Type Of IBD Research Articles

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

ObjectivesCOVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The...

P059 SIGNIFICANTLY INCREASED MUCOSAL EOSINOPHILS IN PATIENTS WITH POST-IBD IBS-D SYNDROME MAY HAVE A NEW AVENUE

Abstract Introduction Inflammatory bowel disease (IBD) patients in remission who present with irritable bowel syndrome with diarrhea (IBS-D) like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS-D. This syndrome was first reported by Isgar et al. who documented IBS-type symptoms in 33% of their patients with chronic ulcerative colitis (CUC) in remission in 1983. In their meta-analysis of 13 studies incorporating 1,703 patients, Halpin and Ford in 2012 calculated a pooled prevalence of 35% for IBS symptoms among IBD subjects in remission. The post-IBD IBS-D syndrome represents a source of considerable stress, incurs morbidity and impairs quality of life of these patients. The etiology of this syndrome is unknown and may be multifactorial such as environmental, psychological, GI motility disarray, genetic components and possibly by gut microbiome. Methods We conducted a retrospective, single-center study of patients with history of IBD and IBS-D like symptoms. The demographic characteristics, type of IBD, colonoscopy, biopsy findings and empirical medical management outcome were analyzed. Results We have found significantly increased mucosal eosinophils (>50 HPF in both side of the colon examined) in our patients with post-IBD IBS-D syndrome. In this study, 15 CUC patients and 20 Crohn’s disease patients with this syndrome were investigated and showed no clinical, serological, mucosal or microscopic IBD activity. These patients had non-bloody diarrhea (5–20 x daily), lower abdominal cramps (%90), mild weight loss (4–6 lbs) and fecal incontinence (%25) who were placed on the GI-hypoallergenic diet and budesonide therapy. Sixty seven percent of these 35 patients with post-IBD IBS-D responded well clinically to this management. Increased mucosal eosinophils in these patients with post-IBD IBS-D may have eosinophilic colopathy that may be related to intestinal permeability disarray. The epithelium in these IBD patients who are in remission may have the production of pro-inflammatory cytokines by the eosinophils, especially IL-23 and IL-33. This interesting area investigation is in progress by our research faculty. Conclusion In summary, this is an exciting new finding that significantly increased mucosal eosinophils in our patients with post-IBD IBS-D syndrome may have a new avenue, eosinophilic colopathy. Interestingly, these patients have responded to the GI-hypoallergenic diet and budesonide therapy. Obviously, we need more patients in the near future with longer follow-up and we hope that the other investigators may confirm our findings.

P094 A COMPARISON OF EXERCISE MEASURES AMONG ADULTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Individuals with IBD, comprised of Crohn’s disease (CD) and Ulcerative Colitis (UC), often have ongoing gastrointestinal symptoms that limit their ability to exercise. Importantly, exercise can help to maintain remission in individuals with IBD. Other positive health outcomes of exercise include improvement in quality of life, social and psychological well-being, weight maintenance, bone health, fatigue management and maintaining muscle mass and function. Unfortunately, many of the tools used to measure exercise are burdensome for clinical utility or are not applicable to the IBD population. The purpose of this secondary analysis was to determine if one question related to physical activity would capture exercise in adults with either UC or CD and those with active or inactive disease. Methods This study is a cross-sectional study using the data obtained from IBD Partners, an internet-based longitudinal cohort of adults ≥ 18 year of age living with IBD. This secondary analysis includes only those participants without a current ostomy or pouch, who completed demographic information, disease activity and exercise characteristics. Disease activity was measured via the simple clinical colitis activity index (SCCAI) for UC and the short Crohn’s disease activity index (sCDAI) for CD. Exercise was measured via the Godin Leisure -Time Activity Index (GLTA) questionnaire that assessed type of exercise and intensity for the past seven days. A separate measurement of physical activity included a single question: “How often did you participate in 1 or more physical activities of 20–30 minutes’ duration per session during your leisure time within the past 6 months?” measured via a 6-point ordered category item. Results A total of 8327 patients with IBD were included. Most (63%) of the participants had CD, and 54% were in remission. Majority of the participants were physically active based on GLTA scores (49.7%), and one question physical activity scores (62%; combined scores of 5 & 6). Polychoric correlation coefficient was computed, with a strong correlation between GLTA and the one question (r = 0.74, p < 0.001). Ordinal regression analysis between the one physical activity question and IBD type (UC vs CD) yielded higher odds of physical activity with UC (Odds ratio (OR)=1.2, 95% CI [1.11 -1.31], p < 0.0001). Similar results were noted with ordinal regression analysis between GLTA scores and UC;(OR=1.2, 95% CI [1.09 -1.3], p < 0.0001). Conclusions Both GLTA and the single question of physical activity were highly correlated. The ordinal regression results were comparable for both measures. Adoption of the single physical activity question may adequately reflect exercise status in IBD patients and reduce burden for clinical use. Further longitudinal studies are need to support the use of one question in measuring exercise in those with IBD.

