectively. Conclusions: The prevalence of CDI among patients with IBD has been found to be low, that is (only 4.4%) in this study population.

Major basic protein is a useful marker to distinguish eosinophilic esophagitis from IBD-associated eosinophilia in children.

The incidence of eosinophilic esophagitis (EoE) is 3-5 times greater in patients with inflammatory bowel disease (IBD) compared with the general population. This study aimed to differentiate true EoE from esophageal eosinophilia in IBDpatients by evaluating expression of major basic protein (MBP) and interleukin-13 (IL-13) in esophageal biopsies. This retrospective study included subjects who had an esophagogastroduodenoscopy with esophageal biopsies for IBD work up or suspicion for EoE. Patients were classified into 5 groups: EoE with ≥15 eosinophils per high power field (eos/hpf), EoE-IBD with ≥15 eos/hpf, IBD eosinophilia with 1-14 eos/hpf, IBD and control groups. Biopsies were stained with MBP and IL-13 antibodies and the results (% staining/total tissue area), demographic, and clinical findings were compared among the groups. The median for MBP staining levels in EoE-IBD was 3.8 (interquartile range 1.3-23), significantly lower than in EoE at 52.8 (8.3-113.2), but higher than in IBD eosinophilia at 0.2 (0-0.9; p < 0.001) and negligible in the IBD and control groups. IL-13 expression in EoE was significantly higher only compared with IBD and controls not with EoE-IBD or IBD eosinophilia. MBP predicted EoE with 100% sensitivity and 99% specificity while IL-13 had 83% sensitivity and 90% specificity using cutoff point from the cohort without EoE-IBD patients. Based on MBP cutoff point that distinguished EoE from non EoE, 56% in EoE-IBD were MBP-positive whereas 100% in EoE group (p < 0.05). MBP may be an excellent marker in distinguishing true EoE from eosinophilia caused by IBD. Our data implied that MBP together with endoscopic and histologic changes can assist EoE diagnosis in IBD patients.

Safety of Ustekinumab in Inflammatory Bowel Disease: Pooled Safety Analysis Through 5 Years in Crohn's Disease and 4 Years in Ulcerative Colitis.

Previously published long-term safety data reported a favorable ustekinumab safety treatment profile for treatment of inflammatory bowel disease (IBD). We present the final cumulative safety data from pooled ustekinumab IBD phase 2/3 clinical studies through 5 years in Crohn's disease (CD) and 4 years in ulcerative colitis (UC). In phase 3 studies, patients received a single IV placebo or ustekinumab (130mg or ~6mg/kg) induction dose followed by subcutaneous maintenance doses of placebo or ustekinumab (90mg q8w or q12w). Analyses included all patients who received one dose of study treatment and included patients who were biologic-naïve and patients with a history of biologic failure. Safety outcomes are summarized and presented using number of events per 100 patient-years of follow-up and corresponding 95% confidence interval. In this final pooled safety analysis, 2575 patients were treated with ustekinumab with 4826 patient-years of follow-up. Rates of key safety events, including MACE and malignancies, were similar between placebo and ustekinumab or not higher for ustekinumab.Opportunistic infections, including tuberculosis, and malignancies were reported infrequently. Rates of key safety events in the IBD group were no higher in the ustekinumab group than in the placebo group for both patients who were biologic naïve or who had previously failed a biologic. No lymphomas or cases of posterior reversible encephalopathy syndrome (PRES; formerly known as reversible posterior leukoencephalopathy syndrome [RPLS] were reported. The final cumulative ustekinumab safety data through 5 years in CD and 4 years in UC demonstrated favorable safety compared to placebo and continues to support the well-established safety profile across all approved indications.

TLR4, IgA and EpCAM Expression in Colorectal Cancer and Their Possible Association with Microbiota as a Pathogenic Factor; An Immunohistochemical and Genetic Study.

