Manifestations Of Inflammatory Bowel Disease Research Articles

P1266 Gender Influence on Cutaneous Manifestations in IBD: A Focus on Contraceptive Use

Abstract Background Inflammatory bowel disease (IBD) encompasses disorders characterized by chronic relapsing intestinal inflammation, often accompanied by extraintestinal manifestations, including skin involvement. The relationship between gender and cutaneous manifestations in IBD remains debated. This study aims to analyze the association between gender, contraceptive use, and the occurrence of cutaneous manifestations in IBD patients. Methods This retrospective study, conducted over eight years from January 2016 to December 2023, included IBD patients. Dermatological lesions (excluding anoperineal lesions) were diagnosed by dermatologists through clinical examinations, cultures, and biopsies as needed. Data were extracted from medical records and analyzed using SPSS version 21.0. Results A total of 273 IBD patients with a median age of 41 years (range 15–72, SD ±13). Females accounted for 51.6% (n = 141). Cutaneous manifestations were observed in 89 patients (32.6%), with a median age of 39 years (range 15–70, SD ±13) and a female-to-male ratio of 1.02. Among these 89 patients, 45 (31.9%) were female, with no significant gender association (P = 0.8). Of the 141 female patients, 18 (24.7%) were using contraception and exhibited cutaneous manifestations, showing a significant association (P = 0.05). Regarding disease type, 62 patients (35.4%) had Crohn's disease, while 27 (27%) had ulcerative colitis, with no significant difference in cutaneous manifestations between the groups (P = 0.18). Different subtypes of cutaneous manifestations included: •Reactive lesions: 32 patients (11.7%), with 19 (13.5%) female (P = 0.6). •IBD-associated lesions: 36 patients (13.2%), with 20 (14.2%) female (P = 0.61). •Treatment-related mucocutaneous lesions: 48 patients (17.6%), with 26 (18.4%) female. •Nutritional malabsorption-related lesions: 28 patients (10.3%), with no significant gender association (P = 0.32). Notably, erythema nodosum was found exclusively in females (n = 5, 1.8%), showing a significant gender association (P = 0.02). Psoriasis occurred in 12 patients (4.4%), with 4 (3%) female, which was not significant (P = 0.19). Aphthous stomatitis affected 23 patients (8.4%), with 14 (9.9%) female (P = 0.35). Pyoderma gangrenosum and vitiligo were rare, with no notable gender disparities. Conclusion This study highlights the complex relationship between gender and skin manifestations in IBD, showing a significant association between erythema nodosum and females, as well as a link between contraceptive use and skin issues. These findings suggest the need for further research into the hormonal and immunological factors involved. Adopting gender-specific strategies in managing IBD-related skin manifestations could improve patient outcomes and inform clinical practice.

P1305 Prediction of extraintestinal manifestations in inflammatory bowel disease using clinical and genetic variables with machine learning

Abstract Background Patients with inflammatory bowel diseases (IBD) may develop extraintestinal manifestations (EIM) that increase their morbidity. We investigated clinical and genetic factors associated with EIM, analyzing an IBD cohort between 2019-2024. We designed predictive models for EIM using machine learning techniques. Methods A total of 414 IBD patients were recruited (314 UC and 100 with CD). The presence of EIM was assessed, and clinical differences between the groups with and without EIM were analyzed using Chi-square tests and Mann-Whitney U tests. In a subset of 227 genotyped patients, genetic variants associated with EIM were identified, and a polygenic risk score (PRS) was calculated. Logistic regression (LR) and Random Forest (RF) predictive models were constructed. Furthermore, univariate/multivariate regression analyses were conducted to confirm associations with EIM. Results Clinical data from 414 patients were analysed, of which 29% (120) had EIM (Figure 1). Of these, 69% (83) had ulcerative colitis (UC). Meanwhile, 294 (71%) did not have EIM, of whom 231 (78.6%) had UC. Significant differences were observed between the groups with and without EIM: median age (45 vs. 52 years, p=0.01), BMI (26 vs. 27, p=0.006), and ESR (9 vs. 10, p=0.01). Categorical variables like family history of IBD (p=0.02) and anti-TNF use (p=0.01) were significant. In genotyped group, 50 of 200 genetic variants were linked to EIM, with 2 significantly increasing EIM risk: rs44107871-TC (PVT1 gene), three-genotype model; OR = 1.89, CI = 1.06-3.41, p-value = 0.03 and rs9936833-C (LINC917, FENDR gene) recessive model OR 2.29, CI = 1.16-4.55, p-value = 0.02, dominant-C model OR 1.86, CI 1.01-3.49, p-value = 0.04, additive-CC model OR = 3.01, CI 1.36-6.80 (p=0.007). The PRS was not discriminative, with an AUC of 0.67 and an accuracy of 0.56. In contrast, the LR and RF models better differentiated groups with and without EIM (Figure 2). Both in EIM univariate and multivariate analyses, significant associations were found with the variables rs9936833TT (univariate: OR=0.33, 95% CI=0.15-0.74, p=0.007; multivariate: OR=0.25, 95% CI=0.10-0.61, p=0.003), family history of IBD (univariate: OR=3.42, 95% CI=1.52-7.76, p=0.002; multivariate: OR=3.86, 95% CI=1.59-9.37, p=0.002), use of anti-TNF (univariate: OR=3.18, 95% CI=1.14-7.19, p=0.005; multivariate: OR=5.18, 95% CI=1.96-13.7, p=0.0009), age (univariate OR: 1.02, 95% CI 1.0-1.04, p=0.03, multivariate OR=1.03, 95% CI 1.00-1.06, p=0.01). Conclusion About third of IBD patients had EIM, as reported. Variants rs9936833 and rs4410871 were linked to higher EIM risk. While PRS had limits, LR and RF models predicted EIM well. Family history of IBD, rs9936833-CC, age, and anti-TNF use were significant risk factors. References Khrom M, Long M, Dube S, et al. Comprehensive Association Analyses of Extraintestinal Manifestations in Inflammatory Bowel Disease. Gastroenterology. 2024;167(2):315-332. doi:10.1053/j.gastro.2024.02.026 Gordon H, Burisch J, Ellul P, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2024;18(1):1-37. doi:10.1093/ecco-jcc/jjad108