P426 In failure of non-optimised adalimumab (ADA) with therapeutic serum levels, a change in biotherapy class is greater than an intensification of ADA dose in IBD patients

Abstract Background Nearly 40% of patients who failed on ADA have therapeutic residual trough levels (pharmacodynamic failure). It is then recommended to change the therapeutic class to a non-anti-TNF biological. In this situation, however, a quarter of patients respond to an ADA dose optimisation. The purpose of this work was to compare these two strategies and identify predictors of response for each strategy. Methods This is a bi-centre, retrospective study based on a clinical and biological database that included patients followed from 2015 to 2016 with an IBD in maintenance treatment with ADA as monotherapy (40 mg/sc/14 days) and in loss of response (CDAI > 220 with faecal calprotectin > 250 µg/g stool for CD and Mayo score > 6 with endoscopic sub-score > 1 for UC). All patients included had residual trough ADA levels > 5 µg/ml. Relapsed patients were treated either with dose optimisation (ADA: 40 mg/sc/7 days) or other biotherapy (ustekinumab or vedolizumab, according to classic regimens and dosages). The primary endpoint was the relapse-free survival rate (defined as clinical and biological or endoscopic activity requiring therapeutic change). The survival curve analysis was performed using the Kaplan–Meier method and the log-rank test. Results In total, 125 patients (mean age: 38 years, 75% CD, sex ratio M/F = 57%, previous infliximab = 42%) were included and 50 were treated with another biological (Vedolizumab: 30 patients, Ustekinumab: 20 patients). The characteristics of the two groups were comparable except for significantly higher levels of CRP and faecal calprotectin at inclusion in the biological change arm. The duration without relapse was significantly longer after the class change (p = 0.0005; HR = 0.39[0.23–0.68]). The relapse-free survival rates at 54 weeks were 35% for the optimised arm and 66% for a class change (p = 0.04). In multivariate analysis, the only long-term response predictor was biotherapy class change vs. ADA dose optimisation (p = 0.042; HR = 0.3[0.02–0.95]). Previous use of IFX or type of IBD were not associated with relapse. For the dose optimisation strategy, in multivariate analysis, only age < 40 years was associated with a progression without relapse (p = 0.007; HR = 0.09[0.01–0.52]). Residual ADA levels were not predictive of response to optimisation (p = 0.73) and no ADA quartile was significantly associated with a more favourable clinical response. For the class change strategy, no relapse predictors were isolated in univariate analysis. Conclusion In patients on ADA who are losing response despite therapeutic rates, the change of class to non-anti-TNF biotherapy allows a significantly greater lasting response than a dose optimisation strategy for ADA.

P666 Neutropenia in inflammatory bowel disease patients on TNF inhibitors: A single-centre, retrospective cohort study

Abstract Background Tumor necrosis factor-α inhibitors (TNFi) have become the mainstay of treatment in moderate to severe cases of IBD. The haematological safety profile of these agents has been documented in multiple clinical trials and post-marketing registries. Nonetheless, neutropenia has been reported in patients receiving TNFi for IBD and other diseases (Bessissow et al 2012). In this study, we aim to ascertain the relationship between the use of TNFi and the development of neutropenia in IBD patients. Methods This is a retrospective cohort study including all adult IBD patients receiving TNFi at our centre from the year 2007 to 2018. Our primary outcome was the development of any neutropenic episode after starting a TNFi. Neutropenia was defined as circulating absolute neutrophil count (ANC) less than 1500/mm3. For our secondary outcomes, we evaluated the impact of concomitant use of (5-ASA) or an immunomodulator on the risk of developing neutropenia. We also looked at the effect of baseline neutrophil and WBC counts on the subsequent development of neutropenia. Results A total of 292 patients met the inclusion criteria, 11 patients were excluded for not having neutrophil count done. The final analysis included 281 patients. The mean age of patients in this study was 33. Adalimumab was the most frequently prescribed TNFi. Of those included, 96 patients (34.2%) developed at least one episode of neutropenia while on a TNFi. The majority of these episodes (67.7%) were mild with ANC between 1000 and 1500/mm3. There was no significant difference in the age, gender, agent used or type of IBD between those who developed neutropenia and those who did not. On the other hand, baseline neutrophil count and concomitant use of azathioprine and 5-ASA were significant independent predictors of neutropenia after commencing TNFi. (Table 1). Conclusion In this study, mild neutropenia was common amongst IBD patients on TNFi. Patients were more likely to develop neutropenia if they have been on concurrent therapy with an immunomodulator or 5-ASA. Future prospective studies are required to further clarify the significance of neutropenia in IBD patients receiving TNFi.