The pathogenesis of inflammatory bowel disease (IBD) and colorectal cancer (CRC) is thought to be related to immune response against gut microbiota. TLR4, IgA, and EpCAM have a role in intestinal local immune response and their altered expression related to both IBD and CRC. Lipopolysaccharide (LPS) is the main activator of TLR4. The objective of this study is to evaluate the possible role of intestinal microbiota in the pathogenesis of IBD and CRC through expression of TLR4, IgA and EpCAM. One hundred five cases were divided into (Group 1/ Control: 10 sections of normal colonic mucosa, Group 2/CRC: 51 cases, Group 3/IBD: 44 cases). Immunohistochemistry for TLR4, IgA, and EpCAM was done. LPS was assessed in all groups. TLR4 gene and protein expression were assessed in colorectal cancer cell line by RT-PCR and immunocytochemistry. There was a significant correlation between TLR4 and tumor grade (P value 0.003 and 0.01 respectively). A significant correlation was found between IgA expression and T stage (P value 0.02) and between EpCAM expression and histologic type (P value 0.02). In comparison of CRC patients to controls; there was a statistically significant different expression of TLR4 positivity, IgA positivity and EpCAM (P value <0.001, 0.004, <0.001 respectively). Patients with CRC were compared to colitis patients and there was a statistically significant different expression of IgA positivity and EpCAM expression (P value <0.001). There was significant higher expression of TLR4 in CRC cell line than the fibroblast by both PCR and immunocytochemistry (P-value: 0.003 and 0.024 respectively). LPS level in CRC patients was significantly higher than the control and IBD groups (P values <0.001 and <0.001 respectively). TLR4, IgA, EpCAM expression in both CRC and IBD might be related to the pathogenic role of microbiota and could represent potential prevention modalities and therapeutic targets.

EXPLORING THE RELATIONSHIP BETWEEN PATIENT SYMPTOMS AND PROVIDER GOALS FOR MUCOSAL HEALING IN IBD: INSIGHTS FROM THE IBD QORUS SURVEY DATA

Abstract INTRODUCTION Patients with inflammatory bowel disease (IBD) often experience symptoms such as abdominal pain, diarrhea, and bloody bowel movements. While these symptoms traditionally guided treatment, their predictive value for disease progression is limited. The latest STRIDE-II guidelines recommend a comprehensive IBD management approach, with an emphasis on short-term symptom relief, intermediate-term biomarker normalization, and long-term achievement of endoscopic remission. This treat-to-target strategy necessitates collaboration between physicians and patients. Our study aims to investigate the relationship between patient-reported outcomes and physician efforts to achieve mucosal healing (MH) using IBD QORUS patient and provider survey data. METHODS This was a multi-center prospective study that used patient and provider matched survey data from the Crohn’s &amp; Colitis Foundation IBD QORUS program. Surveys completed between June 2021-October 2022 were analyzed. Univariate and multivariate analyses were performed to determine the relationship between severity of patient reported symptoms and frequency of MH assessment with modalities including endoscopy and fecal calprotectin, as well as to determine how symptoms and MH status influence treatment. RESULTS In total 5,460 paired patient and provider surveys (Crohn’s disease (CD), n=3,276; ulcerative colitis (UC), n=2,184) were included in the analysis. Demographic information including age, sex and steroid-free MH, as well as severity of patient-reported symptoms were similar between CD and UC patients (Table 1). Abdominal pain severity reported by both IBD populations significantly impacted plans for future endoscopy (CD, p=0.000019; UC, p=0.000055) but not for fecal calprotectin testing. Reported stool frequency in both IBD populations significantly impacted future endoscopy plans (CD, p=0.000001; UC, p=0.000001) and future fecal calprotectin testing (CD, p=0.000304; UC, p=0.000001). Reported blood in stool had no effect on MH assessment in CD patients whereas it significantly affected plans for endoscopy (p=0.000001) and fecal calprotectin testing (p=0.000001) in UC patients. Provider discussions regarding MH occurred with 82.4% of CD patients and 85.3% of UC patients, and treatment plans in those without steroid free MH were influenced by severity of symptoms (p=0.000001). DISCUSSION Patient reported symptoms influenced fecal calprotectin and endoscopy plans in both IBD groups. Similarly, severity of symptoms in those without steroid-free MH significantly affected treatment management. These findings suggest that target-based treatment for IBD is feasible in the clinical setting and holds the potential to enhance patient outcomes.