P0887 Through the lens of inflammatory bowel disease: Impact of rheumatological involvement on disease course

Abstract Background Inflammatory bowel diseases (IBD) are systemic disorders that may be associated with extraintestinal manifestations in up to 40% of patients. Recognizing the recurrent emergence of these manifestations in IBD, with a particular emphasis on rheumatological aspect, becomes a pivotal focal point for a holistic therapeutic approach. The aim of this study was to evaluate the impact of ankylosing spondylitis in IBD on disease course Methods We conducted a retrospective and comparative study, including patients followed for IBD over an 8-year period [2014 - 2022]. Clinico-biological data, disease severity, and long-term outcomes (surgery and disease course) were collected. IBD patients with ankylosing spondylitis (group1) and patients without (group2) were compared. Results One-hundred IBD patients were enrolled with a sex ratio of M/F=2.44 and a mean age of disease diagnose of 37.26±13.46 years. Eighteen patients had ankylosing spondylitis (18%). The two groups were comparable in terms of age at disease onset, gender, smoking status and family history of IBD (p=0.65; p=0.9, p=1 and 0.1 respectively). In Crohn's disease, there was no difference between the two groups regarding the extent of the disease (p=0.71), the presence of upper gastro-intestinal tract involvement (p=0.11) and perineal manifestations (p=0.7). Inflammatory, structuring, and penetrating phenotypes were also comparable between the two groups (p=0.67; p=0.3; p=1 respectively). However, the occurrence of acute intestinal obstruction was significantly more common in ankylosing spondylitis patients (G1:54% vs. G2:10%; p=0.004). As for ulcerative colitis, extensive presentation and the occurrence of disease extension during follow-up was comparable between the two groups (p=0.78 and p=0.66). None of the patients with or without rheumatological involvement had any dermatological or ophthalmological involvement related to IBD, but there was a more significant prevalence of hepatic manifestations in ankylosing spondylitis group (G1:16% vs. G2:2%, p=0.01). The mean number of flare-ups was not significantly different between the two groups (G1:3.21±1.47 vs. G2:2.53±1.4; p=0.06). Regarding treatment, recourse to methotrexate (G1:16% vs. G2:2%; p=0.01) and the use of anti-TNF agents (G1:77% vs. G2:22%; p<0.001) was more frequent in group 1, with no difference in the occurrence of adverse events (p=1), the use of corticosteroids (p=0.22) or azathioprine (p=0.1). Surgical treatment was more frequently indicated in ankylosing spondylitis patients (G1:51% vs. G2:30%; p=0.06) with comparable post-operative relapse of Crohn's disease (p=1). Conclusion In our study, rheumatological involvement was not likely responsible of a more severe clinical phenotype of IBD.

P1235 COlombian PrevaLence of Extraintestinal Manifestations in Inflammatory bowel disease in an adult and pediatric cohort after evaluation by a multidisciplinary group COLEMI – study

Abstract Background Inflammatory Bowel Disease (IBD) is increasingly recognized as a systemic disorder, given its high prevalence of extra-intestinal manifestations (EIM) affecting various organs. The frequency of these manifestations varies depending on factors such as geographical region, IBD subtype, disease location, disease duration, and the timeliness of diagnosis, yet data on this topic remain limited in Latin America. This study aimed to assess the prevalence of the primary EIMs in IBD patients in Colombia, as well as to examine differences between Crohn's disease (CD) and ulcerative colitis (UC). Methods Prospective observational descriptive multicenter study in adult and pediatric patients with IBD of the Colombian IBD Foundation, with suspicious of EIM and after confirmed with by a multidisciplinary group in Colombia. Results A total of 266 out of 482 (55.1%) patients with inflammatory bowel disease (IBD) were suspected of having extra-intestinal manifestations (EIM) by their gastroenterologists, of which 197 (74.1%) were confirmed upon evaluation by a multidisciplinary team, resulting in an EIM prevalence of 40.9%, with a predominance of female patients (67.5%). Of the cohort, 95% were adults and 5% were pediatric patients, with 134/197 (68%) diagnosed with ulcerative colitis (UC) and 63/197 (32%) with Crohn's disease (CD), 49.2% of whom required biologic therapy. In UC patients, extensive colitis (E3) was the most common disease extension, while ileo-colonic (L3) involvement predominated in CD. The most frequent types of EIM were articular (36%), followed by cutaneous (34.5%) and ocular (24.9%) manifestations. The hospitalization rate due to IBD was 72.5%, with EIM present in 37.5% of UC patients and 52.5% of CD patients (Figure 1). Hepatobiliary manifestations (odds ratio [OR] = 1.931; 95% confidence interval [CI] 0.4311-13.66, p=0.44) were more common in UC compared to CD, whereas articular (OR=2.277; 95% CI 1.228-4.22), cutaneous (OR=1.027; 95% CI 0.5474-1.925), oral (OR=2.017; 95% CI 0.8727-4.661), and ocular (OR=2.683; 95% CI 1.374-5.23) manifestations were more frequent in CD (Figure 1). In terms of the number of EIMs, 71.5% of UC patients had one, 16% had two, and 12.5% had three or more, while in CD, 50.7% had one, 27% had two, and 22.2% had three or more. A higher prevalence of EIM was observed in the central region of the country (Figure 2). Conclusion The prevalence of EIM in this Colombian cohort was high (40,9%), predominating the CD, female, extensive disease and higher requirement for biologicals.