P817 Influence of inflammatory bowel diseases on depression and suicidal risk: a questionnaire-based survey

Abstract Background Inflammatory bowel diseases (IBD) patients are at increased risk for mental health problems. Managing IBD patients requires cooperation between gastroenterologists and psychologists and psychiatrists. We would like to assess the frequency of depression and suicidal thoughts among Hungarian IBD patients. Methods Multicentre, questionnaire-based survey among inflammatory bowel diseases patients. Demographic data and patient’s medical history was obtained with self-filling questionnaires. Patients’ psychic status was measured with Patient’s Health Questionnaire (PHQ-9), Beck Hopelessness Scale (short version). The survey was conducted in 3 IBD centres in Hungary, First Department of Medicine, University of Szeged, First Department of Surgery, University of Semmelweis and First Department of Medicine, University of Pécs. Results Three hundred IBD patients filled the questionnaires from the 3 IBD centres. Female-male ratio was 57% - 47%. Mean age at the time of the study was 38.8 years (SD 12.5) and mean disease duration was 11.5 years (SD 8.2). Sixty-two point three% was diagnosed with Crohn’s disease, 37.7% with ulcerative colitis, one patients reported IBD unclassified and three patients did not know the type of IBD. Sixty-nine point three% of the patients self-reported the remission state of IBD, while 30.7% self-reported to have active IBD. Proportion of patients on each category of PHQ-9 scale were the followings: severe 2%, moderate to severe 5.3%, moderate 21.3%, mild 33.6% and 37.6% had normal score. Nine point three% of the patients had elevated suicidal risk. More severe PHQ-9 category was associated with elevated risk for suicide. Significant difference was shown in the Hopelessness Scale’s results among the two genders, female patients had higher risks for suicidal thoughts. Those IBD patients in remission have lower probability for moderate or severe depression. Conclusion We have to be aware of that every IBD patient has increased risk for depression and suicide. Among our patients the rate of moderate to severe and severe depression was relatively low. Every tenth of our patients had elevated risk of suicide.

P228 Cytomegalovirus Infection: is it a cause of flare-up in inflammatory bowel diseases?

Abstract Background The presence of CMV in blood is quite common in patients with severe flares of ulcerative colitis (UC) and Crohn’s disease (CD) and seems to predict an adverse outcome. The impact of antiviral treatment on CMV in this setting (indications and drug options) is an unresolved issue. Our aim was to reassess the CMV role in patients with IBD hospitalised for severe exacerbations, analysing the relationship between CMV positivity, clinical characteristics, antiviral therapy and disease outcomes. Methods We evaluated a homogeneous cohort of 97 consecutive patients with IBD hospitalised from 2012 to 2018. Data regarding age, gender, smoke, familial predisposition, type of IBD, extent, according to Montreal classification, disease activity (clinical and endoscopic), therapy at the time of relapse were registered in a dedicated database. CMV was tested by PCR in whole blood. The relationship between antiviral therapy and disease outcomes (rate of colectomy, mortality) was analysed. Results Among the 97 patients, 51 were females. In the UC group (67 patients, 69.1%), mean age was 48,8, SD ± 17,7 whereas in the CD group (30 patients, 31%), mean age was 39,9 years (SD ± 15,2). Fifteen per cent of patients had a family predisposition for IBD. There were no differences at baseline between UC and CD, except disease duration (longer in UC) and therapy at the time of relapse (high dose steroids more common in UC). Thirty-one patients (32 %) tested positive for CMV on PCR. Smoking habit, shorter disease duration, therapy on admission (high dose steroid and/or immunomodulators) and endoscopic activity assessed by Mayo endoscopic sub-score were the variables significantly related to CMV positivity. Antiviral therapy was adopted in 22% of patients and the decision to treat was based on clinical judgement and viral load. Treated patients had higher endoscopic activity than untreated (Mayo sub-score 3 vs. 2,6, p < 0,004). The mean hospital duration was longer in treated patients 22.3 ( ± 11.1) days, vs. 14,8(+/−8,6) days. 3 patients underwent surgery within 90 days, 2 patients died; all of them were positive for CMV DNA. No significant differences were observed on either colectomy or mortality rate in relation to the use of antiviral therapy. Conclusion This single-centre study confirms that the CMV reactivation during disease flares of IBD is common and related to disease duration, severe endoscopic lesions, and immunosuppression (high dose steroids and/or immunomodulators).Antiviral drugs do not seem to modify surgical outcomes or mortality but increase the hospitalisation length. However, the retrospective design and the limited sample size of the study do not allow to draw definitive conclusions: the real impact on outcome and the role of antiviral therapy will require adequately powered prospective studies.