ASSOCIATION OF HIDRADENITIS SUPPURATIVA AND INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract INTRODUCTION Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin condition that affects apocrine gland-bearing areas. Previous studies have demonstrated that HS is potentially associated with various autoimmune diseases. However, the relationship between HS and inflammatory bowel disease (IBD) has been unclear. METHODS A comprehensive literature search was conducted in electronic databases, PubMed and Embase, from inception to October 2023. We included published studies that provided estimated effects with a 95% confidence interval (CI) or raw data. The quality of the selected studies was evaluated using the Newcastle-Ottawa Scale. Crohn's disease and ulcerative colitis were analyzed separately. Data from each study were combined using the random-effects model and the generic inverse variance method to calculate the pooled odds ratio (OR) with a 95% confidence interval (CI) and I2 statistics. RESULTS Ten case-control studies involving 26,496,569 individuals (110,648 with HS and 26,385,921 without HS) were included in this meta-analysis. HS was associated with significantly higher risk in the IBD group (Pooled OR 2.18; 95% CI 1.42-3.32; P = 0.0003; I2 = 97%). Additionally, our analysis demonstrated a significant association between HS and ulcerative colitis (Pooled OR 1.49; 95% CI 1.26-1.78; P &amp;lt; 0.00001, I2 = 63%) and between HS and Crohn's disease (Pooled OR 1.79; 95% CI 1.33-2.40; P = 0.0001; I2 = 88%). CONCLUSION Our meta-analysis demonstrated that HS is significantly associated with IBD and IBD subtypes (Crohn's disease and ulcerative colitis). This finding emphasizes the need for awareness when patients with HS present with symptoms associated with IBD. Further studies should be conducted to understand the mechanism of the gut-skin axis in shared immune and inflammatory processes.

P1045 Comparative Efficacy of Fecal Microbiota Transplantation for Clostridioides Difficile Infection in Patients with and without Inflammatory Bowel Disease: A Retrospective Cohort Study

Abstract Background Clostridioides difficile infection (CDI) significantly exacerbates and worsens the prognosis of inflammatory bowel disease (IBD). While fecal microbiota transplantation (FMT) is recognized as a safe and efficacious therapy for patients battling recurrent or refractory CDI, but comparative studies focusing on the success rates in IBD and non-IBD patients remain scarce. Our study aims to shed light on this gap in knowledge. Methods In this retrospective cohort study conducted at Chang Gung Memorial Hospital between April 2019 and February 2023, patients undergoing FMT via colonoscopy for recurrent or refractory CDI were enrolled. Participants were categorized into IBD and non-IBD groups based on their underlying conditions. We compared baseline characteristics and clinical outcomes at one-month and one-year follow-up intervals. CDI diagnosis was confirmed through positive CD toxin A/B genes and associated clinical symptoms. Donor specimens were sourced from Chang Gung Microbiota Therapy Center's fecal bank. Results Our study included 88 patients who received FMT, comprising 30 in the IBD group and 58 in the non-IBD group. The indications were recurrent CDI in 31 patients, refractory CDI in 54, and both conditions in 3 patients. Among the IBD subgroup, 20 patients had ulcerative colitis, and 10 had Crohn's disease. In the baseline comparison, the IBD group was significantly younger (mean±SD, 45.23±16.45 years vs. 61.90±24.40 years, P = 0.001) and had fewer comorbidities such as hypertension (10.0% vs. 55.2%, P &amp;lt; 0.001), diabetes mellitus (6.7% vs. 31.0%, P = 0.014), and cancer (3.3% vs. 31.0%, P = 0.012) than the non-IBD group. Additionally, the IBD group had less prior Fidaxomin use (6.9% vs. 26.3%, P = 0.021) and fewer HMG-CoA reductase inhibitor users (0.0% vs. 15.5%, P = 0.025). Post-FMT, IBD severity indices showed significant improvement at one month. The mean partial Mayo score in the IBD group decreased by 2.9 points, the endoscopic Mayo subscore decreased by 0.7 points, and the Crohn’s Disease Activity Index decreased by 79.98 points. At this time, the IBD group showed a similar percentage of negative CDI toxin A/B tests (83.3% vs. 63.8%, P = 0.174) but had lower clinical remission rates (79.5% vs. 96.5%, P = 0.006) compared to the non-IBD group. However, at the one-year follow-up, the eradication rate (94.4% vs. 73.9%, P = 0.112) and clinical remission rate (84.2% vs. 90.3%, P = 0.661) were comparable between both groups. No safety issues or adverse effects were reported in any of the patients. Conclusion FMT demonstrates safety and efficacy in treating recurrent or refractory CDI in both IBD and non-IBD patients, also aiding in mitigating IBD-associated inflammation.