P0728 Interventions for ocular extraintestinal manifestations in inflammatory bowel disease: an umbrella review of systematic reviews

Abstract Background A significant proportion of patients with inflammatory bowel disease (IBD) develop extraintestinal manifestations (EIM). Ocular involvement occurs in an estimated 12–25% of ulcerative colitis cases and 25–50% of Crohn’s disease cases, making it the third most common EIM after rheumatological and dermatological manifestations. There is limited information on treatment options for ocular EIM. To address this gap, we reviewed all systematic reviews (SRs) evaluating drug interventions for ocular EIM. Methods We searched three databases (MEDLINE, Embase, and the Cochrane Database of Systematic Reviews) from inception to May 2024 to identify SRs addressing therapeutic interventions for ocular EIM. The exclusion criteria ruled out studies that were not systematic reviews, did not focus on patients with IBD, or were unrelated to ocular interventions. Screening, selection, and data extraction were performed independently by two authors, with a third author consulted when necessary. The quality of SRs was assessed using the AMSTAR-2 tool. Results Of 1,436 studies, six met the inclusion criteria. The ocular EIMs most commonly reported included uveitis, iritis, scleritis, and episcleritis. The number of studies reporting ocular EIM within each SR varied from two (Guillo, 2021) to 22 (Peyrin-Biroulet, 2017). Therapeutic interventions differed: two SRs evaluated vedolizumab (Zheng, 2024; Chateau, 2019), one focused on ustekinumab (Guillo, 2021), while the others assessed different advanced therapies. Quality assessment using AMSTAR-2 rated the reviews from high to low confidence, with most achieving moderate confidence due to some non-critical weaknesses. The incidence of new ocular EIM after treatment was 1% for both vedolizumab and ustekinumab in two SRs. For existing EIM, ocular symptoms improved in 55–59% of cases with ustekinumab (data from two SRs). However, there was no consistent evidence supporting vedolizumab for treating established ocular EIM. Anti-tumor necrosis factor (TNF) drugs were evaluated in two SRs, showing benefits for most patients with ocular manifestations without notable differences in the effectiveness among the different anti-TNF agents. No SRs focused on the risk of new ocular EIM after starting anti-TNF therapy. Conclusion Infliximab, adalimumab, certolizumab and ustekinumab appear effective for ocular EIM. There is no strong evidence that vedolizumab is effective for treating existing ocular EIM, though it may reduce the occurrence of new EIM. Further research with clear definitions and systematic assessments of ocular manifestations is needed. A multidisciplinary approach remains crucial. References Licona Vera E, Betancur Vasquez C, Peinado Acevedo JS, Rivera Bustamante T, Martinez Redondo JM. Ocular Manifestations of Inflammatory Bowel Disease. Cureus. 2023;15(6):e40299

P0458 The burden, risk factors and laboratory evaluation of anemia in patients with Inflammatory Bowel Disease