P563 Shared decision-making in pregnancy in inflammatory bowel disease: Design of a pregnancy in IBD decision aid (PIDA)

Abstract Background A lack of IBD-specific reproductive knowledge has been associated with increased ‘voluntary childlessness’.Furthermore, a lack of patient and clinician knowledge may contribute to inappropriate medication changes during or after pregnancy that may lead to a flare of disease. Evidence exists for the benefit of decision aids to support decision-making in pregnancy in general, as well as in multiple other chronic disease; however, such a resource for pregnancy in IBD has not been identified. Methods Using International Patient Decision Aids Standards, we have commenced design of our Pregnancy in IBD Decision Aid (PIDA). A steering committee consisting of Canadian and Australian Healthcare professionals with an interest in IBD management in pregnancy, in addition to a patient representative was established. Initial patient and clinician focus groups were conducted. Themes prospectively chosen for discussion included inheritance, fertility, nutrition, medications, mode of delivery, breastfeeding, infant infections and vaccinations. We designed an electronic PIDA draft that incorporates individualised information (for example, type of IBD, pre-conception or pregnant, surgical history and current medications) in personalised decision-making. Further patient focus groups and interviews were conducted to obtain user opinion of the PIDA draft. Results In July 2017, patient and clinician focus groups were conducted at a Canadian site. Patient concerns regarding pregnancy included the impact of disease, previous surgical history on fertility, preterm delivery; the potential impact of current and past drug therapies on the fetus/ infant; and the negative impact of active disease on both maternal and fetal/infant health. Clinician concerns included the absence of pre-conception counselling and potential for lack of patient understanding about the impact of disease activity and IBD medication use in pregnancy. Patient feedback (n = 15) obtained through interviews at two Canadian and one Australian site regarding the current electronic PIDA draft was predominantly positive, with comments pertaining to the adequacy of content coverage, personalisation, readability and unbiased information presentation. Suggestions were made for inclusion of further content such as the impact of IBD on sexual function, expected laboratory changes and the timing of recommencement of medications post-partum. Conclusion The completion of pre and post-PIDA design focus groups and interviews affirmed the role for PIDA. Main decisions that were considered necessary to address included ideal timing of conception pending disease activity, management of medications and delivery methods. Ongoing user feedback is being obtained at Australian and Canadian sites currently.

P846 Comparative study of faecal microbiota in Crohn’s disease patients in remission with and without surgical resection

Abstract Background Inflammatory bowel disease (IBD) is defined as a group of autoimmune diseases that affects the digestive tract by causing chronic inflammatory processes. Crohn’s disease (CD) is one of the major types of IBD. Although there are several efficient drugs for its treatment, almost 80% of patients will require an intestinal resection throughout their lives. Some bacterial species found in faecal samples can be used as indicators to diagnose and monitor activity in CD patients. However, this methodology has not yet been tested in patients that underwent an intestinal resection. The aim of this study was to investigate the changes in the abundance of these species associated with total or partial intestinal resection. Methods In this study, we used 30 faecal samples from patients diagnosed with CD in remission withdrawn from the Biobank of the Hospital Universitari Dr. Josep Trueta of Girona. Fifteen samples corresponded to patients who underwent an intestinal resection. The following markers were quantified by qPCR: Faecalibacterium prausnitzii (Fpra), F. prausnitzii phylogroup I (PHG-I), F. prausnitzii phylogrup II (PHG-II), Escherichia coli (Eco), Akkermansia muciniphila (Akk), Ruminococcus sp. (Rum), Bacteroidetes (Bac) and Methanobrevibacter smithii (Msm). Results The abundances of Fpra, PHG-I, PHG-II, Rum, and Msm were significantly lower (p < 0.05) in resected CD patients, whereas Eco was significantly more abundant in those patients. No significant differences were observed in the abundances of Akk and Bac. Conclusion In resected CD patients, beneficial butyrate-producing bacteria are underrepresented, whereas pro-inflammatory species are overpopulated. Any quantitative relationship of these indicators with the relapse probability would help to stratify these patients for a better orientation of therapeutic strategies.

P030 Dynamics of intestinal inflammation and microbial dysbiosis in pregnant women with IBD and their infants

Abstract Background IBD often affects women during their reproductive years; however, the effect of pregnancy on disease course remains poorly understood. We aimed to assess intestinal inflammation in IBD patients compared with controls as measured by faecal calprotectin (FC). We also investigated whether maternal IBD diagnosis was associated with altered FC in the offspring and if there were particular bacterial taxa that correlated with FC levels. Methods Pregnant women with or without IBD and their infants were prospectively enrolled in the MECONIUM study during 2015–2018 years. FC levels at each trimester of pregnancy and in babies throughout the first 3 years of life were measured using a quantitative enzyme immunoassay (CALPRO AS, Norway). Multivariate regression analysis was applied to investigate FC levels. Stool microbiota composition in the maternal and baby stool was assessed using 16s rRNA sequencing. Results 617 faecal samples from 342 mothers (91 IBD, 251 control) and 1005 faecal samples from 288 infants (born to 76 mothers with and 212 without IBD) were analysed. FC levels in pregnant women with IBD were significantly higher than in control pregnant women regardless of IBD type (Crohn’s disease vs. ulcerative colitis). In IBD mothers FC levels showed a decline during pregnancy (µg/g, median (interquartile range); first trimester 130.8 (102.3–147.3) vs. third trimester 85.9 (44.5–125.4), p = 0.02) (Figure 1). Patients with flare at stool collection had the highest, while those treated with anti-TNF plus thiopurine showed the lowest FC at each trimester. Babies born to mothers with IBD presented higher FC levels than those born to control mothers at multiple time points between 2 and 36 months of age (Figure 2A); the median FC levels were the highest after 1 year up to 3 years in those babies whose mothers presented active disease during pregnancy (Figure 2B). Microbial α-diversity showed an inverse relationship with FC in both mothers (r = −0.25, p = 0.032) and babies (r = −0.31, p = 0.0035). Blautia and Streptococcus abundance were positively correlated with FC in babies. Conclusion FC levels in IBD patients decreased throughout pregnancy. Maternal IBD, lower microbiome diversity and the abundance of certain microbial genera were associated with higher FC in the offspring up to 3 years of life. These findings suggest a potential favourable impact of pregnancy on IBD activity and highlight a possible effect of IBD during pregnancy on the intestinal inflammation in offspring, which could be mediated through altered microbiome.