P1233 Serum insulin is associated with c-reactive protein and gut microbial diversity in inflammatory bowel disease

Abstract Background Obesity, impaired glucose tolerance and unfavorable lipid profile are established risk factors for cardiovascular disease. Patients with inflammatory bowel disease (IBD) may be at increased risk of cardiovascular disease, and new therapies such as JAK inhibitors may further add to this risk. C-reactive protein (CRP) is a marker of systemic inflammation that may increase with active IBD and is correlated with metabolic risk in non-IBD cohorts. Diet, in particular consumption of ultra-processed foods, has been linked to gut dysbiosis and the onset, course, and response to treatment of both IBD and metabolic disease. The aim of this study was to identify metabolic risk in a cohort of individuals with IBD through an analysis of diet, metabolic parameters and stool microbial diversity. Methods This two-week prospective case-control study enrolled non-diabetic individuals with IBD in clinical remission and healthy individuals (HC). Baseline body mass index (BMI), waist circumference (WC) and waist to hip ratio, detailed diet diary, serum metabolic and inflammatory parameters, stool bacterial microbiota and faecal calprotectin (FC) were examined. Results Eighty-one participants; 57 with IBD (26 ulcerative colitis (UC), 31 Crohn’s disease (CD)) and 24 HC participants were recruited. In the IBD group, there was a positive correlation between serum insulin, triglycerides, BMI and WC with CRP and a negative correlation between HDL and CRP (Table 1). There were no associations between measured metabolic risk factors and FC. Stool microbial alpha diversity of the IBD group was lower than that of the HC cohort, with lower species richness (IBD 21.4 v HC 26.8, p&amp;lt;0.01) and Shannon’s diversity index (SDI) (IBD 3.1 v HC 3.4, p=0.03) (Figure 1). In the IBD group, there was a negative association between serum insulin and CRP with stool species evenness (SE) and SDI (insulin: SE r=-0.41, adj-p=0.02, SDI r=-0.39, adj-p=0.02; CRP: SE r=-0.4, p=0.02, SDI r=-0.4, p=0.02) and a negative association between intake of processed meat and stool alpha diversity metrics (SE r=-0.39, adj-p=0.046 and SDI r=-0.42, adj-p=0.02 respectively). There were no significant associations between serum metabolic profile and dietary intake with stool alpha diversity in the HC group. Conclusion Unhealthy diet, higher body weight and suboptimal glucose control were positively associated with CRP in participants with IBD. Gut microbiota with reduced diversity may be a common link between adverse metabolic outcomes and IBD. Serum insulin should be explored as a common biomarker of metabolic and gut microbial health.

P1163 Incidence and risk of hip replacement rate in patients with inflammatory bowel disease in Taiwan

Abstract Background The incidence and prevalence of inflammatory bowel disease (IBD) are low but increasing in Taiwan. Management of comorbidities such as osteoporosis is becoming increasingly important in treating patients with IBD. Hip fracture is the most serious consequence of low bone mineral quality and is associated with excess risk of mortality. The present study aimed to investigate the total/partial hip replacement in IBD patients in Taiwan. Methods In a matched nationwide cohort study, we evaluated the risk of total/partial hip replacement in IBD patients. We conducted univariable and multivariable Cox models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan-Meier curves were plotted to describe the cumulative incidence of hip replacement among the two cohorts. Results a total of 51,301 patients with IBD and 153,903 patients without IBD were included in this study. In Table 1, distribution of gender, age, comorbidities, and medications were similar between two cohorts (SMD&amp;lt;0.1), except stroke, renal insufficiency, steroid, 5-ASA and anti-osteoporotic agents. The mean (standard deviation) age was 51.00 (17.76) and 49.89 (16.85) years and the sex ratio between female and male was approximately 50% and 50% in two cohorts, respectively. As shown in Table 2, patients with IBD had a significantly higher risk of hip replacement than the control group (adjusted HR=1.11, 95% CI=1.03-1.19). For the sake of a visual picture of cumulative incidence of hip replacement, consider the graphic representation in Figure 1 (Kaplan-Meier plot). Compared to female individuals, male individuals had significantly lower risks of hip replacement (adjusted HR=0.73, 95%CI=0.68-0.78). Older patients had more risk of hip replacement. Individuals aged 40-59, aged 60-79, aged &amp;gt;79 had significantly higher risks of hip replacement (adjusted HR &amp;gt;1, p-value&amp;lt;0.05) compared to individuals aged 20-39. Table 3 showed that IBD patients who are females, aged 40-59, or steroid users tended to have a higher risk of hip replacement compared to individuals without IBD (adjusted HR &amp;gt; 1, p-value &amp;lt; 0.05). We further stratified different dose of steroid use in IBD and non-IBD cohorts in Table 4. IBD patients receiving different steroid doses did not show influence on the risk of hip replacement. We demonstrated no difference in the hospital days, mortalities and morbidities among patients with hip replacement in non-IBD and IBD cohorts in Table 5. Higher rate of GI bleeding in IBD group had a significant difference than non-IBD group.; Conclusion Our present results indicate that patients with IBD had an overall higher total/partial hip replacement in Taiwan.