Abstract Background Anemia is the most common extraintestinal manifestation in inflammatory bowel disease (IBD) (1). The laboratory evaluation and determination of anemia in IBD remains challenging (2). The aim of this study was to evaluate the burden, risk factors and types of anemia in IBD patients in Crete. Methods This is a cross sectional study where consecutive IBD patients were included. Demographic, clinical and laboratory data [Hemoglobin (Hgb), Ferritin (Fer)] were recorded (based on an updated IBD registry) while serums of consecutive IBD patients were collected and Soluble transferrin receptor (sTFR), sTFR Index and Hepcidin (Hepc) were measured. Results A total of 151 [69 (45.7%) females, 90 (59.6%) with Crohn’s Disease (CD), 34 (22.5%) anemic and 117 (77.5%) non-anemic] were included. Anemic patients were found to be less frequently smokers (P=0.0182), to have shorter IBD duration (P=0.0112) and more often active disease (P=0.0270) compared to non-anemic IBD patients. No other significant differences in clinical and demographic characteristics were found. In addition, they had significantly lower Hgb, MCV [11.6 (10.7-12.4) vs 14.1 (13.3-15), 80.3 (78.4-85.8) vs 90.6 (86.5-94.5) respectively, both P< 0.0001], Ferritin [35.5 (8.2-69) vs 60 (33-112), P=0.0164], and higher RDW, ESR, sTFR [16.2 (14.9- 17.8) vs 14.2 (13.5-15), 27 (12.5-45) vs 9.5 (8.5-15), 1.85 (1.33-2.67) vs 1.22 (1.02-1.52) respectively, all P<0.0001], CRP [0.6 (0.2-2.5) vs 0.3 (0.1-2), P=0.0028] and sTFR Index [1.14 (0.75-3.10) vs 0.68 (0.55-1.03), P=0.0002)]. In terms of risk factors for anemia development younger age (OR 1.04, CI95% 1.02-1.07), smoking (OR 0.22, CI95% 0.06-0.80) and higher ESR (OR 1.04, CI95% 1.02-1.07) were found to be significant in the multivariate analysis. From the anemic patients (N=34), 17 had iron deficiency (IDA) and the rest non-IDA (anemia of chronic disease and mixed). Patients with IDA compared to non-IDA had significantly higher sTFR and sTFR Index while no difference was found in Hepc (Table 1). sTFR >1.68 mg/l had sensitivity of 76.5% and specificity of 73.3% while sTFR Index >1.1365 has sensitivity 82.4% and specificity 86.7% for IDA diagnosis suggesting that sTFR Index is the most accurate index for IDA diagnosis in IBD patients (Figure 1). Conclusion One out of 5 IBD patients have anemia in our cohort. Risk factors for anemia are the age, smoking status and ESR. sTFR and especially sTFR Index could be useful for true IDA diagnosis in IBD patients in the presence of chronic inflammation.

P0591 Janus Kinase Inhibitors Improve Liver Biochemistry in Patients with Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: an ECCO CONFER Study.

Abstract Background JAK inhibitors (JAKi) can induce and maintain remission in inflammatory bowel disease (IBD). Around 5% of IBD patients develop primary sclerosing cholangitis (PSC). Given the potential involvement of JAK/STAT signaling in PSC pathogenesis, JAKi may have a role in modulating IBD-related PSC. We aim to explore the course of PSC in IBD-PSC patients on JAKi for IBD. Methods Following a call-for-cases via ECCO CONFER (Round 10), we retrospectively collected baseline and outcome data for both PSC and IBD, before and after JAKi treatment, including laboratory tests, imaging and endoscopic findings, histopathology and adverse effects. The data were analyzed both descriptively and comparatively. A p-value of less than 0.05 was considered statistically significant. Results We collected data from 58 patients (53 ulcerative colitis), with a median of disease duration of 5.5 (IQR 2-9) years (Table 1). The median age at PSC diagnosis was 26 (18.25-40.5) years. Each patient had been treated with a median of 2.5 different types of drugs before starting JAKi; 57% received tofacitinib, 26% upadacitinib, 17% filgotinib. At the time of data analysis, the median time of JAKi exposure was 32 (15.75-69) weeks and we will refer to that median time of exposure when analysing each data related to JAKi exposure. At baseline, alkaline phosphatase (ALP) was elevated in 71% of patients (median, 292 U/L, 185-471). After JAKi exposure, ALP dropped to a median of 203.5 U/L (138.7-394.5), p=0.0004. Among this specific group, 30% of subjects reached normal ALP values. Gamma-glutamyl transferase (GGT) was elevated in 80% of patients (350 U/L, 164-552) and dropped to a median value of 127 U/L (95-270), p=0.0055; 13% of this specific group reached normal values of GGT after JAKi exposure. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were high in 58% and 50% of patients, respectively; following JAKi exposure, the median value of both went down significantly. After a median time of 32 weeks of JAKi treatment, 39,6% of patients had to change therapy: 23% due to primary non-response, 62% due to lack of response, 15% underwent colectomy. Patients who had to change therapy were divided into: switch group, treated with additional 40 (36-46) weeks with a different JAKi; swap group, swapped to biologic for additional 27 (24-40) weeks. Better control of liver biomarkers was observed in the switch group (Figure 1). Conclusion Treatment with JAKi can positively impact liver inflammation in terms of cholestasis and cytolysis indexes in patients with PSC and concomitant IBD. References Schregel I, Ramos GP, Ioannou S, Culver E, Färkkilä M, Schramm C; International PSC Study Group. Evaluation of Tofacitinib in Primary Sclerosing Cholangitis and Associated Colitis: A Multicenter, Retrospective Study. Clin Gastroenterol Hepatol. 2023;21(13):3448-3450.e3. doi: 10.1016/j.cgh.2023.01.014. Khrom M, Long M, Dube S, Robbins L, Botwin GJ, Yang S, Mengesha E, Li D, Naito T, Bonthala NN, Ha C, Melmed G, Rabizadeh S, Syal G, Vasiliauskas E, Ziring D, Brant SR, Cho J, Duerr RH, Rioux J, Schumm P, Silverberg M, Ananthakrishnan AN, Faubion WA, Jabri B, Lira SA, Newberry RD, Sandler RS, Xavier RJ, Kugathasan S, Hercules D, Targan SR, RB Sartor, Haritunians T, McGovern DPB. Comprehensive association analyses of Extraintestinal Manifestations in Inflammatory Bowel Disease. Gastroenterology. 2024;167(2):315-332. doi: 10.1053/j.gastro.2024.02.026. Dold L, Kalthoff S, Frank L, Zhou T, Esser P, Lutz P, Strassburg CP, Spengler U, Langhans B. STAT Activation in Regulatory CD4 (+) T Cells of Patients with Primary Sclerosis Cholangitis. Immune Inflamm Dis. 2024;12(4):e1248. doi: 10.1002/iid3.1248.