P508 Safety and efficacy of combining biological therapies together or with small molecules in patients with inflammatory bowel disease: A retrospective multicentre national observational case series study

Abstract Background Few data are available regarding the combination of biological therapies (anti-TNF, anti-integrin, anti-interleukins (IL4, 12/23, 17A, 23)) or with a small molecule in patients with IBD. We here report the safety and efficacy of combining these drugs through a national retrospective multicenter case series. Methods Cases were extracted from local databases within the last 3 years. Combined therapy was defined as the concomitant use for a minimum of 1 day of 2 biologics or 1 biologic with a small molecule. Patients’ demographics, disease’ characteristics and types of combined therapies were recorded. Safety was defined as the occurrence of any serious adverse event (SAE): serious infection, opportunistic infection, any hospitalisation, cancer and death, whereas the efficacy of combination was clinically appreciated by physicians. Results From 8 centres, 23 combined therapies were observed in 19 IBD patients (74% Crohn’s disease, 21% ulcerative colitis and 5% IBD type unclassified). Median age at combination was 43.0 years ([IQR]: 31.5–59.0). Seventeen patients presented with a minimum of 1 concomitant IMID (ankylosing spondylitis (n = 11), psoriasis or psoriatic arthritis (n = 5) and other conditions (n = 5)). Reasons for starting a combination were active IBD (57%), another active IMID (30%) or both (13%). Anti-TNF and anti-integrin were combined in 11 cases, anti-TNF and anti-ILs in 5, anti-integrin and anti-ILs in 4 and other combinations in 3 (anti-TNF+rituximab+methotrexate; anti-IL4+anti-IL12/23; anti-IL12/23+methotrexate+leflunomide). The median duration of combined therapies was 5 months ([IQR]: 2–9). During 15.8 patients/years of combined therapy, 11 adverse events (AE) including 9 SAE were recorded in 8 patients. Eight infections were reported with various combinations: anti-TNF and anti-IL in 4 cases, anti-TNF and anti-integrin in 3 and anti-TNF+rituximab+methotrexate in 1. Two infections (both anti-TNF+ anti-integrin) were graded severe leading to hospitalisation, 6 were graded mild or moderate. Cancer and death were not observed. After combined therapy, IBD disease activity was clinically improved in 44% and remained stable in 50% of patients, whereas clinical improvement of IMID was observed in 25% of patients. Overall, the combination of treatments was withdrawn due to ineffectiveness or serious adverse events in 39% and 4%, respectively. Conclusion In our experience, the combination of biologics in patients with IBD ±. another IMID was associated with short term increased efficacy in almost half of patients but also with a risk of infections in one third. No new safety signals were observed in this difficult to treat patients but extensive data are urgently needed.

750 Incidence and Risk Factors of Constipation in Inflammatory Bowel Disease Patients During Remission

INTRODUCTION: The incidence of constipation in long term follow-up of chronic IBD patients during remission hasn't been studied. Though constipation was observed in patients with proctitis, and hard stools reported in 27% of patients with active UC (1), constipation was not the focus of IBD studies in the past. The overlap of IBS with IBD was studied, a small and similar incidence of constipation was reported in both groups (2). This five-year follow-up study documented the incidence of constipation in IBD patients during remission, analyzing the risk factors related to the IBD Illness. METHODS: 259 Patients with IBD in the GI clinic were followed for 5 years, between 2013-2018. Patients who developed constipation during the remission period were studied to find the incidence of constipation and risk factors related to IBD. The remission was identified as clinical remission for more than 6 mo, or by endoscopic or histologic remission. All patients had KUB documented the high fecal load without obstruction at the time of clinical presentation with constipation. Factors related to IBD illness were analyzed, including gender, type of IBD, period of illness, and intestinal involvement. Those with Proctitis only and those with previous surgeries were extracted. RESULTS: 89/259 patients (34%) developed constipation. 43/89 with UC vs 41/89 with CD (P > 0.1). No statistical significance also found for the gender (54M Vs 35F) and the period of the illness (52 < 5 years, vs 37 > 5 years). The involvement of the distal colon including pancolitis involvement was significantly higher than the involvement of the right side of the colon (67/89 had distal involvement vs 3/89 proximal involvement), to the point of statistical significance (P < 0.05). Patients with skipping lesions with distal involvement were 19/89. CONCLUSION: This study showed a high incidence of constipation in patients with inactive IBD (34%), it was higher than the incidence of patients with hard stools at the time of diagnosis (4/50). The clinical setting of this study with long term observation was different from the clinical setting of the 2 surveillance that reported constipation in IBD patients in the medical literature. Though constipation is a functional symptom, the risk factor of IBD involvement is not related to the IBS. The successful treatment of constipation in this group impacted the quality of life and the management of IBD with medications, only 3 patients in this group required treatment with immunosuppressive or biologic medications.