P379 PD-1-positive cells contribute to the diagnosis of Inflammatory Bowel Disease and can aid in predicting response to vedolizumab

Abstract Background Differentiating inflammatory bowel disease (IBD) from other inflammatory diseases is often challenging. Programmed cell death protein-1 (PD-1) is expressed in T cells and is an indicator of their exhaustion. The role of PD-1 expression in diagnosing IBD and predicting the response of biologic agents remains inconclusive. Methods In this study, endoscopic biopsy samples of 19 patients diagnosed with IBD and other inflammatory diseases were analysed using multiplexed immunohistochemistry . Other inflammatory diseases comprised five patients with intestinal tuberculosis, and five with intestinal Behçet’s disease. Additionally, a separate prospectively maintained "vedolizumab (VDZ) cohort", established in 12 ulcerative colitis(UC) patients who underwent endoscopic biopsy before VDZ administration was analysed to predict response to VDZ. Results In the immunohistochemistry analysis, the cell density of T cell subsets, including helper T cell (Th), cytotoxic T cell (Tc), regulatory T cell (Treg), PD-1+ cell, PD-1+ Th, PD-1+ Tc, and PD-1+ Treg was investigated and compared between IBD and other inflammatory disease. Cell densities of PD-1+ cells (p=0.028), PD-1+ Th (p=0.008), and PD-1+ Treg (p=0.024) were higher in IBD compared with other inflammatory disease.(Figure 1) In addition, the proportion of PD-1+ cells in Th and Treg was higher in the IBD group than in the other inflammatory disease group (median 7% vs. 3%, p=0.008; median 6% vs. 2%, p=0.004, respectively). Comparing within IBD, the cell density of Treg was higher in Crohn’s disease(CD) than in UC (p=0.042), whilst the cell density of Tc was higher in CD than in UC with marginal statistical significance (p=0.066). In the VDZ cohort, patients with a 14-week steroid-free clinical response had higher levels of PD-1+ cells (p=0.026), PD-1+ Th (p=0.026), and PD-1+ Treg (p=0.041) than the no response group.(Table 1) Conclusion We explored the relationship between PD-1 expression and IBD using multiplexed immunohistochemistry. We compared IBD and other inflammatory disease in their expression of various immune cells including PD-1+ cells, and found IBD had higher PD-1 expression, as well as higher PD-1+ Th and PD-1+ Treg compared with other inflammatory diseases. In addition, VDZ-responsive patients had higher PD-1 expression. Our study confirmed the difference in PD-1 expression in IBD and other inflammatory diseases and revealed that PD-1 expression could be a predictive marker for VDZ responsiveness.

P158 Expression of IL-19 and IL-24 in intestinal mucosa of inflammatory bowel disease: An immunohistochemical study