P0356 A case of pulmonary nodules in Ulcerative Colitis and primary sclerosing cholangitis: is it drug or disease?

Abstract Background Pulmonary manifestation of inflammatory bowel disease (IBD) is rare, with a broad range of lung diseases including airways, parenchymal, pleural, and pulmonary vascular disease. It is commonly associated with concurrent use of disease-modifying drugs. We present a case of a 26 year old man with ulcerative colitis and primary sclerosing cholangitis (PSC) who developed lung nodules. Methods Case summary: He was diagnosed with PSC in 2017 and ulcerative colitis in 2018. He had active colitis while on an escalated dose of adalimumab, therefore he was switched to vedolizumab. His faecal calprotectin improved but due to ongoing rectal bleeding, the dose of vedolizumab was escalated from 8 to 4 weekly. 5 months after starting vedolizumab he developed night sweats, dry cough, and breathlessness. He has no history of foreign travel, exposure to tuberculosis, industrial exposure, or bird keeping. Results His initial investigations showed a raised CRP and bilirubin. His CT chest showed numerous lung nodules in both lower lobes. His sputum culture, AFB, and fungal blood markers were negative. Samples were also sent from a bronchoalveolar lavage fluid including for pneumocystis jirovecii, which were negative. He was treated with antimicrobials and antifungal, without improvement. He subsequently underwent a lung biopsy, which showed inflammatory changes in an interstitial pattern, which could be related to the biologic therapy, or underlying disease. Staining for fungus, EBV, CMV, HSV were negative. He was treated as bronchiolitis obliterans organising pneumonitis induced by vedolizumab. Vedolizumab was stopped and prednisolone 40mg was started. His symptoms and inflammatory markers improved, and subsequent pulmonary imaging showed a reduction in the size of the lung nodules. Tapering the prednisolone dose to 10mg unfortunately caused a progression in the lung nodules, despite cessation of vedolizumab, which makes it less likely as the culprit drug. Prednisolone was then increased back up to 40mg, resulting in almost complete resolution of the lung nodules, with the plan for a much slower tapering. Despite the high doses of steroid his colitis is still moderately active on colonoscopy. However, further advanced therapy had to be put on hold while waiting for his lung nodules to resolve. Conclusion It remains difficult to determine whether his pulmonary disease is secondary to the biologic drugs, or the underlying disease process of ulcerative colitis. While pulmonary disease associated with IBD has been widely reported, there is currently unclear understanding of its pathophysiology and treatment. Clinicians need to be aware of this rare entity in IBD in order to improve patient outcomes.

P0403 The relationship between liver stiffness and disease duration in Crohn’s Disease: A prospective cohort study of hepatic manifestations in inflammatory bowel disease

Abstract Background Intestinal mucosal injury is known to contribute to liver disease, and abnormal liver profiles are frequently observed in inflammatory bowel disease (IBD) patients. This study aimed to investigate the hepatic manifestations of IBD in Korea. Methods A prospective cohort to evaluate hepatic abnormalities in IBD was established at Kosin University Gospel Hospital in 2018. From December 2018 to September 2024, patients diagnosed with IBD were consecutively enrolled and underwent abdominal ultrasonography and transient elastography-controlled attenuation parameter (TE-CAP), and laboratory tests including liver function tests, lipid profiles, and fecal calprotectin. Results A total of 383 patients were enrolled, including 218 with ulcerative colitis (UC) and 165 with Crohn’s disease (CD). The mean age was 45.8 (±15.2) years for UC patients and 37.6 (±16.3) years for CD patients. Among the participants, 250 were male, and 133 were female. The mean BMI was 23.1 (±3.49) for UC patients and 22.0 (±4.11) for CD patients. HBsAg was positive in 14 (3.7%) patients, Anti-HBc IgG in 76 (19.8%) patients, Anti-HCV Ab in 6 (1.6%) patients. The proportion of patients with a disease duration more than one year was 123 (56.4%) for UC and 90 (54.5%) for CD. The mean CAP (dB/m) score was 220.0 (±54.5) [UC 230.5 (±52.6), CD 209.4 (±53.5)]. The mean E (kPa) value was 4.71 (±1.94) [UC 4.70 (±1.98), CD 4.65 (±1.80)]. Mean fecal calprotectin levels was 1146.6 (±17.27.7) in UC and 1075.8 (±1720.6) in CD. (Table 1) In total population, CAP score was significantly associated with BMI (r=0.616, P<0.001), triglyceride (TG) (r=0.273, P<0.001). In UC patients, CAP score was significantly associated with BMI (r=0.527, P<0.001) and TG (r=0.285, P<0.001). In CD patients, CAP score was significantly associated with BMI (r=0.660, P<0.001), albumin (r=0.400, P<0.001), total cholesterol (r=0.288, P<0.001), TG (r=0.271, P<0.001) and inversely with fecal calprotectin (r=－0.329, P<0.001). The E value was significantly associated with total bilirubin (r=0.348, P<0.001), ALT (r=0.495, P<0.001) and disease duration (r=0.333, P<0.001). In CD patients with a disease duration of more than one year (n=75), E value was observed to increase gradually as the disease period lengthened (r=0.496, P<0.001). (Figure 1) Conclusion In CD patients, liver stiffness is associated with a longer disease duration. In both UC and CD patients, abnormal lipid profiles are related to the development of fatty liver.

