Inflammatory Bowel Disease Patients In Remission Research Articles

Quiescent ulcerative colitis and Crohn’s disease have potential effect on cognitive function

BackgroundUlcerative colitis (UC) and Crohn’s disease (CD) imply chronic intestinal inflammation with both local and systemic manifestations. Cognition is a lifelong process of learning and memory processing, which has been identified to be affected by chronic systemic illnesses.AimTo evaluate the cognitive functions in inflammatory bowel disease (IBD) patients in remissionPatients and methodsInclusion criteria are as follows: 70 IBD patients in remission and a group of 50 healthy control. Mini-mental state examination (MMSE) was used for assessment of global cognitive function and Trail Making Test (TMT) for assessment of executive functions. TMT consists of part A which measures attention and performance speed and part B which measures mental flexibility. Both tests have been previously validated on Arabic-speaking populations.ResultsThe study included 70 patients (50 UC and 20 CD), who have been in remission for 21 ± 9 months. Of the included cases, about 51 were already on steroids ± azathioprine, and 19 patients were on biologics. Males represented 60% (n = 42) while females 40% (n = 28), and their mean age was 34 ± 8 years. Both cases and controls were matched for age and sex. The mean score of MMSE among IBD cases was significantly worse than controls (28.5 ± 3 versus 30, P < 0.001). Also, the duration of TMT parts A and B was significantly longer in cases than controls. The cases group scored 32 ± 19.5 s in TMT part A, versus 23 s by the controls. In TMT B, the recorded scores were 255 ± 48, versus 234 s in cases and control groups respectively (P < 0.001). In the cases group, 6 patients (8%) had below normal MMSE score of less than 24, with mild (3 patients, mean score was 21) to moderate cognitive impairment (3 patients, mean score was 15). The presence of extraintestinal manifestation was the only disease-related factor that was associated with cognitive impairment. Of the patient-related factor: older age, being divorced, and living in rural areas were associated with poorer cognitive functions.ConclusionIBD patients potentially suffer from cognitive impairment. In our study, factors as extraintestinal complications, older age, marital status, and residence in rural areas could be contributing factors to this impairment.

The Application of Intestinal Stem Cell Organoids in the Treatment of Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) comprises chronic inflammatory disorders affecting the gastrointestinal tract, such as Crohn’s Disease (CD) and Ulcerative Colitis (UC). The escalating global incidence of IBD is multifactorial, involving genetic, microbial, environmental and immunological factors. Despite current therapies emphasizing immune suppression, sustained efficacy remains elusive. Recently, Stem Cell Therapy (SCT) has emerged as a potential avenue for inducing remission in IBD patients. Intestinal Stem Cells (ISCs) have gained attention for their recent emergence in research and potential cultivation into organoids, offering a promising source for IBD treatment. This review focuses on the potential of ISC SCT, emphasizing its organoid culturing capabilities. It highlights organoids’ applications in IBD research, monitors advancements in animal and human trials and examines current limitations and future directions in organoid research for IBD treatment.

ROUTINELY COLLECTED BLOODWORK REVEALS IMMUNE CELL PATTERNS THAT REFLECT DISEASE ACTIVITY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract OBJECTIVE The standard procedure for evaluation of inflammatory bowel disease (IBD) diagnosis and activity requires endoscopy, but there have been many biomarkers identified that are associated with IBD and are collected much less invasively. White blood cell subsets, also known as “the differential”, is a commonly used test for patients with IBD, but the relationship between the differential and disease activity is unknown. Understanding the connection between the differential and disease activity could provide insight to a patient’s clinical presentation without requiring more invasive testing. The aim of this study was to identify patterns present in the differential of IBD patients and use machine learning to determine how these parameters change with IBD activity. METHODS A total of 373 differential counts from 43 patients with IBD were evaluated. All IBD patients with adequate clinical information were included. Disease activity was determined by chart review using the Physician’s Global Activity Score. Binary classification prediction was performed on the training set using multiple supervised machine learning models. RESULTS The outcome was balanced, with 56% of the observations experiencing IBD activity at the time of blood collection. A random forest (RF) model performed best with a final fit accuracy of 0.70 and an ROC-AUC score of 0.75. The RF classifier ranked monocytes and neutrophils as having the highest relative importance to the model. CONCLUSION The optimal RF model demonstrated an overall correctness in its predictions and as reflected in the ROC-AUC score, can discriminate between active disease state and remission in IBD patients. These results indicate that a pattern is present between the differential and IBD activity and with further exploration, may be used to create a predictive model for IBD diagnosis.