724 Does Zinc Deficiency in IBD Predispose Patients to Repeat C. difficile Infection?

INTRODUCTION: Clostridiodes difficile infection (CDI) is the most common hospital-acquired infection in the United States. CDI is more common in patients with inflammatory bowel disease with a greater risk in ulcerative colitis patients compared to Crohn's disease patients. Recent literature revealed an association between decreased zinc levels and CDI via the activation of Th17 cells through the STAT3 pathway. We aimed to investigate the relationship of Zinc levels with the risk of recurrent CDI in IBD patients. METHODS: We performed an IRB retrospective cohort study of patients aged 18-75 with a history of IBD and a positive Clostridium Difficile PCR between January 1, 2012 and December 31, 2016 at a tertiary care center. A second CDI diagnosis within 3 months of the first was defined as recurrent CDI (rCDI). A second diagnosis after 3 months, but within 3 years of the first diagnosis was defined as reinfection. All charts were reviewed for zinc level testing at the time of any CDI. The primary outcome was zinc level at the time of primary diagnosis. This was also broken down by type of IBD. Descriptive statistics were calculated for the primary and secondary outcomes using SAS 9.4 (SAS Institute, Cary, NC). RESULTS: Of 121 patients with IBD and a positive C. difficile PCR, 23 patients had a zinc level tested. The average Zinc level among patients with only one CDI episode was 0.66, while it was 0.62 for rCDI and 0.62 for CDI reinfection. Of the 23 patients with a zinc level, 12 had Crohn's disease and 11 had Ulcerative Colitis. Only three Crohn's patients had one C difficile infection, four had rCDI, and six had C. difficile reinfection with average zinc levels of 0.66, 0.64, and 0.54 respectively. No ulcerative colitis patients only had a primary infection. The six UC patients with rCDI had an average zinc level of 0.64, while those with C. difficilereinfection had an average level of 0.72. CONCLUSION: While the sample size of this study was small, there is a trend for patients with Crohn's disease to have lower zinc levels if they have CDI reinfection compared to primary and rCDI. This could be explained by a sustained increase in the activation of Th17 cells via the STAT3 pathway in Crohn's patients with lower zinc levels. However, the patients with ulcerative colitis in this study did not have a tendency to have lower zinc levels suggesting that a different mechanism may be at play. Further investigation of this relationship in a larger study is required.

Interleukin-1 single nucleotide polymorphisms as risk factors for susceptibility of inflammatory bowel disease: an Iraqi Arab population-based study

ABSTRACTObjectives: It is aimed to determine the association between four single-nucleotide polymorphisms (SNPs) of IL1 genes (rs1800587: IL1A−889 C/T, rs16944: IL1B−511 T/C, rs2234650: IL1R1pst1 1970 T/C and rs315952: IL1RAmspa1 11100 T/C) and the two types of IBD (UC and CD) in samples of Iraqi Arab patients.Materials and Methods: Hundred Iraqi patients (66 UC and 34 CD) were genotyped for these SNPs by polymerase chain reaction-specific sequence primer (PCR-SSP) assay.Results: A significant increased frequency of IL1A−889 C allele was observed in total IBD patients compared to controls (72.0 vs. 56.5%; Odds ratio = 1.98; Corrected p = 0.001). For IL1B−511 and IL1R1pstl 1970 SNPs, the T allele frequency was significantly increased in total patients (62.0 vs. 49.1%; Odds ratio = 1.69; Corrected p = 0.02 and 65.0 vs. 46.7%; Odds ratio = 2.12; Corrected p = 1 × 10−4, respectively). Allele and genotype frequencies of IL1RAmspa 11100 SNP showed no significant variation between total patients and controls. A similar profile of was observed in UC patients, but IL1RAmspa 11100 T allele frequency was significantly increased in patients (72.7 vs. 60.2%; Odds ratio = 1.76; Corrected p = 0.05). Among CD patients, IL1A−889, IL1R1pstl 1970 and IL1RAmspa 11100 SNP allele frequencies shared their distribution in total IBD patients. For IL1B−511 SNP, allele and genotype frequencies showed no significant difference between CD patients and controls.Conclusion: These data suggests a significant role of IL1 SNPs in etiopathogenesis of IBD in Iraqi Arab population.