P0989 Interventions for rheumatological extraintestinal manifestations in Inflammatory Bowel Disease: an umbrella review of systematic reviews

Abstract Background Inflammatory Bowel Disease (IBD) is associated with extraintestinal manifestations (EIMs), commonly affecting the joints, eyes, skin, and liver, and influences treatment selection. We aimed to synthesize evidence from systematic reviews (SRs) with or without meta-analyses on the efficacy of therapeutic options for rheumatological EIMs to better clarify their positioning in the management of IBD Methods We searched MEDLINE, Embase, and the Cochrane Database of Systematic inception to May 31 2024 to identify SRs addressing therapeutic interventions for rheumatological EIMs. The exclusion criteria ruled out studies that were not SRs, did not focus on patients with IBD patients, or were unrelated to articular interventions. Screening, selection, and data extraction were performed independently by two authors, with a third author consulted when necessary. Reporting was aligned with PRISMA standards. The quality of SRs was assessed using the AMSTAR-2 tool Results We screened 1,436 references and included 10 SRs (2 with meta-analyses) in our analysis. The rheumatological EIMs most commonly reported included arthralgia, peripheral arthropathy, axial arthropathy, spondyloarthritis, and sacroiliitis. Therapeutic interventions included in the SRs were anti-TNF agents, methotrexate (MTX), ustekinumab, (UST) vedolizumab (VDZ), and JAK inhibitors. Treatment efficacy was mainly reported through symptom reduction rates. Quality of the SRs rated from high to very low confidence, with most achieving moderate confidence due to some non-critical weaknesses. In four SRs anti-TNF therapy showed high response rates for both axial (range 59.1% to 61.8% in a SR) and peripheral spondyloarthritis (range 73.4% to 81.2% in a SR). One SR reported MTX as effective for peripheral enteropathic arthritis. Data on VDZ, UST, and JAK inhibitors were more controversial. One SR reported that UST was effective for arthralgia and psoriatic arthritis. A more recent meta-analysis showed that the improvement of pre-existing joint manifestations was greater in UST-treated patients compared to VDZ-treated patients (54% vs 42%). For tofacitinib, no change in peripheral arthritis was reported by two SRs. Four SRs evaluated treatment-induced rheumatological EIMs, revealing heterogeneous results, particularly with VDZ. However, data from a recent SRs suggest similar rates of new-onset rheumatological EIMs with VDZ and UST (9% vs. 6%) Conclusion Anti-TNF therapy appears to be effective in managing both peripheral and axial spondyloarthritis. Given the lack of consistent data on new advanced therapies, prospective studies designed to assess the impact of other advances therapeutics on rheumatological EIMs ,with rigorous endpoint assessment, are needed

P1243 Extraintestinal Manifestations in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study in Taiwan

Abstract Background Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), is rare in Taiwan. There are also few reports on the the prevalence rate of extraintestinal manifestations (EIMs) in IBD. This study aimed to assess the risk of EIMs in patients with IBD and examine the relationship between the timing of IBD diagnosis and EIM onset. Methods We conducted a retrospective cohort study using administrative data from the Taiwan National Health Insurance Research Database and Registry for Catastrophic Illness Patients Database from 2013 to 2021. The index date for the cohort was defined as the date of the first recorded IBD diagnosis. EIM diagnoses were identified in the health registry using the appropriate International Classification of Diseases 9 and 10 codes. The selection of EIMs refers to 2024 European Crohn's and Colitis Organisation (ECCO) guidelines, of which include uveitis, scleritis, episcleritis, Oral manifestations, PSC, AIH, spondyloarthropathy with axial/non-axial, pyoderma, gangrenosum, erythema nodosum, and Sweet syndrome1. We calculated the mean and median time of EIM onset relative to IBD and categorizing EIMs as occurring either before or after IBD onset. Results The study included 1,774 IBD patients. The incidence rate (IR) of EIMs in IBD patients was 1.167 per 100 persons/years from 2013 to 2021. The highest IR was 2.105 in 2013, and the lowest was 0.357 in 2021. The rate of EIMs development among IBD patients during the follow-up period from 2013 to 2019. Pyoderma had the highest IR at 0.846 per 100 persons/year, followed by primary sclerosing cholangitis at 0.733 per 100 persons/years, oral mucosa lesion at 0.733 per 100 people and ankylosing spondylitis at 0.564 per 100 persons/years (table1). Our analysis showed that EIMs appeared an average of 2.08 years after IBD diagnosis (median 1.48 years) and 5.50 years before IBD diagnosis (median 5.46 years). Conclusion We firstly reported the EIM risk by 1.167 per 100 persons/years in a relative low prevalence country. However, some classical EIMs mentioned in the 2024 ECCO guidelines do not occur as frequently among IBD patients in Taiwan as expected. We still need further investigation in this issue. We can extend the follow-up period to collect more data, which will allow us to reach a more solid and reliable conclusion.