P903 Persistence, efficacy and tolerance of subcutaneous Infliximab after switch from intravenous infliximab in IBD patients in remission: one-year results from a multicenter prospective cohort

Abstract Background Prospective data after switch from intravenous infliximab (IV-IFX) to subcutaneous (SC-IFX) in Inflammatory Bowel Disease (IBD) is needed. The aim of this prospective multicenter cohort was to describe SC-IFX persistence, efficacy and tolerance after switch from IV-IFX. Methods IBD patients in steroid-free clinical remission (defined by a Harvey Bradshaw index (HBI) ≤ 4 for Crohn’s disease (CD), and partial Mayo Score (PMS) ≤ 2 with no subscore &amp;gt;1 for ulcerative colitis UC)) for at least 6 months on IV-IFX, were enrolled in this prospective cohort if they switched to SC-IFX. Clinical (HBI, PMS), biological (CRP, fecal calprotectin (FC)) and pharmacokinetic evaluations were performed at 3, 6, 12 and 24 months from switch. In case of clinical or biological relapse, as per physicians’ judgement, SC-IFX dose could be increased, or drug changed. Primary endpoint was SC-IFX persistence at week 48 (W48). Secondary endpoints comprised steroid-free clinical remission at W48, proportion of patients who switched back to IV-IFX, HBI and PMS changes and FC, CRP and infliximab serum level changes. Statistical comparisons were performed using Fisher’s exact test. Survival without treatment discontinuation was analysed using a Kaplan-Meyer curve. Results 426 patients were included (72.4% CD, 45.1% female, median age 37 years), with a median time from diagnosis of 143 months in CD, 154 months in UC. At baseline, 74% were on IV-IFX standard dose (5mg/kg every 8-week) and 68 (16%) received combination therapy with an immunosuppressant. Among patients with complete data until W48, SC-IFX persistence was 95.3% (CI, 93.2-97.5). 319/367 (89.9%) were on steroid-free clinical remission. From baseline to W48, median HBI and PMS scores were 0, CRP did not change significantly, median FC rate decreased significantly from 52µg/g to 36 µg/g (p=0.015). Mean Infliximab trough level at inclusion was 7.97µg/mL, while it reached 17.96µg/mL at W48 (p&amp;lt;0.0001). 23 (5.4%) patients had an increase of SC-IFX dose and 22 (5.2%) stopped SC-IFX, of which 6 patients switched back to IV-IFX. SC-IFX persistence was significantly higher among patients treated with SC-IFX monotherapy (98.8%) as compared to those on combination therapy (90.0%) (HR=0.14 [0.04-0.53]). Adverse events were reported in 181/426 patients (42.4%), 12 led to treatment discontinuation. Nine severe adverse events (2%) were reported. Three patients (0.7%) had IBD-related surgery and 8 (1.9%) IBD-related hospitalization. Conclusion In this large multicenter prospective cohort of IBD patients in remission, one-year persistence of SC-IFX after switch from IV-IFX was 95.3%, supporting excellent efficacy and tolerance of SC-IFX.

ECCO Pioneer Award Functional assessment of the microbiome in persistent IBD-related psychological symptoms

Abstract Background and Aims It is well established that patients with inflammatory bowel disease (IBD) experience psychological comorbidities, and that these symptoms persist upon remission of the IBD in more than 50% of patients. The mechanisms underlying this clinical association are unknown, which hampers to objectify the problem and limits the possibilities to intelligently consider targeted treatments. We recently observed behavioral anomalies and neuroinflammation in a mouse model of extinguished chronic colitis, enabling the fundamental study of psychological symptoms in IBD. Fueled by technical evolutions to characterize translationally active bacteria at the single-cell level, their importance in colitis, and a proof-of-concept stool transplantation experiment, the purpose of this project is to determine if specific bacterial functions drive persistent neuroinflammation upon IBD remission. Methods First, a state-of-the-art flow-cytometry based method will be used to temporally map translationally active bacteria during the course of extinguished chronic colitis. Second, the same functional microbial analysis will be achieved in human fecal samples of IBD patients in remission before and after treatment for fatigue, and results will be compared with persistent bacterial changes found in mouse flora. Finally, causality of associated bacteria to induce neuroinflammation will be tested by transplantation studies of bacterial communities isolated from the previous tasks. Anticipated Impact This research may impact the field in the short-term by creating solid scientific awareness that psychological comorbidities are intrinsically linked with IBD remission, and by more specifically attributing a role for specific bacterial functions in these symptoms. In addition, the technique applied may open novel insights for the IBD microbiome community. In the medium-term, this project aims to shed light on the actual bacterial mechanisms that lead to neuroinflammation and behavioral anomalies, which in the long-term could help identify biomarkers for diagnostic purposes or microbiome-related targets to design rational therapeutics for patients with IBD suffering from psychological comorbidities.