Incidence Rates of Infection and Malignancy of Patients Treated With Vedolizumab for Inflammatory Bowel Disease in Clinical Practice

Introduction: The gut-specific integrin antagonist mechanism of vedolizumab (VDZ) is thought to have a favorable adverse effect profile, including a low rate of infection and malignancy. However, data from real-world clinical practice regarding these outcomes is limited. Our aim is to characterize a cohort of patients with IBD and receiving VDZ; to examine the incidence of infection and malignancy; and to identify risk factors associated with the development of these outcomes. Methods: This is a retrospective analysis conducted at a tertiary academic medical center with a center for inflammatory bowel disease. Patients with Crohn's disease or ulcerative colitis and treated with vedolizumab were identified using ICD-9 and 10 codes. Baseline anthropologic, serologic, and clinical data was obtained. Results: Seventy-eight patients were identified, with a mean age and BMI of 43 ± 17 and 27.5kg/m2 ± 5.1. Forty-two (54%) of the patients were female, and 25 patients (32%) were current or prior smokers. Forty-two patients (54%) had ulcerative colitis. A total of 21 patients (27%) had prior IBD-related surgery. Forty-five patients (58%) had accelerated VDZ dosing intervals of either Q4 or 6 weeks. The median VDZ exposure time was 119 weeks (IQR 52-161), totaling 159.4 patient-years of VDZ exposure among all patients. A total of 2 (3%) malignancies were diagnosed (basal cell carcinoma and chronic lymphocytic leukemia), correlating to a malignancy incidence of 1.3 per 100 patient-years of exposure to VDZ. There were 10 infections (13%) diagnosed, making for an incidence of infection of 6.3 per 100 patient-years of exposure to VDZ (Table 1). Older age (> 50 years old), obesity (BMI > 30), smoking status, IBD type, prior IBD surgery, and concomitant immunomodulator use at start of VDZ initiation were not associated with increased risk of either malignancy or infection. Using Kaplan-Meier survival analysis, patients with accelerated dosing (Q4-6 weeks) had similar time to infection versus those with standard dosing (Q8 weeks), P=0.09 (Figure 1).611_A Figure 1. Summary of safety outcomes (development of infections and malignancies) after VDZ initiationConclusion: In this cohort of patients in clinical practice on vedolizumab, the incidence of infection and malignancy were low. No patient characteristics were identified as risk factors for developing either malignancy or infection in this group of patients, including concomitant use of an immunomodulatory at induction with vedolizumab. No significant difference in time to infection as noted with accelerated vedolizumab dosing.611_B Figure 2. Time to infection in patients on VDZ accelerated dosing (Q4W or Q6W) versus those with standard VDZ dosing interval (Q8W)

Hospitalization rates and outcome of invasive bacterial vaccine-preventable diseases in Tuscany: a historical cohort study of the 2000\u20132016 period

BackgroundInvasive bacterial diseases (IBD) are a serious cause of hospitalization, sequelae and mortality. Albeit a low incidence, an increase in cases due to H. influenzae was registered in the past 4 years and, in the Tuscany region, an excess of cases due to N. meningitidis since 2015 is alarming. The purpose of this study is to deepen the knowledge of IBD epidemiology in Tuscany with particular attention to temporal trends.MethodsTuscan residents hospitalized for IBD from January 1st 2000 to March 18th 2016 were selected from the regional hospital discharge database based on ICD-9-CM codes. Age-specific and standardized hospitalization rates were calculated together with case-fatality rates (CFRs). A time-trend analysis was performed; whereas, prognostic factors of death were investigated through univariable and multivariable analyses.ResultsThe average standardized hospitalization rates for invasive meningococcal diseases (IMD), invasive pneumococcal diseases and invasive diseases due to H. influenzae from 2000 to 2016 were 0.6, 1.8, and 0.2 per 100,000, respectively. The average CFRs were 10.5%, 14.5% and 11.5% respectively with higher values in the elderly. Older age was significantly associated with higher risk of death from all IBD. A significant reduction in hospitalization rates for IMD was observed after meningococcal C conjugate vaccine introduction. The Annual Percentage Change (APC) was -13.5 (95% confidence interval (CI) -22.3; -3.5) in 2005–2013 but has risen since that period. Furthermore, a significant increasing trend of invasive diseases due to H. influenzae was observed from 2005 onwards in children 1–4 years old (APC 13.3; 95% CI 0; 28.3).ConclusionsThis study confirms changes in the epidemiology of invasive diseases due to H. influenzae and IMD. Furthermore, attention is called to the prevention of IBD in the elderly because of the age group’s significantly higher rate of hospitalizations and deaths for all types of IBD.

Differences in adiposity and diet quality among individuals with inflammatory bowel disease in Eastern Canada.