Prevalence and Risk Factors of Spondyloarthritis Symptoms in a US-Based Multicenter Cohort of Patients with Inflammatory Bowel Disease.

Spondyloarthritis (SpA), the most common extra-intestinal manifestation of inflammatory bowel disease (IBD), is reported in up to 39% of patients with IBD. Despite this high prevalence, risk factors for developing SpA in patients with IBD are not well described. In this study, we aimed to determine the factors associated with SpA symptoms and their prevalence in an IBD cohort. Two validated screening questionnaires for the detection of SpA in IBD (DETAIL = DETection of Arthritis in Inflammatory boweL diseases, IBIS-Q = IBD Identification of Spondyloarthritis Questionnaire) were administered to IBD patients without a prior diagnosis of SpA in six US academic medical centers. Demographic data, IBD characteristics, and medication history were recorded. Screening questionnaires were completed by 588 patients (220 ulcerative colitis, 349 Crohn's disease, 19 IBD-unclassified) with a median age 40 years (IQR 30 - 53) and median disease duration of 12 years (IQR 6 - 22). The number of positive screens was 130 (22%) for DETAIL, 196 (33%) for IBIS-Q and 204 (35%) for either DETAIL or IBIS-Q. Age, female sex, history of smoking, prior bowel surgery, and history of any biologic or targeted small molecule exposure were associated with a positive screen on univariate analysis (Table 1). After multivariate analysis, female sex (OR 2.03; 95% CI 1.41-2.93), older age (OR 1.02; 95% CI 1.01-1.04), history of smoking (OR 1.67; 95% CI 1.04-2.69), and history of any biologic or targeted small molecule exposure (OR 2.27; 95% CI 1.34-3.84) were independently associated with positive screens. Higher number of biologic exposures was associated with higher risk of positive screens, with the highest risk seen with three or more exposures (OR 3.25; 95% CI 1.75-6.03). A substantial number of IBD patients screen positive for SpA symptoms, indicating a potentially high burden of undiagnosed illness. Factors associated with SpA symptoms include older age, female sex, and more severe disease (based on increased number advanced therapies or prior surgery), whereas IBD phenotype does not independently increase the risk of a positive SpA screen. Further studies are needed to confirm these findings and better characterize SpA in IBD.

Pericardial Effusion as an Extra-intestinal Manifestation of Inflammatory Bowel Disease in a Child

Pericardial Effusion as an Extra-intestinal Manifestation of Inflammatory Bowel Disease in a Child

Hepatobiliary manifestations of inflammatory bowel disease in Saudi Arabia: A retrospective analysis.

To evaluate the features and frequency of hepatobiliary diseases in individuals with Inflammatory bowel disease (IBD). This retrospective study included all IBD patients at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The primary focus was on the prevalence of hepatobiliary diseases, such as primary sclerosing cholangitis (PSC), non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis (AIH), and others. The secondary focus was identifying predictors of these hepatobiliary manifestations in IBD patients. Associations were analyzed using simple and multiple logistic regression analyses. Among a total of 885 patients with IBD patients, 4.3% presented with hepatobiliary manifestations. Of these cases, 31.6% were linked to Crohn's disease (CD). While 65.8% were associated with ulcerative colitis (UC). Primary sclerosing cholangitis (PSC) was most prevalent, especially in females. PSC was linked to specific IBD sites 39.3% of UC patients have the left-sided disease and 10.7% of patients with ileocolonic CD had PSC. The absence of comorbidities was associated with lower odds of developing PSC, while UC diagnosis, adalimumab use, and infliximab use were associated with higher odds of developing PSC. A small percentage of IBD patients experience hepatobiliary complications, with PSC being the most prevalent. The study emphasizes the importance of closely monitoring IBD patients, especially those undergoing anti-TNF therapy.

Hepatobiliary and pancreatic manifestations in inflammatory bowel disease: an umbrella review of meta-analyses.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients. To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases. We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations. We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria. A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40-2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93-3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52-2.76) and CD (IRR = 2.31; 95% CI = 1.25-4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population. The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs. CRD42023451461.

Ocular Manifestations of IBD: Pathophysiology, Epidemiology, and Iatrogenic Associations of Emerging Treatment Strategies.