BODY FAT COMPOSITION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A COMPARATIVE STUDY BETWEEN SKINFOLDS AND ULTRASONOGRAPHY.

Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. A total of 101 patients with IBD were included, 75 with Crohn's disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn's disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD. • Inflammatory bowel diseases are associated with changes in nutritional status. • Skinfolds measurements and ultrasound are valid methods for assessing body composition and body fat. • These methods despite comparable are not identical and are useful in clinical nutritional practices in IBD.

Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing.

Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn's disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.

Adherence to ECCO Guidelines for Management of Iron Deficiency and Anemia in Inflammatory Bowel Diseases Among Israeli Adult and Pediatric Gastroenterologists.

The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA) were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD). An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and PGs. Questions explored 3 areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD. Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every 3 months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively ( P < 0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every 6 months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10 g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs ( P > 0.1). In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.

Evaluation of Albumin, Transferrin and Transthyretin in Inflammatory Bowel Disease Patients as Disease Activity and Nutritional Status Biomarkers.

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is often accompanied by malnutrition that manifests itself as nutrient deficiencies and body mass loss or deficit. The purpose of this study is to evaluate the utility of albumin, transferrin and transthyretin levels in the assessment of nutritional status and IBD activity. The case-control study included 82 IBD patients. The serum concentrations of albumin, transferrin and transthyretine were determined by a quantitative sandwich enzyme-linked immunosorbent assay (ELISA). Significantly lower median concentrations of albumin were found in the IBD patients vs. controls and in CD patients compared to the UC patients. Significantly higher median transthyretin concentrations were found in the IBD patients compared to the healthy subjects. There were no significant differences in median transferrin concentrations between the IBD patients and the healthy subjects. Significantly higher albumin levels were found in IBD patients in remission compared to patients with moderate and severe exacerbation of IBD symptoms. There were no significant differences in the median transferrin or transthyretin levels in patients with IBD depending on disease activity. No differences were identified in the median transferrin or transthyretin levels in the IBD patients according to nutritional status. The median albumin concentrations in the IBD subjects were significantly higher in patients with normal body fat, normal BMI and normal waist circumferences compared to those with an abnormal nutritional status. The albumin levels reflect both nutritional status and disease activity and therefore cannot be considered a prognostic marker of malnutrition in IBD. As regards the utility of transferrin and transthyretin as markers of activity and nutritional status in IBD patients, further studies are required.

Lower gastric sensitivity in quiescent inflammatory bowel disease than in irritable bowel syndrome

ObjectiveVisceral hypersensitivity is considered a key symptom in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), both of which seriously affect health-related quality of life (HrQoL). Previous findings are mostly based on invasive procedures that may interfere with the assessment of visceral perception. The current study, therefore, investigates whether IBD and IBS are characterized by altered perception of ‘natural’ gastric distensions (‘interoception’). MethodsTwenty IBD patients in remission (13 Crohn's disease, 7 ulcerative colitis), 12 IBS patients, and 20/12 matched healthy control (HC) individuals, respectively, underwent the water load test, in which they could drink ad libitum until the subjective thresholds of satiation (stage 1) and fullness (stage 2) were reached. Gastric motility was assessed using electrogastrography. ResultsIBD patients drank significantly more water until satiation than IBS patients, whereas no differences between patients and HC groups were observed. Electrogastrographic patterns were comparable between groups, suggesting no pathologies in gastric motility in IBD or IBS. The amount of water consumed until satiation negatively correlated with HrQoL related to bowel symptoms in IBD patients, but was positively associated with emotional well-being in IBS patients. ConclusionOur findings implicate relative gastric hypersensitivity in IBS, and relative hyposensitivity in IBD patients, which are both related to specific HrQoL aspects.

Effectiveness of Mindfulness-Based Cognitive Therapy in reducing psychological distress and improving sleep in patients with Inflammatory Bowel Disease: study protocol for a multicentre randomised controlled trial (MindIBD).