Abstract Background Interleukins are considered as targets for future inflammatory bowel disease ( IBD) treatments. IL-19 and IL-24 are members of IL-10 family and through the JAK-STAT pathway induce proinflammatory cytokine production. A retrospective single center study was performed to study the IL-19 and IL-24 expression in 121 patients with moderate to severe IBD, before and after treatment with biologics. Methods A retrospective study of 121 patients with moderate to severe IBD was performed using immunochemistry between 1999 and 2017. This study included 72 patients with Crohn's disease (CD), 49 with Ulcerative Colitis (UC) and 20 healthy controls. The age, gender, disease extent, severity and treatment choice were recorded. Endoscopy reports before and after 12 months of treatment were retrieved. Intestinal biopsy samples were retrieved from the Histopathology Lab before and 1 year after treatment with biologics. A signed consent was received from all the patients involved and the study was approved by the Bioethics Committee of Aristotle University of Thessaloniki. The histological specimen were stained for IL-19 and IL-24 before and one year after treatment with biologics. The results were analysed using SPSS for each of the IBD groups (CD, UC) and further to subgroups depending the biologic treatment they received, anti-Tumor Necrosis Factor alpha(anti-TNFa), Vedolizumab (VDZ), Ustekinumab (USK). Results A statistically significant increase was found in IL-19 and IL-24 patients in IBD patients versus healthy controls (P&amp;lt;0.05). On the biologics treated group and the anti-TNFa subgroup, there was statistically significant increase in IL-24 expression post treatment (P&amp;lt;0.01). In UC patients, the IL-24 expression was significantly increased after a successful treatment in relation with Mayo score ( P&amp;lt;0.01). On the CD group, a reverse statistically significant correlation was found between the pre-treatment IL-19 expression and the Harvey Bradshaw Index (H.B.I.) score reduction in the anti-TNFa and the VDZ subgroups (p&amp;lt;0.05). Conclusion A possibly proinflammatory role of IL-19 was found on the CD group. This can be used as a tool in the future to assess the disease activity and support the diagnosis as a diagnostic biomarker, as IL-19 was found normal in healthy controls. An anti-inflammatory role of IL-24 was found especially in the UC group and in relation with the activity index score post-treatment. This can be used potentially as a marker of response to treatment in active UC, assisting the clinical management. Further research is needed to delineate the exact role of these interleukins in intestinal inflammation.

P346 Assessing Brain Morphology in Functional Gastrointestinal and Inflammatory Bowel Disorders Using Functional Magnetic Resonance Imaging (fMRI)

Abstract Background Functional gastrointestinal disorders (FGIDs) and non-specific inflammatory bowel diseases (IBD) are increasingly common in young adults. Studies have shown abnormal interhemispheric interactions in FGIDs and altered Default Mode Network (DMN) connectivity in brain regions linked to gastric sensations and emotional regulation. This study explores these neural mechanisms in FGIDs and IBDs, focusing on chronic visceral pain and its association with DMN reorganization. Methods The study included patients with functional dyspepsia (FD), N=18; irritable bowel syndrome (IBS), N=20 and IBD, N=18 alongside a control group of 18 healthy volunteers. Selection criteria included the Rome III Criteria for FGIDs and various diagnostic tests for IBDs. MRI scans were conducted using a 3T Achieva TX Scanner, applying standard T1 and T2 sequences without contrast agents. Functional imaging utilized T2 Gradient Echo-Planar Imaging. Results DMN analysis showed no anterior-posterior split. Significant differences were observed in the IBD group compared to controls, particularly in the left superior frontal gyrus. When comparing all patient groups with controls, increased DMN connectivity was noted in the left cingulum and supplementary motor area. These areas were also significant when comparing only FGIDs patients with controls, indicating altered DMN connectivity in these disorders. Please see: Figure 1 and Table 1. Conclusion The study highlights differences in DMNs between patient and control groups, especially in the left superior frontal gyrus, left cingulum, and left supplementary motor area. All disease groups showed variations from controls in the DMN pattern within the left cingulum. Significant differences in the DMN of the supplementary motor area were observed in functional gastric disease groups compared to controls. These findings suggest a link between brain areas involved in sensorimotor processes and symptoms of FD and IBS, providing insights into the neural basis of these conditions. Despite varied changes, common features differentiating the entire study group from healthy controls were identified. This condensed version focuses on the key aspects of your original text, ensuring that the main findings and methodology are clearly presented within the character limit.

Habitual Dietary Intake and Adherence to Dietary Guidelines of Patients with Inflammatory Bowel Diseases

Inflammatory bowel disease (IBD) belongs to a group of autoimmune conditions characterized by chronic inflammation and mucosal ulceration of the gastrointestinal tract. The etiology of IBD is complex. The etiological factors include environmental factors, among which diet is important. The aim of this study was to evaluate the diet of IBD patients. This case–control study was carried out on 82 patients with IBD; the control group consisted of 80 clinically healthy subjects. Food intake was assessed using a 24 h recall and frequency food questionnaire. Energy intake in the IBD group was insufficient and significantly lower than in the control group. The energy intake in the group of patients with active IBD was significantly lower than in the group of subjects in remission. The total fat and protein intake was significantly lower in the IBD group compared to the healthy subjects. IBD patients were characterized by underconsumption of all food groups analyzed, except for the intake of red meat and poultry. Our study showed inadequate intake of energy and most nutrients in IBD patients, even during the remission period. The study indicates the need for routine assessment of dietary intake and nutrition among IBD patients, as well as potential dietary interventions aimed at improving the energy and nutritional quality of diet in order to optimize treatment outcomes and prevent the development of accompanying diseases.