Inflammatory bowel disease (IBD) is a complex, multisystemic disease and is associated with ocular pathology in 4-12% of patients. In general, ocular disease affects Crohn's patients more frequently than those with ulcerative colitis. Episcleritis and uveitis are the most common presentations, with episcleritis often correlating with IBD flares, whereas uveitis presents independently of IBD activity and, in some cases, may even alert clinicians to a new diagnosis of IBD. Corneal EIMs encompass a range of pathologies, such as the common and benign keratoconjunctivitis sicca (dry eye disease), which nevertheless causes significant patient discomfort, and the rarer condition of peripheral ulcerative keratitis, which warrants urgent review due to the risk of corneal perforation. Alongside EIMs, clinicians should also be aware of the iatrogenic consequences to the eye following treatment of IBD. Corticosteroids may cause cataracts, glaucoma, and-indirectly via hyperglycaemia-diabetic retinopathy. Methotrexate is irritating to ocular tissues and may cause conjunctivitis and blepharitis. Biologic medications, such as anti-TNFα agents, overlap in their use as treatment of both IBD and uveitis, and yet in some patients may also increase the risk of acute uveitis flares, as well as opportunistic, sight-threatening infections. With integrated care between gastroenterology and ophthalmology, patient outcomes can be improved by facilitating earlier detection and management of ocular disease. This narrative review summarises the ocular extraintestinal manifestations of IBD, including pathophysiology, epidemiology, and current treatment strategies.

Arthralgia and Extraintestinal Manifestations in Crohn's Disease Elevate the Risk of IBD-Related Arthritis over Sacroiliitis.

Inflammatory bowel disease (IBD) related arthritis is the most prevalent extraintestinal manifestation (EIM) of IBD, ranging between 10 and 39%. Magnetic resonance enterography (MRE) is used to assess small bowel disease involvement in Crohn's disease (CD) and can detect signs of sacroiliitis in up to 23.5% of patients. The predicting role of sacroiliitis detected on MRE is still unknown. The aim of this study is to evaluate the predictive role of sacroiliitis at MRE and other clinical features for IBD-related arthritis development in a cohort of adult patients with CD. Between December 2012 and May 2020, consecutive patients with CD who performed MRE were enrolled in the study. Patients with a previous diagnosis of IBD-related arthritis were excluded. A baseline demographics and clinical characteristics of the patients were retrospectively collected. The identification of new-onset IBD-related arthritis events during the follow-up was based on rheumatological clinical diagnosis and fulfillment of the ASAS classification criteria. Ninety-five patients, mean age 43.9 years (standard deviation [SD] ± 16.6), 52.6% female were enrolled in the study with a median follow-up of 83months (Q25:75 25:143). Six out 95 (6.3%) developed IBD-related arthritis with a mean time of 11months (SD ± 16.8). Sacroiliitis detected on MRE was not associated with an increased risk of IBD-related arthritis (odds ratio [OR] = 2.12 [95% confidence interval (CI) 0.36, 12.53, p = 0.408]). In contrast, the presence of arthralgia and EIMs were found to be a predictor for IBD-related arthritis development (OR = 84.0 [95% CI 8.18, 862.39, p < 0.0001] and OR = 7.37 [95% CI 1.25, 43.32, p = 0.027], respectively). This study highlights that sacroiliitis, as assessed by MRE, was not associated with the development of IBD-related arthritis, whereas extraintestinal manifestations and arthralgia were significantly associated with later IBD-related arthritis development in patients with CD.

S115 Extraintestinal Manifestations in Inflammatory Bowel Disease: The Experience at Cleveland Clinic Abu Dhabi, A Large Tertiary Hospital in United Arab Emirates

S115 Extraintestinal Manifestations in Inflammatory Bowel Disease: The Experience at Cleveland Clinic Abu Dhabi, A Large Tertiary Hospital in United Arab Emirates

Inflammatory Bowel Diseases and Nephropathies: Exploring the Gut-Kidney Axis.

Inflammatory bowel disease (IBD) can extend beyond the gastrointestinal tract, affecting extraintestinal organs and significantly increasing morbidity and mortality. Despite early studies revealing kidney involvement in nearly a quarter of patients with IBD, renal manifestations have been notably overlooked. Among these manifestations, nephrolithiasis, obstructive uropathy, and fistula formation between the bowel and urinary tract are the most reported occurrences. Additionally, renal parenchymal involvement in IBD, including glomerulonephritis (GN), tubulointerstitial nephritis, and amyloidosis, has been documented. GN is particularly noteworthy, as a significant proportion of patients progress to end-stage kidney disease (ESKD). Although GN has long been recognized as a potential extraintestinal manifestation (EIM) of IBD, it has often been dismissed as an anecdotal association. Recently, several studies highlighted the clinical correlation between GN and IBD, suggesting a pathogenic interplay involving gut inflammation, dysbiosis, and intrinsic glomerular processes. Thus, our objective is to elucidate the basis of IBD-related nephropathies, with a specific focus on IgA nephropathy (IgAN) and the gut-kidney axis.

Overlap syndrome in Crohn’s disease

The diagnosis of inflammatory bowel diseases (IBD) in children can be challenging for pediatricians. Extra-intestinal manifestations, such as hepatobiliary pathology, often complicate the diagnosis of these conditions. Hepatobiliary pathology is often an extraintestinal manifestation of inflammatory bowel disease. Patients with combined liver pathology (autoimmune hepatitis and primary sclerosing cholangitis) and inflammatory bowel disease have a higher risk of resistance to treatment, the need for liver transplantation, and a worse prognosis for liver cirrhosis compared to those with isolated liver disease. The article presents a clinical case of the development of overlap syndrome (a combination of autoimmune hepatitis and primary sclerosing cholangitis) in Crohn’s disease in a 7-year-old patient.