BackgroundMany patients with Inflammatory Bowel Diseases (IBD) suffer from psychological distress, fatigue and sleep disturbances, which are associated with reduced quality of life (QoL) and increased societal costs. Only limited psychosocial treatment options are available. As Mindfulness-Based Cognitive Therapy (MBCT) has demonstrated to improve psychological distress, QoL and sleep in other populations, MBCT might also be effective in patients with IBD.MethodsThe MindIBD study is a prospective, multicentre, randomised controlled trial comparing MBCT plus Treatment As Usual (TAU) versus TAU alone in a targeted number of 136 IBD patients in remission, aged 16 years and older with at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) total score ≥ 11). Primary outcome is reduction of psychological distress post-intervention, measured by the HADS. In addition, the effect of MBCT on sleep quality (including actigraphy and electroencephalography recordings), fatigue, disease activity, perceived disease control, QoL and positive mental health will be examined. Assessments will be conducted at baseline and at 3, 6, 9 and 12 months follow-up. Cost-effectiveness will be determined and a process evaluation will be conducted.DiscussionThis study will provide valuable insight into the clinical effect of MBCT on psychological distress, sleep quality, fatigue and QoL in IBD patients and into the cost-effectiveness. If effective, MBCT can be a valuable addition to the available psychosocial interventions for patients with IBD. Moreover, findings from this study may also be applicable in patients with other chronic conditions.Trial registrationClinicalTrials.gov: NCT04646785, registered on 30/11/2020.

P404 Persistence of subcutaneous infliximab after switching from intravenous in a French national cohort of IBD patients in remission

Abstract Background Subcutaneous infliximab (IFX-SC) was launched in France for the treatment of patients with inflammatory bowel disease (IBD) in 2021. Real-life and pharmacokinetic (PK) data after switching from intravenous infliximab (IFX-IV) to IFX-SC are needed. The PEREM study is a French multicenter prospective cohort aiming to describe the persistence of IFX-SC after switch from IFX-IV. Methods IBD patients in steroid-free clinical remission [Harvey Bradshaw Index (HBI) ≤ 4 for Crohn’s disease (CD) and partial Mayo score (PMS) ≤ 2 with each subscore ≤ 1 for UC] for at least 6 months on IFX-IV therapy were proposed to switch to IFX-SC as part of routine care. Patients were included in 40 centers between Oct 2021 and May 2022. Clinical scores (HBI, PMS), biological samples (CRP and fecal calprotectin - FC), PK and anti IFX antibodies (ATI) were evaluated 3, 6, 12 and 24 months after switch. In case of IFX-SC discontinuation, time and reason for withdrawal were documented. Safety and adverse events of interest were recorded. The primary endpoint was IFX-SC persistence at 12 months. As not all patients met this primary endpoint at the time of writing this abstract, we present here the results at 6 months (M6). Results Among the 444 patients included [44% female, median age: 37 years (Min, Max: 18-88), 72% Crohn’s], 71% were receiving IFX-IV at a dose of 5 mg/kg every 8 weeks and 84% were treated on monotherapy. Among the 417 patients analyzed, five withdrew their consent before the M6 visit and 324 were assessed at M6; 25/324 (7.7%) discontinued IFX-SC before M6 (seven for relapse, twelve for intolerance, two for pregnancy, four for unknown reasons) including one (0.3%) switch back to IFX-IV. Rate of survival without IFX-SC discontinuation at M6 was 92.6% (95% CI 89.3-95.1). Among the patients evaluated at M6, median clinical scores did not vary between inclusion and M6: HBI from 0 (IQR: 0-1) to 0 (IQR: 0-1), PMS from 0 (IQR: 0-0) to 0 (IQR: 0-0), respectively. The median CF and CRP levels were respectively 52 μg/g (IQR: 19-142) at inclusion and 37 μg/g (IQR: 14-129) at M6, and 1 mg/L (IQR: 1-4) at inclusion and 1 mg/L (IQR 0-4) at 6 months. At baseline, median infliximab levels were 6.6 μg/mL (min, max: 0-29) and 20 μg/mL (min, max: 0.3- 79.2) at M6. No major safety signals were recorded. Conclusion In a national real-life multicenter cohort, rate of persistence of IFX-SC after 6 months was 92.6% in IBD patients switched in remission, without significant clinical or biological changes. Treatment switch was associated with an increase in IFX levels. These data are confirming the good efficacy and safety of IFX-SC after switch.