The Potential Association Between Inflammatory Bowel Diseases and Apical Periodontitis: A Systematic Review and Meta-Analysis.

Recent literature has suggested a potential association between inflammatory bowel diseases (IBD) and apical periodontitis (AP). The present systematic review and meta-analysis sought to analyse and appraise the available evidence regarding the reported association. Following 2020 PRISMA guidelines, a comprehensive search of multiple online databases (PubMed, Scopus, Web of Science, and Google Scholar) was conducted for all relevant studies published from the date of inception until 27 April 2023 using various relevant keywords. All observational studies that assessed the association between IBD and AP in humans were eligible for inclusion. The quality of the selected studies was carried out independently by two reviewers, and meta-analysis was performed using Comprehensive Meta-Analysis Version 2.2.064. Six studies (five case-control studies and one cohort study) were included. A total of 657 patients (277 with IBD) were included in 5 case-control studies, and 48,223 subjects (35,740 with AP) were included in the cohort study, where 188 developed IBD on follow-up. The pooled data from the five case-control studies revealed that IBD was significantly associated with a higher risk of AP (OR=1.71, 95% CI: 1.21-2.42; I2=10.337%, fixed-effect, p=0.002). The qualitative analysis also showed that most of the included studies found a higher mean number of teeth with AP in IBD groups than the healthy controls. Newcastle-Ottawa Scale (NOS)-based quality appraisal results demonstrated that five studies were of high quality, and one was of moderate quality. The results suggest a potential association between IBD and AP. Large-scale and prospective studies are required to further confirm and elucidate the nature of such an association.

Fyzická aktivita detských pacientov s nešpecifickými črevnými zápalovými ochoreniami – výhody a limitácie

Summary: Introduction: Inflammatory bowel diseases (IBDs) are a group of diseases including Crohn’s disease, ulcerative colitis and unclassified IBD. They are chronic, immune-mediated inflammatory diseases of the gastrointestinal tract. Due to their extraintestinal manifestation, they are considered to be systemic diseases. IBD has a negative impact on health-related quality of life. The treatment is life-long and may be accompanied by side effects. Low-intensity activity of moderate duration is sufficient to elicit improvements in fitness, decrease stress, and improve symptoms. In this study, the relationship between physical activity and IBD development and course is described. Aims: To assess the relationship between physical activity and exercise capacity and the severity and course of IBD. Methods: Probands with IBD and healthy controls underwent pulmonary function testing (PFT) and cardiopulmonary exercise testing (CPET). The results were compared between these two groups; in the IBD group, the results were correlated with disease activity parameters as well. In the IBD group, the probands were encouraged to perform regular physical activity. After 0.5–1 year, they underwent another CPET. Their exercise capacity development was objectively assessed and it was correlated with their IBD development. Results: Forty-one children were included in the study. Twenty of them were healthy controls, while 21 comprised the IBD patient group. These probands underwent the PFT and CPET. When comparing healthy controls and IBD patients, significant differences were found in peak oxygen uptake and peak work rate. In the IBD group, a negative correlation was found between peak work rate and C-reactive protein concentration. In faecal calprotectin, a significant correlation was found only in the subgroup with ulcerative colitis – the negative correlation with peak oxygen uptake and partial pressure of CO2 in exhaled air in the peak of the exercise. PCDAI correlated positively with ventilatory index, peak dead space and tidal volume ratio but negatively with peak work rate, work rate at the time of anaerobic threshold, peak oxygen uptake and oxygen uptake efficacy slope. In PUCAI, we found a positive correlation with CO2 ventilatory uptake at the time of anaerobic threshold and negative correlations with peak oxygen uptake and oxygen uptake efficacy slope. In further CPET in the IBD group, a significant decrease was found in faecal calprotectin and PCDAI or PUCAI; there were also positive correlations between PCDAI/PUCAI changes and resting heart rate changes. The negative correlation was found in the correlation with the changes in peak oxygen uptake, metabolic index and ventilatory equivalent for CO2 at the time of anaerobic threshold. Conclusion: These results suggest that regular recreational physical exercise positively impacts IBD. When adhering to treatment recommendations, doing sport professionally is also possible. Key words: inflammatory bowel diseases – physical activity