The objective of the current study was to characterize the relationship between diet quality and body composition in participants living with IBD, specifically Crohn’s disease (CD) or ulcerative colitis (UC), in Atlantic Canada. Participants from the Atlantic Partnership for Tomorrow’s Health (PATH) study are residents of one of the four Atlantic Canada provinces. Participants who completed the dietary questionnaire and had body composition measured were included in the study (n = 12,462 without IBD, n = 111 CD, n = 119 UC). A greater number of participants with IBD reported having multiple chronic conditions compared to those without IBD. Those with UC had statistically higher body weight and body mass index (BMI) compared to those without IBD. Overall, significant positive correlations were observed between adiposity and servings of refined grains, and meats and alternatives such as eggs and fish, whereas negative correlations were observed with servings of vegetables, fruit, whole grains, and alternatives such as tofu, and nuts/seeds. Participants with IBD (both CD and UC) consumed more refined grains than those without IBD. Using logistic regression analysis, participants consuming more servings of vegetables and whole grains were less likely to have CD where as those consuming more serving of fruit and bean/legumes were less likely to have UC. In the Atlantic PATH cohort, which includes a region of the world with a high incidence of IBD, distinct differences in adiposity and diet quality were observed in individuals with specific types of IBD compared to those without. There is a need for collaborative efforts to address weight management and diet quality issues in those living with IBD in the Atlantic Canadian region.

Role of CT Enterography in the Diagnosis of Crohn's Disease

Background: Crohn's disease is a multifactorial chronic inflammatory disease characterized by non-caseating granuloma formation with a tendency toward remission and relapse, it affects any part of the GIT from mouth to anus with 80% small bowel involvement, most commonly the terminal ileum, with characteristic multiple discontinuous sites involvement (skip lesions) and transmural inflammation. Aim of the Work: The purpose of this study is to highlight the value of CT in diagnosis of (CD) and its ability to assess the degree of activity and its complications. Patients and Methods: This prospective study was conducted on 87 patients with GIT symptoms where CTE was performed to evaluate its possible impact on accurate diagnosis, detection of complications and consequent guidance for management planning. It was performed in radiological department of Ain –Shams University hospital: CT Unit in the period from “July 2017 to April 2018. The patients’ age ranged between (24 – 72 years) with a mean of 48 years. Results: Of the 87 patients with GIT symptoms that were highly suggestive of inflammatory bowel disease evaluated, 32 were UC, 21 were CD, 9 were other types of IBD and 25 were normal. Of the 21 CD patients evaluated, 7 were male and 14 were female. Conclusion: The role of MDCT in the diagnosis of Crohn’s disease and its complications is undeniable, with a proven efficacy in identifying the enteric and extra-enteric manifestations of the disease. However, advancements in CT E protocol design have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose. Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by this study.

Antenatal Management for Women with Inflammatory Bowel Disease: Experience from Our 'IBD MOM' Clinic.

Inflammatory bowel disease affects women during their reproductive years and thus pregnancy outcomes. IBD MOM is a multidisciplinary, single-center clinic established to benefit women with IBD and their neonates. The aim of this study was to evaluate the perinatal outcomes of the IBD MOM clinic patients compared to patients who attended antenatal and gastrointestinal disease community clinics (IBD CC). This single-center, prospective study was conducted from 2011 to 2015. The primary outcome was cesarean delivery; secondary was adverse perinatal outcomes. In parallel, a new pregnancy-oriented, disease severity score was evaluated for its association with perinatal risk (score low = 0 to severe = 5). We identified 90 women in the IBD MOM clinic and 206 in the IBD CC. Maternal age, smoking habits, pregnancy complications, and type of IBD (CD/UC) were similar between groups. Rates of labor induction and birth weight were also similar between IBD MOM and IBD GI. The IBD MOM overall preterm delivery (PTD) rate (< 37weeks) was significantly higher 18.9 versus 9.7% (P = 0.028). The IBD MOM group had a significantly higher IBD MOM disease severity score that correlated with a higher rate of PTD. The overall IBD MOM score and scores > 3 were significantly associated with PTD risk in both groups (P = 0.013 and P = 0.004, respectively). Women with moderate and severe IBD who attended a multidisciplinary clinic may benefit from this unique center. Healthcare planning policies can assume that costly, multidisciplinary clinics for women with IBD should be reserved for those with moderate and severe disease.

Overcoming a barrier to IBD

Colitis Inflammatory bowel disease (IBD) is a group of disorders linked to inflammation of the gastrointestinal tract. Colitis is a type of IBD that affects the inner lining of the colon and has been linked to a gene known as C1orf106 . Mohanan et al. found that C1orf106 encodes a protein that stabilizes the integrity of epithelial junctions and enhances barrier defense (see the Perspective by Citi). IBD-associated mutations in C1orf106 lead to greater cytohesin-1 protein levels, changes in E-cadherin localization, and enhanced susceptibility to intestinal pathogens. Modulation of C1orf106 may thus hold promise for treating colitis and other IBDs. Science , this issue p. [1161][1]; see also p. [1097][2] [1]: /lookup/doi/10.1126/science.aan0814 [2]: /lookup/doi/10.1126/science.aat0835