P532 1-Year Clinical Outcome of Subcutaneous Infliximab compared with Intravenous Infliximab in Patients with Inflammatory Bowel Disease During Maintenance Therapy

Abstract Background Although pharmacokinetic profile of subcutaneous infliximab (SC IFX) is superior to conventional intravenous infliximab (IV IFX), long-term efficacy and safety of SC IFX have not been compared with those of IV IFX in patients with inflammatory bowel disease (IBD). This cohort study aimed to evaluate the loss of response (LOR) and durable remission in IBD patients treated with SC IFX after switching from IV IFX compared with those in IBD patients who continued IV IFX. Methods This prospective cohort study enrolled 61 IBD patients with clinical remission who received scheduled IFX maintenance therapy from May to September 2022. Of them, 38 patients were switched to SC IFX with a shared decision-making between patients and physician. After dose optimization, they were followed up for one year. Clinical remission was defined as HBI &amp;lt; 5 in in patients with Crohn’s disease (CD) and partial Mayo ≥ 2 in in patients with ulcerative colitis (UC). Biochemical relapse was defined as CRP ≥ 0.5 mg/dL in patients with CD and UC. Results LOR occurred in three (8%) patients of the SC IFX group and 5 (22%) patients of the IV IFX group, showing no significant difference between both groups (p = 0.140). The clinical and biochemical remission were not significantly different between the SC and IV groups (clinical remission: 20/23, 87% vs 33/38, 87%, p = 1.000; biochemical remission: 22/23, 96% vs. 34/38 89%, p = 0.641). The patients with IFX trough level &amp;lt; 3 μg/mL was significantly lower in the SC IFX group (0/38, 0%) than in the IV IFX group (10/23, 43%; p &amp;lt; 0.001). The incidence of IFX-related adverse events did not differ significantly between both groups (26% vs. 39%; p = 0.446). Conclusion SC IFX switch induced similar 1-year durable remission rate and safety profile with continuing IV IFX in patients with IBD during maintenance therapy. Pharmacokinetic profile was superior in patients treated with SC IFX compared with IV IFX.

SYSTEMATIC REVIEW OF THE PREVALENCE OF ANXIETY AND DEPRESSION DISORDERS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Background: Mental health is an important but often disregarded part of inflammatory bowel disease (IBD) patient care, with difficulties defining effective medications and psychological health services. Anxiety and sadness are the most frequent psychosocial problems among IBD patients. The rising frequency of these mental problems calls for mental screening of all IBD patients at the initial appointment. Objective: A growing number of research on anxiety and depression in IBD have been undertaken nevertheless, there is no clear consensus on the prevalence of anxiety and depression in this group. The goal of this systematic review was to consolidate current data on the prevalence of depression and anxiety disorders in individuals with IBD. Methods: Authors began with recognizing the important examination proof that spots light on the prevalence of anxiety and depression among IBD patients. We led electronic writing look in the accompanying data sets: Ovid Medline (2010 to present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2010 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: There were 10 articles found, with a total of 26097 participants. The pooled prevalence estimate for anxiety disorders was 20.3%, and 13.3% for depression. When compared to those in remission, IBD patients in active illness showed a 75.6% greater prevalence of anxiety. Depressive symptoms were more common in Crohns disease than in UC (P0.001), and more common in active illness than in IBD patients in remission (P= 0.004). Conclusion: Results from this systematic review indicate that patients with IBD have about a 20.3% prevalence rate of anxiety and a 13.3% prevalence rate of depression.

Low-FODMAP Diet for the Management of Irritable Bowel Syndrome in Remission of IBD.

Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). The aim of this study was to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. On the patients who met the IBS diagnostic criteria, anthropometric measurements, laboratory tests and lactulose hydrogen breath tests were performed. A low-FODMAP diet was introduced for 6 weeks. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39) (95% CI (53.4%; 76.9%)). The difference between the two groups (with SIBO at baseline (33 of 48 patients) and without SIBO at baseline (6 of 11 patients)) in the low-FODMAP diet's effectiveness was not statistically significant (p = 0.586). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation. In IBD patients in remission who meet the IBS criteria, the dietary intervention of a low-FODMAP diet is effective for a reduction in IBS-like symptoms, regardless of the coexistence of bacterial overgrowth.

S1031 Association Between Nutritional Profile and Disease Activity in a Sample of Lebanese Patients With Inflammatory Bowel Disease (IBD): A Case Control Study