Inflammatory Bowel Disease and Irritable Bowel Syndrome: What Differences in Mentalization Abilities? A Scoping Review

Mentalization is a psychological process that enables individuals to understand the self and others in terms of intentional mental states. The aim of this scoping review was to provide an overview of the findings on mentalization in patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). A literature search, in line with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols extension for Scoping Review guidelines, was conducted in the following bibliographic databases: PubMed, PsycINFO, and Scopus. Databases were queried using the following strings (with Boolean operators): (“mentaliz*” OR “metacogniti*” OR “theory of mind” OR “ToM” OR “reflective function*”) AND (“irritable bowel syndrome” OR “IBS” OR “inflammatory bowel disease” OR “IBD”). In line with the eligibility criteria, seven articles were included. Results showed that no significant differences in metacognitive ability were found between patients in the IBD and IBS groups. This review revealed the mentalizing difficulties for patients with IBD and IBS. These results should be interpreted with caution since they are based on a few studies that used different instruments to assess mentalizing processes. Future studies are needed to clarify the role of mentalization in patients with these gastrointestinal conditions.

Abstract 13363: Echocardiographic Coronary Flow Velocity Parameters in Assessing Sub-Clinical Atherosclerosis in Inflammatory Bowel Disease Patients: A Meta-Analysis

Introduction: Chronic inflammatory diseases are linked to atherosclerosis and cardiovascular events. However, there are conflicting results in the literature regarding differences in echocardiographic Coronary Flow velocity parameters, which serve as markers of subclinical atherosclerosis, between inflammatory bowel disease (IBD) patients and healthy controls. Hypothesis: We aim to assess the Coronary Flow Velocity Reserve (CFVR), baseline Diastolic Peak Flow Velocity (DPFV), and hyperemic DPFV in IBD patients. Methods: We conducted a systematic search of databases, from January 1, 2014, to June 1, 2023, to gather relevant studies. The pooled mean differences in various parameters between IBD patients and controls were calculated using the standard mean difference with 95% confidence interval (CI), and random effect model was used when heterogeneity (I 2 ) crossed 50%. Results: 4 studies with 342 participants were included. The mean age of the IBD group was 39.25 years and of the control group was 41.25 years. Male comprised 51.46% of the study participants. IBD patients had a significantly lower CFVR (SMD; -1.12 95%CI; [-1.62, -0.61], p-value&lt;0.01) and hyperemic DPFV (SMD; -0.68, 95%CI [-1.09, -0.27], p-value&lt;0.01) than healthy controls. Whereas, Healthy controls had a lower baseline DPFV (SMD; 0.69 95%CI; [0.35, 1.04], p-value&lt;0.01) than the IBD group. Conclusions: IBD was associated with Coronary Microvascular Disease assessed as impaired CFVR and hyperemic DPFV. This suggests reduced myocardial perfusion in IBD patients and the need for regular cardiovascular risk assessment and targeted interventions to mitigate the increased risk of cardiovascular events.

Serum Anti-Spike Antibodies Are Not Affected by Immunosuppressants in SARS-CoV-2 Vaccinations Given to Brazilian Patients with Inflammatory Bowel Disease.

This study aimed to evaluate humoral responses after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of patients with inflammatory bowel disease (IBD). Patients with IBD enrolled in a tertiary outpatient unit were followed up between September 2021 and September 2022 via serial blood collection. Immunoglobulin G antibody titers against SARS-CoV-2 were measured before administration and 1 and 6 months after the administration of two doses of different vaccination regimens. The results were compared with those of a healthy control group obtained during the same period. The mean pre-vaccination antibody titers were 452.0 and 93.3 AU/mL in the IBD (n = 42) and control (n = 89) groups, respectively. After two doses of the vaccine, the titers significantly increased in both groups (IBD, 8568.0 AU/mL; control, 7471.0 AU/mL; p < 0.001). One month after the second dose, no significant differences were observed between the two groups (p = 0.955). Significant differences between vaccination schemes in the IBD group were observed, with higher titers in those who received Pfizer, younger patients (p < 0.005), and those with a previous coronavirus disease 2019 (COVID-19) infection (p < 0.012). The use of immunosuppressants and immunobiologicals did not affect the overall humoral response to COVID-19 vaccine in patients with IBD, but specific vaccine regimens, age, and previous coronavirus infection significantly did. This study reinforces the positive impact of booster doses and the safety of SARS-CoV-2 vaccination.