Introduction: Many studies have evaluated dietary habits of patients with inflammatory bowel disease (IBD) and their impact on disease activity. This study aims to evaluate this association in Lebanese patients with IBD, as no investigation of this kind has been done in Lebanon. Methods: In this prospective study, patients with IBD were identified by their treating physicians while controls were recruited via emails sent to staff and students at the affiliated university. Both groups were gender and age matched. Baseline characteristics and nutritional profile, as assessed using a validated food frequency questionnaire (FFQ) adapted to the Lebanese diet were compared between cases and controls. Cases were divided into 2 groups, those in remission and those with active disease according to the Harvey-Bradshaw Index for Crohn’s disease (HBCD) and Ulcerative Colitis Activity Index (UCAI). Results: A total of 47 patients with IBD and 101 controls were included. There was no difference in mean age between cases and controls. Patients with IBD consumed significantly less % of lipids, saturated fatty acids (SFAs), fiber, and sucrose compared to controls (p=0.0001). The multivariate analysis comparing cases to controls showed higher odds of consuming more % carbohydrates of total energy intake (TEI) at 1.31 (95%CI; 1.15-1.51) and more % proteins of TEI at 1.25 (95%CI;1.09-1.43), and lower odds of consuming fiber at 0.934 (95%CI;0.89-0.99). There was no difference in odds of fat consumption between cases and controls. Of 47 IBD patients, 25 UC and 22 CD, 28 were in clinical remission (HBCD ≤ 4 or UCAI ≤ 2) and 19 had active disease. IBD patients in remission consumed more % protein than controls (p=0.032). The % intake of poly-unsaturated fatty acids (PUFAs) was higher among IBD patients with active disease than those in remission, specifically among those with UC (p=0.032). Conclusion: Although there was a difference in protein consumption between cases and controls, it was only significant between controls and IBD patients in remission. It is possible that differences in diet between patients with IBD and controls were associated with nutritional restrictions patients impose on themselves. In contrast, consumption of PUFAs was associated with active disease in IBD patients, which concords with the available literature. This study could serve as a steppingstone for future prospective and experimental studies that could inform nutritional rehabilitation for IBD patients (Table). Table 1. - Energy Intake, Macronutrients and Micronutrients Per Day in Controls, IBD Patients in Remission and IBD Patients with Active Disease Controls (n=101) IBD patients in Remission (n=28) IBD patients with active disease (n=19) p-value DRI Energy Intake (kcals/day) for men 2622.4 ± 0.21 1923.53 ± 0.16 1644.37 ± 0.03 0.015 2300-2900 Energy Intake (kcals/day) for women 2597.2 ± 0.17 1563.15 ± 0.05 1897.14 ± 0.13 0.0001 1900-2200 BMI (kg/m2) 23.29 ± 0.06 25.87 ± 0.06 24.03 ± 0.08 0.007 N/A Average (%) of Protein of TEI 16.06 ± 0.09 18.62 ± 0.05 16.48 ± 0.08 0.004 10-35 Average (%) of Lipids of TEI 38.33 ± 0.08 30.28 ± 0.06 33.02 ± 0.07 0.0001 20-35 MUFAs (%) 12.33 ± 0.11 11.52 ± 0.06 11.04 ± 0.12 0.119 15-20 PUFAs (%) 6.05 ± 0.15 5.14 ± 0.10 6.58 ± 0.12 0.032 5-10 SFAs (%) 11.95 ± 0.12 6.50 ± 0.14 6.84 ± 0.14 0.0001 < 10 Average (%) of carbohydrates of TEI 45.15 ± 0.05 50.68 ± 0.03 49.30 ± 0.05 0.0001 45-65 Average Sucrose (g) 89.16 ± 0.21 43.89 ± 0.22 52.70 ± 0.21 0.0001 50 Average Lactose (g) 5.60 ± 0.59 5.17 ± 0.44 5.17 ± 0.44 0.942 N/A Average Fibers (g) 28.09 ± 0.18 18.02 ± 0.10 21.52 ± 0.20 0.0001 20-38 Alcohol (yes), n (%) 22 (23.9%) 4 (14.3%) 6 (31.6) 0.918 N/A Vitamin D supplementation (yes), n (%) 15 (14.9%) 13 (46.4%) 5 (26.3%) 0.006 N/A Categorical variables were reported as numbers and percentages, test used: chi-square test. Continuous variables were reported as geometric means ± Standard deviation, test used: independent t-test. p<0.05. IBD= Inflammatory Bowel Diseases, DRI= Daily Recommended Intake, BMI= Body Mass Index, TEI= Total Energy Intake, MUFAs= Mono-unsaturated Fatty Acids, PUFAs= Poly-unsaturated Fatty Acids, SFAs= Saturated Fatty Acids, N/A= Not applicable.

S1063 Corticosteroid Use in Inflammatory Bowel Disease (IBD) Patients May Lead to Worse IBD-Related Outcomes After COVID-19 Infection

Introduction: There is growing but limited data on the effects COVID-19 has on the disease course of IBD. COVID-19 can enter epithelial cells of the gut via ACE receptors causing cell dysfunction, inflammation, and dysbiosis. Thus, we set out to evaluate IBD outcomes during and three months after COVID-19 infection. Methods: We performed a retrospective case series comparing IBD patients in remission versus not in remission diagnosed with COVID-19 seen in a single tertiary care center from March 2020 to March 2021. COVID-19 diagnosis was made by positive rapid antigen and/or PCR. We analyzed demographics, medications, need for hospitalization, changes to immunosuppressive therapy, and IBD severity and remission status noted by endoscopic scoring or Physician Global Assessment at the time of COVID-19 diagnosis and 3 months post infection. Results: We identified 57 IBD patients, 30 in remission and 27 not in remission, diagnosed with COVID-19. Comparison of baseline characteristics and COVID-19 and IBD related outcomes are noted in Table. Patients not in remission were more likely to be on steroids, including prednisone and budesonide, and biologics (0% vs 40.7%, p=0.00001; 73.3% vs 96.3%, p=0.03). Patients not in remission were significantly more likely to need escalation in treatment (OR 15.08; CI 2.98-76.3, p=0.001) and had more IBD related hospitalization and surgery at 3 months compared to patients in remission (18.5% vs 0%, p=0.02). We then excluded patients who had changes in IBD medications 90 days prior to COVID-19 diagnosis and found there was still an increased risk for treatment escalation (OR 7, CI 1.27-38.58, p=0.0254). Additionally, patients not in remission on steroids had an increased risk of escalation of IBD related medications, hospitalization, and surgeries than patients not in remission who were not on steroids (OR 12, CI 1.76-81.7, p=0.0111). Conclusion: Our study suggests COVID-19 likely has minimal impact on the clinical course of IBD patients in remission. It remains unclear what the effects are on those not in remission, especially those on corticosteroids. Corticosteroid use is associated with impaired immune response and may lead to dysbiosis by downregulation of protective mucin gene expression as shown in animal models. Thus, infection with COVID-19 in patients on steroids may contribute to an increased risk of dysbiosis and subsequent disease flare. Further study is warranted to study the effects of steroids on IBD related outcomes in patient with COVID-19 infection. Table 1. - Comparison of IBD related outcomes in patients in remission versus those with active disease at time of COVID-19 diagnosis and 3 months afterwards Remission (SD)N = 30 Not in remission (SD)N = 27 P-value Demographics Age 40.2 (16.3) 35.3 (13.7) 0.25 Sex Male 46.7% 33.3% 0.42 Female 53.3% 66.7% 0.42 Race White 70% 74% 0.78 Black 20% 18.5% 1.00 Asian 10% 3.7% 0.61 Hispanic 0% 3.7% 0.47 BMI 26.2 (5.6) 24.8 (4.0) 0.36 Comorbidities Organ transplant 3.3% 7.4% 0.60 Cardiovascular disease 13.3% 11.1% 1.00 Diabetes 3.3% 3.7% 1.00 Chronic lung disease 0% 3.7% 0.47 HTN 10% 7.4% 1.00 Current malignancy 3.3% 0% 1.00 CKD 3.3% 7.4% 0.60 Tobacco use 3.3% 3.7% 1.00 Chronic liver disease 20% 14.8% 0.73 IBD Characteristics Crohn's disease 73.3% 63.0% 0.57 Ulcerative colitis 26.7% 37% 0.57 Activity Mild Moderate Severe 14.8%77.8%7.4% IBD medication use None 6.7% 0% 0.49 5-ASA 23.3% 14.8% 0.51 Immunomodulator 6MP/AZA 3.3% 11.1% 0.34 MTX 10% 7.4% 1.00 Corticosteroids 0% 40.7% 0.00001 Budesonide 0% 18.5% 0.02 Prednisone 0% 22.2% 0.01 Biologics 73.3% 96.3% 0.03 Vedolizumab 16.7% 22.2% 0.74 Anti-TNF 43.3% 51.9% 0.60 Ustekinumab 13.3% 22.2% 0.49 Tofacitinib 0% 0% 1.00 COVID-19 Outcomes Hospitalization 13.3% 7.4% 0.67 ICU with intubation 0% 0% 1.00 Any COVID-19 therapy 3.3% 14.8% 0.18 Death 0% 0% 1.00 IBD medications held 13.3% 29.6% 0.13 IBD Outcomes at 3 months Experienced IBD flare 10% 51.8% 0.005 Escalation of immunosuppression 10% 44.4% 0.00319 Initiation of new steroid therapy 6.7% 22.2% 0.19 IBD related hospitalization/surgery 0% 18.5% 0.02

Histopathological assessment of the microscopic activity in inflammatory bowel diseases: What are we looking for?

Advances in diagnostics of inflammatory bowel diseases (IBD) and improved treatment strategies allowed the establishment of new therapeutic endpoints. Currently, it is desirable not only to cease clinical symptoms, but mainly to achieve endoscopic remission, a macroscopic normalization of the bowel mucosa. However, up to one-third of IBD patients in remission exhibit persisting microscopic activity of the disease. The evidence suggests a better predictive value of histology for the development of clinical complications such as clinical relapse, surgical intervention, need for therapy escalation, or development of colorectal cancer. The proper assessment of microscopic inflammatory activity thus became an important part of the overall histopathological evaluation of colonic biopsies and many histopathological scoring indices have been established. Nonetheless, a majority of them have not been validated and no scoring index became a part of the routine bioptic practice. This review summarizes a predictive value of microscopic disease activity assessment for the subsequent clinical course of IBD, describes the most commonly used scoring indices for Crohn's disease and ulcerative colitis, and comments on current limitations and unresolved issues.

Anemia in Patients with Ulcerative Colitis in Remission: A Cross-Sectional Study from Pakistan

Background and Aim: Anemia is an extra intestinal manifestation of inflammatory bowel disease that frequently causes complications. In inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease, anemia is mostly caused by iron deficiency which impacts the patient's quality of life [1, 2]. The present study aimed to assess the anemia in ulcerative colitis patients in remission. Methodology: A cross-sectional study was conducted on 82 ulcerative colitis patients at the Department of Medicine and Gastroenterology, Jinnah hospital, Lahore from February 2021 to January 2022. All the patients were assessed for anemia based on Mayo clinical score &lt;3 for at least three months. Hemogram tests such as CBC, vitamin B12 serum levels, ferritin, folic acid levels, concentration of C - reactive protein (CRP), and transferrin were performed for the initial screening. Further, patients were evaluated for the determination of different causes of anemia. Patients were categorized into mild, moderate, and severe anemia cases. Oral iron, intravenous iron, and blood transfusion were given to mild, moderate, and severe anemia patients respectively. SPSS version 25 was used for data analysis. Results: Of the total 82 ulcerative colitis patients, there were 48 (58.5%) male and 34 (41.5%) females. The prevalence of anemia in ulcerative colitis patients and control was 51.2% (n=42) and 11.9% (n=5) respectively. The hemoglobin mean values in UC patients and control was 11.95 g/dL and 13.21 g/dL respectively. Out of 42 ulcerative colitis patients, the prevalence of mild, moderate, and severe anemia was 52.4% (n=22), 35.7% (n=15), and 11.9% (n=5) respectively. Iron deficiency was the prevalent etiology of anemia found in 22 (52.4%) patients followed by chronic anemia disease with iron deficiency found in 8 (21.9%). Hemoglobin level has no association with ferritin level. Hemoglobin level has no association with ferritin level. The hemoglobin level was increased with oral iron and intravenous iron by 1.6 g/dL and 2.3 g/dL respectively. Conclusion: The present study concluded that prevalence of anemia was higher in ulcerative colitis patients. The most common etiology of anemia was iron deficiency in both groups. Increased CRP and moderate activity associated to anemia disease was significantly related with comorbid anemia. Oral iron and intravenous iron could increase hemoglobin levels in ulcerative colitis associated anemia patients. Keywords: Anemia, Ulcerative Colitis, Iron deficiency

Lower Impact of Disease on Daily Life and Less Fatigue in Patients With Inflammatory Bowel Disease Following a Lifestyle Intervention.

Despite the potential benefits of diet and physical activity, evidence for beneficial effects of a combined lifestyle intervention is lacking in patients with inflammatory bowel disease (IBD). Therefore, we assessed its effects on impact of disease on daily life, clinical disease activity, fatigue, and health-related quality of life (HRQoL) in patients with IBD. A 6-month single-arm intervention study was performed in adult IBD patients in remission or with mildly active disease. Participants received personal dietary and physical activity advice from a dietician and a physiotherapist in 6 consults. At baseline and over time, questionnaires on diet quality, physical activity, and disease-related outcomes were completed and fecal calprotectin was determined. Data were analyzed by linear mixed models. During the intervention, diet quality significantly increased (P < .001), but the level of physical activity remained the same. Over time, impact of the disease on daily life reduced (P = .009) and fatigue decreased (P = .001), while clinical disease activity, HRQoL, and fecal calprotectin did not change. Improvement in diet quality was significantly associated with a lower impact of disease on daily life (β = 0.09; 95% confidence interval [CI], 0.03 to 0.15; P = .003) and less fatigue (β = -0.13; 95% CI, -0.20 to -0.07; P < .001) but not with clinical disease activity, HRQoL, and fecal calprotectin. No associations were found with physical activity. This combined lifestyle intervention significantly improved diet quality, and this improvement was associated with a reduction in the impact of disease on daily life and fatigue in patients with IBD in remission or with mildly active disease.